Saúde sexual e reprodutiva em penitenciária feminina, Espírito Santo, Brasil

OBJECTIVE: To describe the sociodemographic profile and health problems of inmates in a women's prison. METHODS: A descriptive study was conducted from March to September 1997 in a women's prison in the state of Espírito Santo, Brazil. All inmates were invited to participate in the study. A total of 121 women aged more than 18 years were interviewed. A structured questionnaire was used to collect data on sociodemographics, clinical and criminal past history. Following the interview, subjects underwent clinical and gynecological examination. RESULTS: Of 121 women included in the study, the mean age was 30.2 years (SD 8.98) and the mean of schooling was 4.8 years (SD 3.50). All participants reported previous sexual activity, the mean age of the first sexual intercourse was 15.2 years (SD 2.55) ranging from 9 to 27 years. Previous STDs were reported by 28%; 12 (9.9%) were pregnant at the time. Teenage pregnancy was often reported. Most women reported no use of either any contraceptive methods or condoms. Tubal ligation was seen in 19.8% and abnormal Pap smear in 26.9%. CONCLUSIONS: Knowledge about health problems inside the prison system can contribute to promoting and increasing social rehabilitation. However, effective results could be seen only with collaboration between public health authorities and the prison system.OBJETIVO: Identificar o perfil sociodemográfico e as condições de saúde das mulheres encarceradas em penitenciária feminina. MÉTODOS: Foi realizado estudo descritivo de março a setembro de 1997, em penitenciária feminina do Estado do Espírito Santo. Todas as presidiárias foram convidadas a participar da pesquisa. Participaram 121 mulheres com idade superior a 18 anos, avaliadas por meio de entrevista aplicada, explorando informações sociodemográficas, clínicas e criminais, registradas em questionário estruturado, seguida de exame clínico-ginecológico. RESULTADOS: Um total de 121 mulheres foram incluídas. A média de idade das participantes foi de 30,2 anos (DP 8,98) e de escolaridade, 4,8 anos (DP 3,50). Todas já haviam tido atividade sexual pregressa; a idade média do primeiro coito foi de 15,2 anos (DP 2,55), variando de nove a 27 anos; e 28% apresentavam história de doença sexualmente transmissível (DST). Doze (9,9%) mulheres estavam grávidas no momento da entrevista. História de gravidez na adolescência foi freqüente. A maioria não adotava nenhum método contraceptivo e nem fazia uso de preservativos. Laqueadura tubária foi observada em 19,8% e citologia cervical anormal em 26,9%. CONCLUSÕES: O conhecimento sobre problemas de saúde existentes dentro do sistema carcerário pode contribuir para fortalecer e ampliar o papel de reabilitação que lhe é conferido. Entretanto, somente a cooperação entre os órgãos de saúde pública e o sistema penitenciário pode produzir resultados eficientes

Perfil epidemiológico de adolescentes vivendo com HIV/AIDS no Espírito Santo, Brasil: um estudo transversal

