Artigos e Materiais de Revistas Científicas - ODS/05

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Beyond HIV prevention: Assessment of the benefits of pre-exposure prophylaxis for sexual quality of life
(2024) BERTEVELLO, Daniel A.; VASCONCELOS, Ricardo; CERQUEIRA, Natalia B.; FREITAS, Angela C.; CUNHA, Ana; I, Vivian Avelino-Silva
Background: Pre-exposure prophylaxis (PrEP) may favor sexual satisfaction by reducing the fear of HIV and promoting less restrictive sexual practices. These benefits may be even higher among PrEP users with mental health issues. Methods: We invited adult PrEP users to answer a questionnaire including demographics, questions on the sexual experience compared to the period before PrEP use, and the Hospital Anxiety and Depression Scale. Factors associated with improvements in the sexual experience were investigated using modified Poisson models. Results: We included 221 participants; most were white males. A large percentage of participants reported improvements in quality of sex after PrEP initiation; the composite outcome ""PrEP-associated improvement in the quality of sex"" was observed in 92 (42%), whereas the outcome ""PrEP-associated improvement in the fear of HIV acquisition"" was observed in 120 participants (54%). Demographics and depression/anxiety were not significantly associated with the outcomes. Conclusion: PrEP has positive effects beyond HIV prevention, improving several aspects of sexual quality of life. These benefits are valid incentives for PrEP use and prescription.
Dimensions of harassment at school: dialogs about gender with young high school students in Sao Paulo/Brazil
(2023) SILVA, Cristiane Goncalves da; LEITE, Vanessa Jorge; PONTES, Julia Clara de
In this article, we discuss uses of ""harassment"" as a category employed by young students from public high schools to make sense of violence and gender discrimination experiences that occur in and out of school. The analysis is based on fieldwork records produced within the scope of a multicenter, mixed -methods research carried out in nine schools located in Sao Paulo. Harassment appears as a polysemic category that, by naming violence, helps to face gender and generation hierarchies and inequalities. We infer that the young girls have questioned norms and attitudes that feed gender inequalities in schools; in addition, they have denounced the silence or inadequacy of the institution in facing the problem. This enables to identify convergences with a new sensibility regarding violence against women that globalized feminist discourses have brought to the surface.
Oral Pre-Exposure Prophylaxis for HIV Discontinuation in a Large Cohort of Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) ZEBALLOS, Diana; MAGNO, Laio; SOARES, Fabiane; EUSTORGIO FILHO, Marcos; AMORIM, Leila; PINTO JR., Jony Arrais; GRECO, Dirceu; GRANGEIRO, Alexandre; DOURADO, Ines
Purpose: This study aimed to describe pre-exposure prophylaxis (PrEP) for HIV discontinuation in adolescent men who have sex with men (aMSM) and adolescent transgender women (aTGW) and to identify factors associated with discontinuation. Methods: The PrEP1519 study included a cohort of aMSM and aTGW aged 15-19 years old, and itwas conducted in three large Brazilian capital cities. For this analysis, we included adolescents who initiated PrEP. PrEP discontinuationwas defined as no possession of PrEP pills for >90 days. Kaplan-Meier curves were used to analyze the probabilities of discontinuation, and survival distributions stratified bycovariates were compared using log-rank or Wilcoxon tests. Cox regression models were used to estimate the adjusted hazard ratio (aHR) with a 95% confidence interval (95% CI). Results: We included 908 adolescents, 829 (91.30%) aMSM and 79 (8.70%) aTGW, most of whom were 18-19 years (80.29%). The incidence rate of discontinuation was 75.6 per 100 person-years. The probability of discontinuation was 52.61% in the first year. The multivariate analysis demonstrated that the aTGW (aHR = 1.63; 95% CI: 1.02-1.64) and adolescents with a medium (aHR = 1.29; 95% CI: 1.02-1.64) or low (aHR = 1.65; 95% CI: 1.29-2.12) perceived risk of HIV infection had an increased risk of discontinuation, whereas the adolescents with a partner living with HIV had a lower risk of discontinuation (aHR = 0.57; 95% CI: 0.35-0.91). Discussion: Adolescents with a high risk for discontinuation may need additional support that emphasizes the value of PrEP as a tool for HIV prevention because PrEP discontinuation was associated with a disconnect between HIV risk perception and HIV prevention. (c) 2023 Society for Adolescent Health and Medicine.
Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) MEDEIROS, Danielle Souto de; MAGNO, Laio; GUIMARAES, Mark Drew Crosland; GRANGEIRO, Alexandre; EUSTORGIO FILHO, Marcos; SOARES, Fabiane; GRECO, Dirceu; WESTIN, Mateus; FERRAZ, Dulce; ZUCCHI, Eliana Miura; DOURADO, Ines
Purpose: This study aimed at describing the prevalence of symptoms of depression among 15-19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. Methods: This is a cross-sectional study of baseline data among 730 aMSM and 56 aTGWrecruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of >= 22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. Results: Our findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12-2.70), sexual violence (aOR = 1.79; 95% CI = 1.07-2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23-2.38) were independently associated with severe symptoms of depression in aMSM. Discussion: The high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis. (c) 2023 Society for Adolescent Health and Medicine.
When Ethics and the Law Collide: A Multicenter Demonstration Cohort Study of Pre-Exposure Prophylaxis Provision to Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) ZUCCHI, Eliana Miura; FERGUSON, Laura; MAGNO, Laio; DOURADO, Ines; GRECO, Dirceu; FERRAZ, Dulce; TUPINAMBAS, Unai; GRANGEIRO, Alexandre
Purpose: To explore legal and ethical challenges related to adolescents' participation in human immunodeficiency virus (HIV) research that may affect their best interests. Methods: We analyzed the ethical principles and legal aspects of the participation of 15-17-year-old men who have sex with men and transgender women in the pre-exposure prophylaxis (PrEP) 1519 study, a PrEP demonstration cohort study in three Brazilian cities. The analyses of ethics review committees' (ERCs) evaluations and court decisions followed ethical and human rights principles. An HIV vulnerability score was created, and descriptive statistics and multivariate logistic regression were performed using data from 347 participants. Results: The ERCs evaluated the benefits and risks of research participation, all finding that the benefits outweighed the risks. ERCs deferred responsibility for decisions about waiving parental consent to the judiciary. State courts reached different decisions about waiving parental consent, reflecting variation in recognition of adolescents' evolving capacities and the adolescent as a subject of sexual rights and the primary agent capable of deciding on their health and best interests. The most vulnerable adolescent participants were found in sites where the blanket waiver was in place. Discussion: Judicializing the ethical review process is detrimental to fulfilling the ethical principle of justice and vulnerable adolescents' access to health research. ERCs must be sufficiently independent and autonomous and have the capacity to respect, protect, and help fulfill the rights of participants while ensuring the generation of adequate evidence to inform public health practice. (c) 2023 Society for Adolescent Health and Medicine.
Same-Day Initiation of Oral Pre-Exposure Prophylaxis is High Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) SOARES, Fabiane; MAGNO, Laio; PINTO JR., Jony Arrais; GRANGEIRO, Alexandre; BRUXVOORT, Katia; GRECO, Dirceu; DOURADO, Ines
Purpose: This study analyzed the sociodemographic and behavioral characteristics of adolescent men who have sex with men (aMSM) and transgender women (aTGW) initiating oral pre-exposure prophylaxis (PrEP) in human immunodeficiency virus (HIV) prevention clinics. Methods: PrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aMSM and aTGWaged 15-19 years living in three large Brazilian capital cities. For this analysis, we included adolescents who enrolled in PrEP1519 from February 2019 to August 2021. Adolescents who visited PrEP clinics were classified into four groups based on PrEP eligibility and on their decision to use PrEP: (1) ineligible for same-day PrEP initiation; (2) eligible for same-day PrEP initiation, initiated PrEP at first visit; (3) eligible for PrEP initiation, initiated PrEP after the first visit; and (4) eligible for same-day PrEP initiation but declined. The groups that were eligible for same-day PrEP initiation were compared using the Chi-square and Fisher's exact tests. Results: Of the 1,254 adolescents enrolled in the PrEP1519 study, 61 (4.9%) were considered ineligible for same-day PrEP initiation. Of the 1,193 eligible for same-day PrEP initiation, 1,113 (93.3%) initiated PrEP [1,054 initiated PrEP in the first visit (88.3%) and 59 in subsequent visits (4.9%)] and 80 (6.7%) did not. Despite 90% of the PrEP decliners reporting a low risk of HIV infection, most reported condomless anal sex in the past six months (70%). Discussion: Same-day PrEP initiation among aMSM and aTGW was high, highlighting that this strategy was important to promote PrEP initiation among adolescents with increased vulnerability to HIV in Brazil. (c) 2023 Society for Adolescent Health and Medicine.
Safeguarding HIV prevention and care services amidst military conflict: experiences from Ukraine
(2023) LOPATINA, Yaroslava; ZAKOWICZ, Anna Maria; SHABAROVA, Zoya; FORD, Terri; FONSECA, Fernanda F.; ODOKE, Wilfred; HOMBERGH, Jan van den; I, Vivian Avelino-Silva; BENZAKEN, Adele Schwartz; MILES, Ralph C.
