The Increase in Domestic Violence in Brazil From 2009-2014

In recent decades, the rise violent phenomena in Brazil has reached epidemic proportions. However, the prevalence of domestic violence (DV) across different states in the country is not well established. The objective of this study was to describe the distribution of DV across Brazilian states from 2009 to 2014. An ecological study based on spatial analysis techniques was performed using Brazilian states as geographical units of analysis. A multilevel Poisson model was used to explain the risk of DV in Brazil according to age, sex, period (fixed effects), the Human Developing Index, and the victim’s residence state (random effects). The overall average rate of DV almost tripled from 2009-2010 to 2013-2014. The rate of DV in Brazil in the 2013-2014 period was 3.52 times greater than the 2009-2010 period. The risk of DV in men was 74% lower than in women. The increase of DV against women during period under study occurred mainly in the Southeast, South, and Midwest. DV was more frequent in adolescence and adulthood. DV is gradually increasing in recent years in Brazil. More legislation and government programs are needed to combat the growth of violence in society. NCP Rodrigues conceived of the study, participated in its design and coordination, helped to draft the manuscript and performed the statistical analysis. All authors helped to draft the manuscript, read and approved the final manuscript

Spatial and temporal patterns of infant mortality and its components in Rio de Janeiro

ABSTRACT Objectives. The study aims to assess the trend of neonatal, post-neonatal, and infant mortality from 1996 to 2020 within the metropolitan region of the state of Rio de Janeiro and other regions. Methods. Ecological study using the region as analysis unity. Data were accessed from the Mortality Information System and Live Birth Information System in the capital Rio de Janeiro, in the neighboring areas of Niterói, São Gonçalo, Baixada Fluminense, and the remaining regions of the state of Rio de Janeiro State. We applied Poisson multilevel modeling, where the models’ response variables were infant mortality and its neonatal and post neonatal components. Fixed effects of the adjusted models were region and death year variables. Results. During the 1996-2020 period, the Baixada Fluminense showed the highest infant mortality rate as to its neonatal and post neonatal components. All adjusted models showed that the more recent the year the lower the mortality risk. Niterói showed the lowest adjusted risk of infant mortality and its neonatal and post neonatal components. Conclusion. Baixada Fluminense showed the highest mortality risk for infant mortality and its neonatal and post-neonatal components in the metropolitan region. The stabilization in mortality rates in recent years was identified by the research

Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017

The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted

Knowledge on the HPV vaccine among university students

The objective is to evaluate knowledge on HPV vaccine and its use among university students. This is a cross-sectional study with 301 participants, of which 202 medical students from UERJ and UNIFESO (101 freshmen = M1 and 101 from the 6th year = M2) and 99 UERJ literature students (50 freshmen = L1 and 49 of the last year = L2). Information was obtained by questionnaires. Input and statistical analysis were carried out with the EPI-INFO 3.5.2 Program. Results showed that, among medical students, 21% of M1 and 16% of M2 used the HPV vaccine (p=0.35), mostly adopted by women (M1=29.7% and M2=21.3%) than men (M1=5.4% and M2=7.5%). Similarly, female students showed more interest in using the vaccine (M1=85.1% and M2=80%) than male (M1=56.2% and M2=20.5%). Among literature students, only women received the vaccine (L1=6.5% and L2=22.2%) and no men were vaccinated (p=0.04). More women expressed interest in receiving the vaccine than men (♀ L1=76%, L2=65% and ♂ L1=47%, L2=40%). Comparison among genders regardless of the course showed that the vaccination rate is higher among women (p<0.001), as is the interest in being vaccinated (p=0.004). We concluded that the majority of male university students know less about the HPV vaccine than the female ones, use less and are less interested in being vaccinated, in all the groups interviewed. Vaccination coverage is low among the university population and is higher among medical students

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

A cérvice uterina da adolescente: estudo da prevalência e dos fatores associados ao câncer de colo uterino e suas lesões precursoras em população de adolescentes atendidas em Hospital Público do Município do Rio de Janeiro The uterine cervix of the adolescent: study of the prevalence and factors associated with the uterine cervix cancer and their precursor lesions in a teenagers' population attended at a Public Hospital of the Municipality of Rio de Janeiro

O colo do útero é o segundo local mais comum de instalação do câncer entre as mulheres. A associação entre este tipo de câncer e a infecção pelo Papilomavirus humano encontra-se bem estabelecida, sendo a presença do vírus considerada condição necessária, embora não suficiente, para o desenvolvimento da neoplasia. O primeiro contágio pelo HPV ocorre geralmente no início da vida sexual e, como esta idade vem diminuindo, torna-se cada vez mais precoce o risco de surgimento destas lesões. A partir da observação de vários casos de lesões intra-epiteliais cervicais de alto grau (HSIL) em pacientes do Ambulatório de Ginecologia para Adolescentes do Hospital Municipal Cardoso Fontes e, considerando que esta faixa etária não está coberta pelo Programa Nacional de Controle do Câncer do Colo do Útero-Viva Mulher, conduzimos esta pesquisa a partir de duas questões básicas: o estudo da prevalência da HSL e do câncer em adolescentes, e identificação dos fatores associados com a presença dessas lesões.A população de estudo foi constituída por 702 adolescentes de ídades entre 12 e 19 anos completos e com vida sexual ativa, atendidas no período de 1993 a 2002. O delineamento do estudo foi do tipo transversal, sendo o rastreamento feito através da citopatologia e colposcopia e a confirmação do diagnóstico histológico através da biópsia da cérvice uterina.As variáveis de exposição estudadas foram características sócio-demográficas e as relacionadas à saúde reprodutiva, hábitos e comportamento sexual. Os fatores associados à doença do colo uterino foram identificados a partir de análise multivariada realizada através de regressão logística, sendo empregados os programas EPI-INFO e SPSS para construção do banco de dados e a análise estatística.O exame histopatológico revelou a prevalência de 8,4 por cento de lesões intraepiteliais de alto e baixo grau. Houve um caso de câncer invasor. Ao considerar apenas a doença relevante do colo uterino, obteve-se prevalência 3 por cento. A cada nova gestação, a chance de doença relevante do colo uterino em adolescentes foi 2,2 vezes maior. A idade também esteve associada a este desfecho, dobrando a cada ano de idade a chance de adquirir a doença. A alta prevalência de lesões intra-epiteliais cervicais observadas em nosso estudo sugere a importância da inclusão das adolescentes sexualmente ativas no Programa Viva Mulher para detecção e tratamento precoces dessas lesões, evitando o comprometimento da saúde da adolescente