Personal beliefs and social norms regarding the sexual exploitation of girls in age-disparate transactional sexual relationships in Brazil: a mixed-methods study.

BACKGROUND: In the global debate around transactional sex little attention has concentrated on Brazil, despite ranking fourth globally in absolute number of girls married or co-habiting by the age of 15 years, and evidence showing that these unions often begin as age-disparate transactional sex (ADTS). This article contributes to filling this gap by exploring the personal beliefs and social norms related to ADTS in urban (favela) communities of Rio de Janeiro, Brazil between adult men (> 18 years) and girls and adolescents (G/A) (< 18 years) with a minimum 5-year age disparity. The primary objective of this study was to identify the social norms that promote and prevent ADTS, and the dynamics between individual beliefs and social norms, to provide contextualized recommendations to prevent ADTS in this setting. METHODS: An exploratory, sequential, mixed-methods design was used, starting with a qualitative phase that included semi-structured, in-depth interviews and focus groups, and a subsequent quantitative phase comprising of a community survey. The items for the quantitative questionnaires were developed based on the qualitative results. RESULTS: Mixed methods results indicate that in these communities ADTS is normalised and not considered exploitative. We identified three themes related to the reasons ADTS occurs: girls' responsibility, male desires and benefits of ADTS. Men's role in ADTS was largely minimised because of a general acceptance of a notion of masculinity characterised by hypersexuality and lack of impulse control. Individual beliefs, however, did not tend to align with these social norms. CONCLUSIONS: In this study, personal beliefs and social norms often did not align, suggesting that initiatives working to change personal or attitudes regarding ADTS may not lead to meaningful change in ADTS behaviours, and social norms interventions may be more effective. Our findings reinforce the need to develop programs tailored to local understandings of ADTS, targeting not only girls but also a wide range of actors. Interventions could also consider the structural factors acting in local and global contexts that promote or prevent ADTS

Socioenvironmental conditions and intestinal parasitic infections in Brazilian urban slums: a cross-sectional study

Intestinal parasitic infections (IPIs) are neglected diseases with limited data regarding prevalence in Brazil and many other countries. In increasingly urban societies, investigating the profile and socioenvironmental determinants of IPIs in the general population of slum dwellers is necessary for establishing appropriate public policies catered to these environments. This study assessed the socioenvironmental conditions and prevalence of IPIs in slums of Rio de Janeiro, RJ State, Brazil. Methods A cross-sectional study covering an agglomeration of urban slums was conducted between 2015 and 2016 using participants observation, a socioeconomic survey, and the spontaneous sedimentation method with three slides per sample to analyze fresh stool specimens ( n =595) searching for intestinal parasites. Results Endolimax nana ( n =95, 16.0%) and Entamoeba coli ( n =65, 10.9%) were the most frequently identified agents, followed by Giardia intestinalis ( n =24, 4.0%) and Ascaris lumbricoides ( n =11, 1.8%). Coinfections caused by E. nana and E. histolytica/dispar and by Entamoeba coli/A. lumbricoides were significant. The use of piped water as drinking water, the presence of A. lumbricoides , and contamination with coliform bacteria and Escherichia coli were more common in major area (MA) 1. Children (0-19 years) had a greater chance of living in poverty (OR 3.36; 95% CI: 2.50- 4.52;

Community perceptions of transactional sex with children and adolescent girls, a qualitative study in favelas of Rio de Janeiro.

The sexual exploitation of children and adolescents is a frequently underestimated health problem which includes transactional sex (TS), or the practice of sexual activity based on an expected return of benefits, favours and/or support in some form. This qualitative study focuses on age-disparate transactional sex (ATS) in urban favela communities of Rio de Janeiro between adult men (over 18) and girls and adolescents (G/A) (under 18), involving a minimum 5-year age disparity. We have employed social norms theory as a framework to identify the prevailing social norms contributing to or protecting children and adolescents from these relationships. Data collection utilised semi-structured interviews (n = 30) and ten focus groups with a total of 130 men/boys and women/girls selected through purposive sampling and varying in age from 15 to 65. Overall the findings identify factors, especially the essentialisation of gender, which promote the acceptability of ATS. When ATS surpassed the acceptability threshold, social norms discouraged direct interference. Concluding remarks point to possible strategies for reducing the occurrence of ATS. These must include girls, boys, women and men with community involvement in the deconstruction of social norms involving gender, age and economic consumption