Ukraine stands out among European countries concerning HIV epidemiological data. Since February 2022, the military conflict with Russian forces has posed unprecedented challenges to HIV prevention and care. AIDS Healthcare Foundation (AHF), a global non-profit organisation with operations in Ukraine since 2009, implemented a preparedness plan to protect staff members and support local facilities in the continuity of care throughout the war. In this manuscript, we describe the strategies adopted by AHF to anticipate the risk of military conflict, steps to implement a preparedness plan, main challenges faced by local staff members and managers, adaptations needed as the conflict evolved, and indicators of HIV care 1 year before and 1 year after the onset of the conflict. Our experience shows that safeguarding the organisation's human resources has been a prerequisite to sustain services throughout the war.
Violence, discrimination, and sexual health practices among adolescent men who have sex with men, transgender women and travestis in three cities in Brazil
(2023) RYNGELBLUM, Marcelo; GRANGEIRO, Alexandre; ZUCCHI, Eliana Miura; COUTO, Marcia Thereza; DOURADO, Ines; MAGNO, Laio; TUPINAMBAS, Unai; PERES, Maria Fernanda Tourinho
The HIV epidemic has a disproportionate impact on adolescent and young men who have sex with men (AMSM) and transgender women and travestis (ATGW), with an increased HIV prevalence over the last 10 years. Violence affects the lives of these populations, undermining their ability to self-care and making them more vulnerable to HIV infection. In this study, we aimed to examine the association between different types of victimization by violence and discrimination and sexual health practices of these adolescent populations in steady and casual relationships. We conducted a cross-sectional study using baseline data from the cohort of PrEP1519 project. We used the mean score of sexual health practices as our outcome and the cumulative score of discrimi-nati on (within family, community, education, religious, online and public spaces) and violence (physical, sexual and intimate partner) as our exposure variable. We performed linear regression analyses to estimate the association between exposure and outcome. We found that 90% of AMSM and 95% of ATGW experienced at least one form of violence in the three months prior to this study and about 45% of ATGW suffered sexual violence during the same period. Experiencing discrimination within healthcare settings (from facilities or providers) was negatively associated with sexual health practices. Discrimi-nation and violence negatively affect sexual health practices. HIV prevention and care of AMSM and ATGW people should involve listening to their experi-ences and addressing discrimination and violence in this population.
Methodological issues in qualitative research on HIV prevention: an integrative review
(2023) SPADACIO, Cristiane; SANTOS, Lorruan Alves dos; SORRENTINO, Isa da Silva; GOMES, Romeu; CASTELLANOS, Marcelo Eduardo Pfeiffer; ZUCCHI, Eliana Miura; GRANGEIRO, Alexandre; COUTO, Marcia Thereza
In view of the growing concern about the use of qualitative approach in health research, this article aims to analyze how the qualitative theoretical -method-ological framework of HIV prevention is presented in empirical research. We conducted an integrative literature review with the following guiding ques-tions: ""How is the qualitative theoretical-methodological framework expressed in empirical research on HIV prevention?""; ""What are the limits and poten-tials of the qualitative methodological designs employed?"". In the qualitative methodological discussion, five dimensions guided the methodological course and the presentation of findings, from the analysis of the characterization of qualitative studies to the contextualization of the studies and the methodologi-cal approaches used, highlighting the use of semi-structured interviews with thematic content analysis. We also examined social categories and analytical references, drawing attention to the plurality of these theoretical-conceptual references and to the authors' polyphony, and identified the limits and po-tentials of qualitative research. This study focuses on a scientific topic that is related to a wide variety of social groups and analyzes how they are af-fected by it, examining issues related to social inequality and other analytical possibilities surrounding HIV prevention, and providing resources for a com-prehensive methodological discussion. Hence, avoiding the risk of conducting qualitative research based on checklists that limit inventiveness and openness to different designs and forms of execution and analysis is as pivotal as ensur-ing that the research is consistent and detailed in publications.