Introduction: The AIDS epidemic has undergone several transformations, and, in recent years, there has been an increase in cases of HIV/AIDS among adolescents and young people. Thus, it is essential to know this population to base health actions scientifically. Objective: This study aims to analyze the epidemiological profile of adolescents living with HIV/AIDS in Espírito Santo, Brazil. Methods: A descriptive, sectional study in which notifications of HIV/AIDS among adolescents aged 13 to 19 between 2010 and 2020 were analyzed. Results: 523 adolescents with HIV/AIDS were found in the analyzed period (an average of 47 cases/year). There was a predominance of male adolescents (68.8%), older than 16 years (mean=18.0 years), of mixed race/colour (54.6%), living in the metropolitan region near the capital. It was observed that the schooling of females is lower, with 47.2% of them in elementary school, while 45.0% of the boys are in high school. In most cases, the infection occurred via sexual intercourse, among men, through homosexual relations (55.0%), and among women, through heterosexual relations (82.2%). The HIV viral load was detectable in almost all (84.8%) cases, and 11 (6.8%) of these adolescents died. Conclusion: The epidemiological profile of HIV and AIDS cases among adolescents in Espírito Santo shows a higher frequency of cases in males aged 16 to 19 years, with incomplete high school education, who acquired HIV through unprotected sex in homosexual relationships. We highlight the high percentage of young people with detectable viral loads and deaths due to complications of AIDS.Introdução: A epidemia da AIDS passou por diversas transformações e, nos últimos anos, observa-se aumento de casos de HIV/AIDS entre adolescentes e jovens. Assim, é fundamental conhecer essa população para embasar cientificamente as ações em saúde. Objetivo: analisar o perfil epidemiológico de adolescentes que vivem com HIV/AIDS no Estado do Espírito Santo, Brasil. Método: estudo descritivo, seccional, no qual foram analisadas notificações de HIV/AIDS entre adolescentes de 13 a 19 anos, entre 2010 e 2020. Resultados: foram encontrados 523 adolescentes vivendo com HIV/AIDS no período analisado (média de 47 casos/ano). Prevaleceu os adolescentes do sexo masculino (68,8%), com mais de 16 anos (média=18,0 anos), de raça/cor parda (54,6%), residentes na região metropolitana, próxima a capital. Foi observado que a escolaridade do sexo feminino é menor, estando 47,2% delas no ensino fundamental, enquanto 45,0% dos rapazes já estão no ensino médio. Em grande parte dos casos a infecção ocorreu via sexual, sendo, entre os homens, através de relações homossexuais (55,0%) e entre as mulheres por meio de relações heterossexuais (82,2%). A carga viral de HIV foi detectável em quase totalidade (84,8%) dos casos e 11 (6,8%) destes adolescentes evoluíram para óbito. Conclusão: O perfil epidemiológico dos casos de HIV e AIDS, entre os adolescentes, no Estado do Espírito Santo, demonstra maior frequência de casos no sexo masculino, na faixa etária de 16 a 19 anos, com ensino médio incompleto, que adquiriram HIV por via sexual desprotegida, em relações homossexuais. Destaca-se a alta porcentagem de jovens com carga viral detectável e os óbitos em decorrência de complicações da AIDS

Prevalência de HIV em gestantes e transmissão vertical segundo perfil socioeconômico, Vitória, ES

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseníasis. MÉTODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 años diagnosticados con hanseníasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyó 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificación operacional. Se usaron datos del Sistema de Información de Agravios de Notificación, Prontuarios y entrevistas. Se utilizó regresión logística condicional y abordaje jerárquico. RESULTADOS: Posterior al análisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con más de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clínica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapéutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, hábitos de vida, organización de los servicios de salud, formas clínicas y esquemas terapéuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, así como garantizar la regularidad del tratamiento.OBJETIVO: Descrever a prevalência de infecção por HIV em gestantes e a taxa de transmissão vertical, segundo o perfil socioeconômico dos bairros de residência das mães. MÉTODOS: Estudo ecológico exploratório utilizando a base de dados do Sistema de Informação de Agravos de Notificação de gestantes HIV-positivas e aids em crianças notificadas entre 2000 e 2006 em Vitória, ES. Para análise das informações socioeconômicas foi utilizado o Índice de Qualidade Urbana. A prevalência de HIV em gestantes e a taxa de transmissão vertical foram calculadas. A distribuição espacial dos casos foi realizada no programa Terraview 3.2.0. Para verificar a associação entre a qualidade urbana e a prevalência de HIV em gestantes utilizou-se o modelo de regressão de Poisson. RESULTADOS: Um total de 137 gestantes e 14 crianças infectadas por transmissão vertical foi notificado no período. Sete crianças correspondiam a mães HIV-positivas sem notificação de caso no período analisado. A prevalência de infecção em gestantes no período foi de 0,44% e a taxa de transmissão vertical foi de 9,7%. CONCLUSÕES: A prevalência de infecção por HIV em gestantes e a transmissão vertical associam-se à qualidade urbana do bairro de residência, indicando que os bairros com menor qualidade urbana devem ser priorizados quanto às ações para redução da transmissão vertical.OBJECTIVE: To describe HIV prevalence in pregnant women and the rate of vertical transmission according to socioeconomic status of residential neighborhoods. METHODS: Ecological exploratory study, which used the Information System of Notifiable Diseases database on HIV-positive pregnant women and AIDS in children, reported from 2000 to 2006, in Vitória, Southeastern Brazil. For analysis of socioeconomic data the Urban Quality Index was utilized The HIV prevalence rate in pregnant women and vertical transmission rate were calculated. Spatial distribution was carried out by Terraview 3.2.0. To verify the association between urban quality and HIV prevalence in pregnant women, Poisson regression was used. RESULTS: A total of 137 HIV-positive women and 14 children infected by vertical transmission was reported. Seven children matched to HIV-positive mothers without notification in the period analyzed. HIV prevalence among pregnant women in the period was 0.44%, and the vertical transmission rate was 9.7%. CONCLUSIONS: The prevalence of HIV infection among pregnant women and vertical transmission were associated with the urban quality of residential neighborhood. Neighborhoods with lower urban quality should be prioritized in actions to reduce vertical transmission

Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in TB-HIV co-infected patients in Brazil : a hierarchical polytomous analysis

Background: TB patients co-infected with HIV have worse treatment outcomes than non-coinfected patients. How clinical characteristics of TB and socioeconomic characteristics influence these outcomes is poorly understood. Here, we use polytomous regression analysis to identify clinical and epidemiological characteristics associated with unfavorable treatment outcomes among TB-HIV co-infected patients in Brazil. Methods: TB-HIV cases reported in the Brazilian information system (SINAN) between January 1, 2001 and December 31, 2011 were identified and categorized by TB treatment outcome (cure, default, death, and development of MDR TB). We modeled treatment outcome as a function of clinical characteristics of TB and patient socioeconomic characteristics by polytomous regression analysis. For each treatment outcome, we used cure as the reference outcome. Results: between 2001 and 2011, 990,017 cases of TB were reported in SINAN, of which 93,147 (9.4%) were HIV co-infected. Patients aged 15–19 (OR = 2.86; 95% CI: 2.09–3.91) and 20–39 years old (OR = 2.30; 95% CI: 1.81–2.92) were more likely to default on TB treatment than those aged 0–14 years old. In contrast, patients aged ≥60 years were more likely to die from TB (OR = 2.22; 95% CI: 1.43–3.44) or other causes (OR = 2.86; 95% CI: 2.14–3.83). Black patients were more likely to default on TB treatment (OR = 1.33; 95% CI: 1.22–1.44) and die from TB (OR = 1.50; 95% CI: 1.29–1.74). Finally, alcoholism was associated with all unfavorable outcomes: default (OR = 1.94; 95% CI: 1.73–2.17), death due to TB (OR = 1.46; 95% CI: 1.25–1.71), death due to other causes (OR = 1.38; 95% CI: 1.21–1.57) and MDR-TB (OR = 2.29; 95% CI: 1.46–3.58). Conclusions: socio-economic vulnerability has a significant effect on treatment outcomes among TB-HIV co-infected patients in Brazil. Enhancing social support, incorporation of alcohol abuse screening and counseling into current TB surveillance programs and targeting interventions to specific age groups are interventions that could improve treatment outcomes

Sentiment Analysis in Understanding the Potential of Online News in the Public Health Crisis Response

This study analyzes online news disseminated throughout the pre-, during-, and post-intervention periods of the "Syphilis No!" Project, which was developed in Brazil between November 2018 and March 2019. We investigated the influence of sentiment aspects of news to explore their possible relationships with syphilis testing data in response to the syphilis epidemic in Brazil. A dictionary-based technique (VADER) was chosen to perform sentiment analysis considering the Brazilian Portuguese language. Finally, the data collected were used in statistical tests to obtain other indicators, such as correlation and distribution analysis. Of the 627 news items, 198 (31.58%) were classified as a sentiment of security (TP2; stands for the news type 2), whereas 429 (68.42%) were classified as sentiments that instilled vulnerability (TP3; stands for the news type 3). The correlation between the number of syphilis tests and the number of news types TP2 and TP3 was verified from (i) 2015 to 2017 and (ii) 2018 to 2019. For the TP2 type news, in all periods, the p -values were greater than 0.05, thus generating inconclusive results. From 2015 to 2017, there was an ρ = 0.33 correlation between TP3 news and testing data (p -value = 0.04); the years 2018 and 2019 presented a ρ = 0.67 correlation between TP3 news and the number of syphilis tests performed per month, with p -value = 0.0003. In addition, Granger's test was performed between TP3 news and syphilis testing, which resulted in a p -value = 0.002, thus indicating the existence of Granger causality between these time series. By applying natural language processing to sentiment and informational content analysis of public health campaigns, it was found that the most substantial increase in testing was strongly related to attitude-inducing content (TP3)