Measuring social norms and attitudes about age-disparate transactional sex: Psychometric testing of the NAATSS

Background: Transactional sex between girls under 18 years-old and adult men at least ten years older, known as age-disparate transactional sex (ADTS), is an established risk factor for HIV, STI and early pregnancy among girls and women. Social norms or beliefs about what others expect from you and what others do can sustain behaviours such as ADTS even when individuals may be personally against them. In order to evaluate interventions to change social norms, validated instruments for measuring change in personal beliefs and social norms regarding ADTS are needed. Methods: Items for the Norms and Attitudes on Age-Disparate Transactional Sex Scale (NAATSS) were generated based on qualitative interviews and expert panel review. The reliability and validity of the NAATSS was tested in a representative sample (N = 431) from Brazilian favelas. Factor analysis assessed construct validity, Cronbach's alpha assessed reliability, and t-tests and analysis of variances tested hypothesized differences between gender, age, and previous experience with ADTS in both the social norms and personal beliefs domains. Findings: Factor analysis revealed three factors in each domain. The factors were labelled “Attributions to Girls’ Behaviour” which has 5 items, “Men's Motivations” with 5 items, and “Girls’ Readiness to have Sex” with 3 items. The subscales evidenced acceptable reliability with Cronbach's alphas ranging from 0.72 to 0.83 for the social norms subscales and 0.59 to 0.82 for the personal beliefs subscales. Interpretation: The items were developed based on qualitative research and expert rankings and the resulting Norms and Attitudes on ADTS Scale exhibits strong psychometric properties. Each of the three subscales within the two domains illustrate good factor structure, acceptable internal consistency reliability, and are supported by the significance of the hypothesized group differences. Funding: This work was supported by the OAK Foundation [grant number OCAY-16-188]

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Determinação Social das Infecções por Parasitas Intestinais na Estratégia de Saúde da Família: uma Contribuição para a Humanização do Serviço