Efficacy and safety of long-acting cabotegravir compared with daily oral tenofovir disoproxil fumarate plus emtricitabine to prevent HIV infection in cisgender men and transgender women who have sex with men 1 year after study unblinding: a secondary analysis of the phase 2b and 3 HPTN 083 randomised controlled trial
(2023) LANDOVITZ, Raphael J.; HANSCOM, Brett S.; CLEMENT, Meredith E.; V, Ha Tran; KALLAS, Esper G.; MAGNUS, Manya; SUED, Omar; SANCHEZ, Jorge; SCOTT, Hyman; ERON, Joe J.; RIO, Carlos del; FIELDS, Sheldon D.; MARZINKE, Mark A.; ESHLEMAN, Susan H.; DONNELL, Deborah; SPINELLI, Matthew A.; KOFRON, Ryan M.; BERMAN, Richard; PIWOWAR-MANNING, Estelle M.; RICHARDSON, Paul A.; SULLIVAN, Philip A.; LUCAS, Jonathan P.; ANDERSON, Peter L.; HENDRIX, Craig W.; ADEYEYE, Adeola; ROONEY, James F.; RINEHART, Alex R.; COHEN, Myron S.; MCCAULEY, Marybeth; GRINSZTEJN, Beatriz
Background Injectable cabotegravir was superior to daily oral tenofovir disoproxil fumarate plus emtricitabine for HIV prevention in two clinical trials. Both trials had the primary aim of establishing the HIV prevention efficacy of long acting injectable cabotegravir pre-exposure prophylaxis (PrEP) compared with tenofovir disoproxil fumarate plus emtricitabine daily oral PrEP. Long-acting PrEP was associated with diagnostic delays and integrase strand-transfer inhibitor (INSTI) resistance. This report presents findings from the first unblinded year of the HIV Prevention Trials Network (HPTN) 083 study. Methods The HPTN 083 randomised controlled trial enrolled HIV-uninfected cisgender men and transgender women at elevated HIV risk who have sex with men, from 43 clinical research sites in Africa, Asia, Latin America, and the USA. Inclusion criteria included: a negative HIV serological test at the screening and study entry, undetectable HIV RNA levels within 14 days of study entry, age 18 years or older, overall good health as determined by clinical and laboratory evaluations, and a creatinine clearance of 60 mL/min or higher. Participants were randomly allocated to receive long-acting injectable cabotegravir or daily oral tenofovir disoproxil fumarate plus emtricitabine PrEP. After study unblinding, participants remained on their original regimen awaiting an extension study. HIV infections were characterised retrospectively at a central laboratory. Here we report the secondary analysis of efficacy and safety for the first unblinded year. The primary outcome was incident HIV infection. Efficacy analyses were done on the modified intention-to-treat population using a Cox regression model. Adverse events were compared across treatment groups and time periods (blinded vs unblinded). This trial is registered with ClinicalTrials.gov, NCT02720094. Findings Of the 4488 participants who contributed person-time to the blinded analysis, 3290 contributed person-time to the first unblinded year analysis between May 15, 2020, and May 14, 2021. Updated HIV incidence in the blinded phase was 0 center dot 41 per 100 person-years for long-acting injectable cabotegravir PrEP and 1 center dot 29 per 100 person-years for daily oral tenofovir disoproxil fumarate plus emtricitabine PrEP (hazard ratio [HR] 0 center dot 31 [95% CI 0 center dot 17-0 center dot 58], p=0 center dot 0003). HIV incidence in the first unblinded year was 0 center dot 82 per 100 person-years for long-acting PrEP and 2 center dot 27 per 100 person-years for daily oral PrEP (HR 0 center dot 35 [0 center dot 18-0 center dot 69], p=0 center dot 002). Adherence to both study products decreased after study unblinding. Additional infections in the long-acting PrEP group included two with on-time injections; three with one or more delayed injections; two detected with long-acting PrEP reinitiation; and 11 more than 6 months after their last injection. Infection within 6 months of cabotegravir exposure was associated with diagnostic delays and INSTI resistance. Adverse events were generally consistent with previous reports; incident hypertension in the long-acting PrEP group requires further investigation. Interpretation Long-acting injectable cabotegravir PrEP retained high efficacy for HIV prevention in men and transgender women who have sex with men during the first year of open-label follow-up, with a near-identical HR for HIV risk reduction between long-acting injectable cabotegravir and daily oral tenofovir disoproxil fumarate plus emtricitabine PrEP during the first year after unblinding compared with the blinded period. Extended follow-up further defined the risk period for diagnostic delays and emergence of INSTI resistance. Funding Division of AIDS at the National Institute of Allergy and Infectious Diseases, ViiV Healthcare, and Gilead Sciences.
Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life An Individual Participant Data Meta-Analysis
(2023) LENNON, Matthew J.; LAM, Ben Chun Pan; LIPNICKI, Darren M.; CRAWFORD, John D.; PETERS, Ruth; SCHUTTE, Aletta E.; BRODATY, Henry; THALAMUTHU, Anbupalam; RYDBERG-STERNER, Therese; NAJAR, Jenna; SKOOG, Ingmar; RIEDEL-HELLER, Steffi G.; ROEHR, Susanne; PABST, Alexander; LOBO, Antonio; DE-LA-CAMARA, Concepcion; LOBO, Elena; BELLO, Toyin; GUREJE, Oye; OJAGBEMI, Akin; LIPTON, Richard B.; KATZ, Mindy J.; DERBY, Carol A.; KIM, Ki Woong; HAN, Ji Won; OH, Dae Jong; ROLANDI, Elena; DAVIN, Annalisa; ROSSI, Michele; SCARMEAS, Nikolaos; YANNAKOULIA, Mary; DARDIOTIS, Themis; HENDRIE, Hugh C.; GAO, Sujuan; CARRIERE, Isabelle; RITCHIE, Karen; ANSTEY, Kaarin J.; CHERBUIN, Nicolas; XIAO, Shifu; YUE, Ling; LI, Wei; GUERCHET, Maelenn M.; PREUX, Pierre-Marie; ABOYANS, Victor; HAAN, Mary N.; AIELLO, Allison E.; NG, Tze Pin; NYUNT, Ma Shwe Zin; GAO, Qi; SCAZUFCA, Marcia; SACHDEV, Perminder S. S.
IMPORTANCE The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. OBJECTIVES To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. DATA SOURCE AND STUDY SELECTION Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). DATA EXTRACTION AND SYNTHESIS Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. MAIN OUTCOMES AND MEASURES The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. RESULTS The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P =.001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P =.02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P =.07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. CONCLUSIONS AND RELEVANCE This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive usewas associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
Association of PM2.5 mass and its components with ovarian reserve in a northern peninsular province, China: The critical exposure period and components
(2024) PANG, Lihong; JIANG, Mingdong; SUI, Xinlei; DOU, Yunde; YU, Wenhao; HUXLEY, Rachel; SALDIVA, Paulo; HU, Jingmei; SCHIKOWSKI, Tamara; KRAFFT, Thomas; GAO, Panjun; ZHAO, Yueran; ZHAO, Han; ZHAO, Qi; CHEN, Zi-Jiang
Background: A possible role of PM2.5 components on ovarian reserve has not been adequately unexplored. Objective: To evaluate the association between PM2.5 components and women' ovarian reserve over critical exposure periods in northern China, where the level of air pollution is among the nation's highest.Methods: We included 15,102 women with serum anti-Mullerian hormone (AMH) measurements from the Center for Reproductive Medicine of Shandong University during 2015-2019. Concentrations of PM2.5 and its five major components (0.1 degrees x 0.1 degrees), including sulfate, nitrate, ammonium, organic matter, and black carbon, were assigned to each residential address. Multivariable linear mixed effect models combined with constituent -residual models were performed to estimate the effect sizes of essential components over six short-to long-term exposure periods.Results: The strength of association was stronger during the process from primary to small antral follicle compared with other longer windows. For every interquartile range increase in PM2.5 mass was associated with -8.7% (95%CI:-12.3%,-4.9%) change in AMH and the effect size was greatest for sulfate. Women with the lower level of attained education and those living inland were more susceptible compared with other population subgroups.Conclusion: Exposure to specific components of air pollution during critical exposure windows is associated with a decline in ovarian reserve. These data add to the growing body of evidence that environmental factors have adverse effects on reproductive health, particularly for vulnerable population subgroups.
Parental attitudes and beliefs about sexuality of individuals with intellectual disability: Insights from a Brazilian sample of parents of individuals with Williams syndrome
(2023) MONTEIRO, Rebeca Orselli; TAFLA, Tally Lichtensztejn; RODRIGUEZ, Juliana Dalla Martha; TEIXEIRA, Sabine Triguero; HONJO, Rachel Sayuri; KIM, Chong Ae; TEIXEIRA, Maria Cristina Triguero Veloz
BackgroundThe affective expression of sexual behaviour in individuals with Williams syndrome can lead to risky behaviours, especially if parents do not have information on how to provide sex education or support from specialised professionals.MethodThe Attitudes to Sexuality Questionnaire for Individuals with Intellectual Disabilities was used to identify parental beliefs, attitudes and concerns about the sexuality and sex education of individuals with intellectual disabilities. The sample comprised 35 parents of individuals with Williams syndrome (mean age 12.8 years (SD = 4.5), 57.1% male).ResultsParents believe in the possibility of marriage and sexual relationships for individuals with intellectual disability when they are older and agree with sexual reproduction in adulthood. Parents consider that sex education, in addition to parental guidance, should be provided by professionals.ConclusionsThis data highlights the need for parents to have clear guidelines on interventions in respect of the sexuality of individuals with intellectual disability.