Prevalencia de sífilis y características del comportamiento de los jóvenes indígenas del Paraguay, 2016

El objetivo fue determinar la prevalencia de sífilis y características de comportamiento de los jóvenes indígenas del Paraguay en el 2016. Se realizó un estudio observacional, descriptivo de corte transversal con muestro probabilístico estratificado bietapico, que incluyó a jóvenes indígenas de 15 a 18 años de cinco familias lingüísticas de Paraguay. Se utilizó un cuestionario estructurado y para el tamizaje de sífilis se utilizó una test rápido treponémico y para confirmar los resultados reactivos se realizó VDRL, considerando como resultado positivo si el test rápido era positivo + VDRL positivo a una dilución de 1:4 o mayor y si la VDRL era menor a 1:4 con TPHA positivo. Los resultados se expresan como medidas de tendencia central, dispersión y proporciones. Ingresaron al estudio 546 jóvenes de 15 a 18 años, el 67,03% era del sexo femenino. Se identificaron 36 casos de sífilis, que representa una prevalencia de 6,6% [IC95%: 4,7-9,0]. Mayor prevalencia de sífilis se observó en los jóvenes que consumieron alcohol en la última relación sexual 20,6% (14/68) (p<0,001), sexo transaccional 40% (2/5) (p=0,010) y no utilización de condón 20,6% (14/68) (p<0,001). Se encontró una alta prevalencia de sífilis en la población juvenil indígena, relacionada al consumo de alcohol en la última relación, práctica de sexo transaccional y no utilización de preservativos. Se recomienda la implementación de estrategias específicas con abordaje intercultural apropiadas para una población joven, orientadas a disminuir las prácticas de riesgo y promocionar la utilización de preservativos

Enhancing interventions for prevention-of-mother-to-child- transmission (PMTCT) of hepatitis B virus (HBV)

Prevention of mother to child transmission (PMTCT) of hepatitis B virus (HBV) infection is a cornerstone of interventions to support progress towards elimination goals for viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth-dose vaccine, and post-exposure prophylaxis with hepatitis B immunoglobulin (HBIG) for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which PMTCT implementation can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits

The fight against sexually transmitted infections cannot stop in the COVID-19 era: a brazilian experience in online training for sexually transmitted infections guidelines

Introduction: The Brazilian Ministry of Health had planned face-to-face workshops for professional training about the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections for the year 2020. Due to the COVID-19 pandemic, the workshops were cancelled, and a new strategy was adopted: virtual meetings, called Webinars—Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections 2020. Objective: To report the experience at the Ministry of Health in online training about the clinical protocol and therapeutic guidelines for comprehensive care for people sexually transmitted infections for health professionals in 2020. Methods: The webinars were held in partnership with the Brazilian Society of Sexually Transmitted Diseases and the Pan American Health Organization. Each chapter of the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections—2020 was converted into a webinar, with the participation of at least three experts, two speakers, and a moderator. Results: In total, 16 webinars were presented, covering topics such as sexually transmitted infections surveillance, prevention, diagnosis, treatment, public policies, and sexual violence. The initiative had more than 77,000 hits, with an average of 4,900 hits per webinar and the topic “syphilis” being the most accessed. The event reached all 27 federative units of Brazil, as well as 27 other countries. About 500 questions were received from the audience and answered during the sessions and/or through a document published later on by the Ministry of Health. Conclusion: Given the high number of hits and inquiries received, we can conclude that health professionals remained engaged in the topic of sexually transmitted infections during the pandemic. This experience shows the great potential of innovative methods for distance learning to promote continuing education, including a series of webinars aimed at strengthening the fight against sexually transmitted infections.