Made available in DSpace on 2017-12-08T11:28:37Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) caroline_ignacio_ioc_dout_2017.pdf: 35444015 bytes, checksum: 02cbc149df4df52e93af9cc59698887b (MD5)Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Introdução: As infecções por parasitoses intestinais (IPIs) são doenças transmitidas por protozoários ou helmintos, consideradas \201Cdoenças negligenciadas da pobreza\201D, que continuam inibindo melhorias em qualidade de vida de aproximadamente uma em cada quatro pessoas, apesar dos avanços biomédicos. Sua persistência destaca o papel das atribuições sociais, políticas, econômicas e culturais, além de biomédicas, que envolvem as IPIs. Existem instrumentos de políticas públicas para o enfrentamento destas doenças, diretamente e indiretamente, através de ações sob as condições promotoras da doença. Porém, a sua gestão ocorre principalmente no âmbito da Atenção Básica (AB) do Sistema Único de Saúde (SUS). No Complexo de Manguinhos, Rio de Janeiro, a AB é organizada pela Estratégia de Saúde da Família (ESF). Por isso, o objetivo do estudo foi analisar o processo de gestão do autocuidado relacionado às doenças negligenciadas da pobreza com foco nas parasitoses intestinais, no Complexo de Manguinhos, RJ, a fim de contribuir para a humanização dos serviços no SUS, no âmbito do plano \201CBrasil Sem Miséria\201D (BSM). Material e Métodos: Por ser orientado através da busca de resultados aplicáveis que visam ser aplicados na transformação de um problema, esse estudo se situou no âmbito de pesquisa ativista qualiquantitativa. A sua metodologia foi desenvolvida ao longo do estudo de acordo com a necessidade de aprofundar os achados levantados na aplicação dos questionários de Conhecimentos, Atitudes e Práticas (QCAP) (n=58 profissionais de saúde, n=571 moradores), questionário socioeconômico e habitacional (QSEH) (n=318) e do levantamento epidemiológico das parasitoses intestinais através da realização de exames coproparasitológicos através do método de sedimentação espontânea (n=595 amostras) Foram incluídas entrevistas semiabertas, uma sessão técnica, oficina e levantamento bibliográfico realizado com fontes acadêmicas e não acadêmicas. Indicadores foram desenvolvidos a partir das observações e dos resultados obtidos ao longo da pesquisa e validados em apresentação na comunidade. Resultados: A prevalência de IPIs foi de 29,4% com a predominância dos protozoários. Em relação aos conhecimentos, atitudes e práticas, foi detectada familiarização e banalização das IPIs. As falas não conectaram o conhecimento geral sobre as IPIs com formas de prevenção. Esses resultados levaram à realização de uma sessão técnica sobre as IPIs no CM com os profissionais de saúde. Essa sessão técnica, somada com as entrevistas aos moradores e a oficina com os Agentes Comunitários de Saúde, contribuíram para identificar complexos processos de vulnerabilização da saúde no território que vão além de questões biomédicas e construir a matriz de indicadores. Essa matriz foi validada como ferramenta de educação permanente na ESF. Conclusão: Os resultados evidenciam a necessidade de incorporar avaliações dos processos na educação permanente que visa à humanização. A matriz pode contribuir para a inclusão da discussão sobre os processos socioambientais do território e sobre o papel do conhecimento dos profissionais da ESF no seu papel como gestores do autocuidado no CM.Introduction: Intestinal parasitic infections (IPIs) are diseases transmitted by protozoan and helminths, considered neglected diseases of poverty, which continue to inhibit improvements in quality of life for one in four people, despite biomedical advances. Their persistence highlights the role of social, political, economic and cultural attributions, in addition to biomedical, which involve IPIs. There are instruments of Public Policy for tackling these diseases directly or indirectly by acting on the promotors of disease. However, the management of IPIs occurs mostly in the realm of primary health care (PC) in the Unified Health System (SUS). In the Complexo de Manguinhos, Rio de Janeiro, PC is organized by the Family Health Strategy (FHS). Therefore, the objective of this study was to analyze the self-care management process related to the neglected diseases of poverty with a focus on intestinal parasites, in the Complexo de Manguinhos, RJ, to contribute to humanizing health care in SUS, in the realm of the Brazil Without Extreme Poverty Plan. Methods: Guided by a search for results that can be applied to solve a real problem, this study is in the realm of quali-quantitative activist research. The methodology was developed throughout the study according to the need to further investigate the preliminary results of the Knowledge, Attitudes and Practices Surveys (KAPS) (n=59 health care providers, n=571 residents), the Socioeconomic Survey (n=318), and the epidemiological survey of intestinal parasites through parasitological analysis using the spontaneous sedimentation method (n=595 samples) Semi-structured interviews, a technical session, workshop and a review of academic and non-academic literature. Results: The prevalence of IPIs was 29.4% with a predominance of protozoan infections. Regarding knowledge, attitudes and practices, a familiarity and banalization of IPIs was noted. The answers did not show a link between general knowledge regarding IPIs and prevention. These results led to the realization of a technical session regarding IPIs in the CM with the health professionals. This technical session, in addition to the interviews with the residents and the workshop with the Community Health Workers, contributed to the identification of complex processes of vulnerabilization of health which go beyond biomedical issues and construct the indicator matrix. The matrix was validated as a tool for permanent education within the FHS. Conclusion: The results show a need for incorporating process evaluations in permanent education promoting humanization. The matrix can contribute to the inclusion of discussion regarding the socioenvironmental processes of the territory and the role of the knowledge of health professional of the FHS on their role as self-care managers in the CM