Prevalence of HIV-1 infection and associated characteristics in a Brazilian indigenous population: a cross-sectional study
(2023) SCHNAUFER, Erica C. S.; BARBOSA, Marcelo S.; MARQUES, Michele F. R.; BRITO, Gabriel T.; FERREIRA, Tiago S.; RIBEIRO, Anny D. C.; VALIENTE, Anna C.; MACHADO, Indianara R.; GONCALVES, Crhistinne C. M.; TANAKA, Tayana S. O.; GUIMARAES, Monick L.; RIBEIRO, Suzana M.; CRODA, Julio; SIMIONATTO, Simone
Background Despite significant progress in the areas of prevention, diagnosis, and treatment, HIV continues to result in a substantial number of fatalities on a global scale each year. Gaining insights from epidemiological data can prove instrumental in the development of health promotion strategies, particularly within vulnerable populations, such as indigenous groups. Consequently, our study aimed to investigate the prevalence of HIV infection within the indigenous population residing in the second-largest region of Brazil. Additionally, we sought to explore the subtypes of HIV-1 and detect any drug-resistance mutations present within this population.Methods In this cross-sectional study, we aimed to evaluate the prevalence of HIV-1 infection and explore its associated characteristics within the indigenous population residing in the villages of Jaguapiru and Bororo, located in the Dourados area of Mato Grosso do Sul (MS), Brazil. Blood samples were collected for rapid HIV screening, serological tests, nucleic acid amplification, and HIV subtyping. Additionally, the HIV-1 viral load and CD4+ T lymphocyte count of the people living with HIV (PLHIV) were assessed at the time of recruitment and 24 weeks later.Findings Out of the 2190 invited individuals, 1927 (88%) were included in this study. The average age of the participants was 34.2 (& PLUSMN;13.8) years, with a majority of 74% being female. Moreover, 68.44% of the participants identified themselves as belonging to the Guarani-Kaiowa ethnic group. HIV seroprevalence was 0.93% (18/1927), and 73.22% (1411/1927) were unaware of their serological status. The prevalence of HIV-1 was higher in single indigenous people [10/617 (1.62%)], who received government benefits [14/1021 (1.37%)], had less than five years of formal education [11/685 (1.61%)], had sexual intercourse with users of injectable drugs [2/21 (9.52%)], with history of sexually transmitted infections (STIs) [10/62 (16.2%)] and incarceration [3/62 (4.84%)]. Of 18 positive samples, 44.4% (8/ 18) were successfully amplified, and HIV-1 subtype C was prevalent. Furthermore, we identified HIV-1 drug resistance mutations in four patients, specifically from the classes of Protease Inhibitor, Nucleoside Reverse Transcriptase Inhibitor, and Non-Nucleoside Reverse Transcriptase Inhibitor. Notably, three of these patients exhibited a high viral load even after 24 weeks of undergoing antiretroviral therapy. Out of the 18 PLHIV, 66.66% (12/18) had a viral load below 1000 copies/mL, while 50% (9/18) had a CD4+ T lymphocytes count greater than 350 cells/mL after 24 weeks of treatment.Interpretation Despite the concerted efforts to control HIV infection, the prevalence observed in the indigenous popu-lation under study surpassed that reported in other Brazilian indigenous groups. This disparity highlights the dispro-portionate impact of the disease on this particular group. The detection of drug-resistance mutations further emphasizes the critical need to expand diagnostic coverage, closely monitor treatment strategies, and maintain ongoing molecular surveillance. These measures are imperative for enhancing HIV management within this vulnerable population. Funding This study was partially funded by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Fundacao de Apoio ao Desenvolvimento do Ensino, Ciencia e Tecnologia do Estado de Mato Grosso do Sul (FUN-DECT), Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES), Secretaria do Estado de Saude (SES) of Governo do Estado de Mato Grosso do Sul, and Universidade Federal da Grande Dourados (UFGD). Copyright & COPY; 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Country-level gender inequality is associated with structural differences in the brains of women and men