State of Europe’s Fathers: Men’s Caregiving in the European Union

Report for the European United Left / Nordic Green Left (GUE/NGL) in the European ParliamentGender equality is one of the founding values of the EU and Member States have established the promotion of the equality of men and women in the labour market, as well as in their work-life balance and responsibilities as priorities for the EU. Data shows that increasingly women and men work outside the home, but, at the same time, women remain the main household caregivers and take on a double burden in the private domain. Although true equality between men and women will only be achieved when men take on 50 percent of the caregiving and domestic work, equal distribution is the exception rather than the rule. This report explores trends in men’s caregiving in Europe (with a particular focus on fatherhood) and five key areas for change: implementing laws and policies to promote gender equality; transforming gender norms that reproduce harmful gender stereotypes; supporting the physical and financial security of families; helping couples and co-parents thrive together; and, putting fathers care into action. The main objective of the State of Europe´s Fathers is to contribute to theoretical and policy approaches that understand how gender equality, including caregiving, constitutes a collective social good to be promoted in general and in particular in times of crisis and develop an evidence-based and detailed roadmap for social policies toward gender equality and men’s greater participation in caregiving. By taking into account the current state-of-the-art of gender-based violence prevention and gender justice, this report focuses on concrete strategies for promoting gender equality in Europe and the engagement of men in caregiving and unpaid care work as a way to prevent gender-based violence and promote healthy and more equal gender relations

Evaluation matrix for health promotion programs in socially vulnerable territories

Submitted by Sandra Infurna ([email protected]) on 2018-02-06T12:19:01Z No. of bitstreams: 1 rosana_oliveira_etal_IOC_2017.pdf: 282384 bytes, checksum: 4210a6509559bf4bfc19fd1aea157067 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2018-02-06T12:24:28Z (GMT) No. of bitstreams: 1 rosana_oliveira_etal_IOC_2017.pdf: 282384 bytes, checksum: 4210a6509559bf4bfc19fd1aea157067 (MD5)Made available in DSpace on 2018-02-06T12:24:28Z (GMT). No. of bitstreams: 1 rosana_oliveira_etal_IOC_2017.pdf: 282384 bytes, checksum: 4210a6509559bf4bfc19fd1aea157067 (MD5) Previous issue date: 2017Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovações em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovações em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Inovações em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Assessoria de Planejamento Estratégico. Rio de Janeiro, RJ. Brasil.A promoção da saúde possui um conjunto de estratégias para trazer saúde e reduzir desigualdades. No entanto, tem sido um desafio avaliar a efetividade de programas de promoção de saúde. Este artigo apresenta o desenvolvimento e a aplicação de Matriz de Avaliação, construída por meio de indicadores quali-quantitativos e multidimensionais, que estão apoiados nas políticas públicas voltadas para territórios com vulnerabilidade social. Estudo transversal, com realização de programa de promoção da saúde e a finalidade de desenvolver uma Matriz de Avaliação, com possibilidade de aplicação em duas áreas de distinta vulnerabilidade socioambiental. A Matriz de Avaliação demonstrou ser de fácil aplicação e permitiu detectar os pontos fortes e fracos dos programas de promoção da saúde aplicados em diferentes territórios. Verificou-se que a adesão dos gestores, das equipes, da população e dos diversos setores da sociedade foram decisivos para o sucesso do programa. Adicionalmente, os agentes de saúde se destacaram como atores essenciais devido ao seu vínculo com a população. As contribuições incluem instrumento e metodologia para avaliar os programas de promoção da saúde, que podem ser aplicados em realidades distintas e modificados de acordo com o território.Health promotion has a set of strategies for advancing health and reducing inequalities. However, evaluating the effectiveness of health promotion programs has been a challenge. This paper shows the development and application of the Evaluation Matrix, constructed with qualitative-quantitative and multidimensional indicators supported by public policies targeting socially vulnerable territories. This is a cross-sectional study with the implementation of a health promotion program in order to develop an Evaluation Matrix to be applied in two distinct socio-environmentally vulnerable areas. The Evaluation Matrix proved to be easily applicable and enabled the detection of strengths and weaknesses of health promotion programs applied in different territories. The participation of managers, teams, population and multiple sectors of society was decisive for the success of the program. Furthermore, community health workers stood out as essential stakeholders due to their linkages with the population. Contributions include a tool and methodology for evaluating health promotion programs to be applied in different territories and modified according to the territory