(2023) ZUGMAN, Andre; ALLIENDE, Luz Maria; MEDEL, Vicente; BETHLEHEM, Richard A. I.; SEIDLITZ, Jakob; RINGLEIN, Grace; ARANGO, Celso; ARNATKEVICIUTE, Aurina; ASMAL, Laila; BELLGROVE, Mark; BENEGAL, Vivek; BERNARDO, Miquel; BILLEKE, Pablo; BOSCH-BAYARD, Jorge; BRESSAN, Rodrigo; BUSATTO, Geraldo F.; CASTRO, Mariana N.; CHAIM-AVANCINI, Tiffany; COMPTE, Albert; COSTANZI, Monise; CZEPIELEWSKI, Leticia; DAZZAN, Paola; FUENTE-SANDOVAL, Camilo de la; FORTI, Marta Di; DIAZ-CANEJA, Covadonga M.; DIAZ-ZULUAGA, Ana Maria; PLESSIS, Stefan Du; DURAN, Fabio L. S.; FITTIPALDI, Sol; FORNITO, Alex; FREIMER, Nelson B.; GADELHA, Ary; GAMA, Clarissa S.; GARANI, Ranjini; GARCIA-RIZO, Clemente; CAMPO, Cecilia Gonzalez; GONZALEZ-VALDERRAMA, Alfonso; GUINJOAN, Salvador; HOLLA, Bharath; IBANEZ, Agustin; IVANOVIC, Daniza; JACKOWSKI, Andrea; LEON-ORTIZ, Pablo; LOCHNER, Christine; LOPEZ-JARAMILLO, Carlos; LUCKHOFF, Hilmar; MASSUDA, Raffael; MCGUIRE, Philip; MIYATAAAA, Jun; MIZRAHI, Romina; MURRAY, Robin; OZERDEM, Aysegul; PAN, Pedro M.; PARELLADA, Mara; PHAHLADIRA, Lebogan; RAMIREZ-MAHALU, Juan P.; RECKZIEGEL, Ramiro; MARQUES, Tiago Reis; REYES-MADRIGAL, Francisco; ROOS, Annerine; ROSA, Pedro; SALUM, Giovanni; SCHEFFLER, Freda; SCHUMANN, Gunter; SERPA, Mauricio; STEIN, Dan J.; TEPPER, Angeles; TIEGO, Jeggan; UENO, Tsukasa; UNDURRAGA, Juan; UNDURRAG, Eduardo A.; VALDES-SOSAOOO, Pedro; VALLIY, Isabel; VILLARREALU, Mirta; WINTON-BROWNRRR, Toby T.; YALIN, Nefize; ZAMORANO, Francisco; ZANETTI, Marcus V.; WINKLER, Anderson M.; PINE, Daniel S.; EVANS-LACKO, Sara; CROSSLEY, Nicolas A.
Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women's worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7,876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women's brains and provide initial evidence for neuroscience-informed policies for gender equality.
Telehealth effectiveness for pre-exposure prophylaxis delivery in Brazilian public services: the Combine! Study
(2023) GRANGEIRO, Alexandre; SANTOS, Lorruan Alves do; ESTEVAM, Denize Lotufo; MUNHOZ, Rosemeire; ARRUDA, Erico; MORAES, Renata Amaral de; WINKLER, Lisiane de Quadros; NEVES, Lis Aparecida de Souza; SANTOS, Juliane Cardoso Villela; KRUPPA, Mariele; ZUCCHI, Eliana Miura; ESCUDER, Maria Mercedes; LEAL, Andrea Fachel; KOYAMA, Mitti Ayako Hara; PERES, Maria Fernanda Tourinho; COUTO, Marcia Thereza; NETO, Jose Eluf; Combine Res Grp
IntroductionPre-exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals).MethodsBetween July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in-person follow-up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in-person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent-to-treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period.ResultsOf 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25-months of use: 4.90; 95% CI: 1.32-18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40-6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24-2.94) and decreasing for those who reported higher-risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29-0.88). After an average follow-up period of 1.6 years (95% CI: 1.5-1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45-0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in-person and telehealth (p = 0.486) or at pre- and post-telehealth follow-ups (p = 0.245). Sexually transmitted infections increased between the pre-follow-up and post-follow-up choices and were not associated with in-person or telehealth (p = 0.528). No HIV infections were observed.ConclusionsOur findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.
Association between Community Violence, Disorder and School Environment with Bullying among School Adolescents in Sao Paulo - Brazil
(2023) AZEREDO, Catarina Machado; MARQUES, Emanuele Souza; OKADA, Leticia Martins; PERES, Maria Fernanda Tourinho
The role of contextual-level factors in bullying is still not clear, and evidence is mostly from high-income countries. Our objective was to investigate the association between community violence, disorder, school environment and bullying among school adolescents. We used data from a representative sample of 9th grade Brazilian adolescents (n = 2108) from the Sao Paulo Project for the social development of children and adolescents (SP - PROSO). Multilevel logistic regression models stratified by sex were used to assess the association between variables at student and school/neighbourhood level and bullying victimization or perpetration. For both sexes, we found that adolescents who perceived high violence between students and high school disorder were more likely to be bullies and victims. Boys who perceived high community violence and disorder in their neighbourhood were more likely to be bullies (OR3tertile = 2.73 CI95%: 1.57-4.74). Girls attending schools where the principal reported high community violence and disorder in the neighbourhood (ORhigh = 10.24 CI95%: 2.11-49.59) and inside the school (ORhigh = 6.83 CI95%: 1.48-31.56) were more likely to be bullies. Boys from schools whose principal perceived violence between students were less likely to be victims (ORhigh = 0.35 CI95%: 0.16-0.78) and bullies (ORhigh = 0.21 CI95%: 0.07-0.64). Girls attending schools with signs or posters about tolerance/gender equality and about violence were less (OR = 0.12 CI95%: 0.03-0.50) and more likely (OR = 25.88 CI95%: 4.28-156.63) to report being bullies, respectively. Community violence, disorder and school environment were associated with bullying victimization and perpetration among adolescents. Sex-specific associations should be further investigated. Prevention and management of school violence in adolescence should consider contextual-level characteristics.
Sexual behavior and self-declaration of sexual orientation among people 18-64 years in Brazil: results from the Knowledge, Attitudes, and Practices survey, 2013 and the National Health Survey, 2019
(2023) SZWARCWALD, Celia Landmann; PASCOM, Ana Roberta Pati; SOUZA JUNIOR, Paulo Roberto Borges de; DAMACENA, Giseli Nogueira; CASTILHO, Euclides Ayres
Background Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs). Methods Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18-64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott's correction, was applied. Results Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1-4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9-2.5), and between the WSW proportions (4.6%; 95% CI 4.0-5.4%) and (2.1%; 95% CI 1.8-2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18-24 and 25-34 years, and individuals not living with a partner. Conclusions The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.
An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation
(2023) BACCHUS, Loraine J.; D'OLIVEIRA, Ana Flavia Pires Lucas; PEREIRA, Stephanie; SCHRAIBER, Lilia Blima; AGUIAR, Janaina Marques de; GRAGLIA, Cecilia Guida Vieira; BONIN, Renata Granusso; FEDER, Gene; COLOMBINI, Manuela
BackgroundHealth systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA-Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil.MethodsThe study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN).ResultsHERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Nucleo de Prevencao da Violencia (Violence Prevention Nucleus-NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW.ConclusionTraining should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.
Human Papillomavirus Positivity at 3 Anatomical Sites Among Transgender Women in Central Brazil
(2023) OLIVEIRA, Brunna Rodrigues de; SILVA, Bruno Vinicius Diniz E.; SANTOS, Kamila Cardoso dos; CAETANO, Karlla Antonieta Amorim; MOTA, Giana; SADDI, Vera Aparecida; RABELO-SANTOS, Silvia Helena; VILLA, Luisa Lina; VADDIPARTI, Krishna; COOK, Robert L.; TELES, Sheila Araujo; CARNEIRO, Megmar Aparecida dos Santos
BackgroundTransgender women (TGW) are susceptible to the acquisition of sexually transmitted infections (STIs), including human papillomavirus (HPV). Nonetheless, the exact data for this population are scarce. We estimated HPV positivity at the anal, genital, and oral sites among TGW and also identified the related characteristics and behaviors that could be risk factors for HPV infection in a sample of TGW in Brazil. Furthermore, we characterized the site-specific HPV genotypes among those who were positive for HPV at these 3 sites.MethodsA cross-sectional study was conducted on TGW in Goiania City (Central-Midwest region), Brazil, between April 2018 and August 2019. Respondent-driven sampling was applied for recruitment. Next, self-collected anal, genital, and oral samples were examined for HPV DNA using polymerase chain reaction (SPF-10 primer). Human papillomavirus genotypes were identified in 12 TGW.ResultsIn the TGW included in the study, the anal, genital, and oral HPV positivity values were 77.2% (95% confidence interval [CI], 67.3%-84.6%), 33.5% (95% CI, 26.1%-48.9%), and 10.9% (95% CI, 5.8%-17.0%), respectively. In addition, the majority of 12 participants who tested for HPV had multiple genotypes. HPV-52 was the most prevalent genotype identified at the anal (66.6%) and genital (40.0%) sites, whereas HPV-62 and HPV-66 were the most common at the oral site (25.0%).ConclusionsA high HPV positivity was observed among TGW. Therefore, additional epidemiological studies on HPV genotypes should generate health intervention information, including the prevention, diagnosis, and treatment of sexually transmitted infections.

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