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Comportamento Suicida na Infância: por que devemos pensar sobre isso?
No full textA prevenção do suicídio infantil ocorre através do reconhecimento de seus riscos pelos profissionais de saúde de todos os níveis. A Atenção Primária e as Emergências são, geralmente, a porta de entrada desses pacientes.FiocruzText
Por una estrategia de vacunación equitativa contra COVID-19 para la población privada de libertad
No full textTodos os autores contribuíram na redação e revisão do manuscrito. ORCID: Luciana Simas (0000-0003-2494-8747); Bernard Larouze (0000-0001-9906-6293); Vilma Diuana (0000-0002-7373-3446); Alexandra Sánchez (0000-0001-5617-1173).As pessoas privadas de liberdade (PPL) têm risco elevado de infecção pelo SARS-CoV-2, especialmente em países de baixa e média renda como o Brasil, onde mais de 700 mil PPL vivem, na maioria, em celas coletivas, insalubres, pouco ventiladas, superlotadas 1 e, não raro, com acesso limitado a água. Essas condições desumanas 2 não permitem respeitar as principais medidas preconizadas para prevenção da pandemia, quais sejam, distanciamento social e medidas de higiene individuais e coletivas 3. As máscaras faciais disponibilizadas em algumas prisões são utilizadas, na maioria das vezes, só para deslocamentos externos e raramente no interior das celas, onde a situação de aglomeração é permanente. O artigo explica que, como medidas de contenção da transmissão, foram interrompidas visitas, transferências entre unidades prisionais e atividades coletivas em escolas e oficinas e mesmo o banho de sol, que se tornou mais raro. Por outro lado, foram pouco aplicadas medidas desencarceradoras, recomendadas pelo Conselho Nacional de Justiça (CNJ), para reduzir a superlotação nas prisões por meio da liberdade provisória ou definitiva de PPL em final de cumprimento da pena ou em regime semiaberto, ou ainda prisão domiciliar para aqueles com maior risco de evolução grave ou fatal, sejam presos com comorbidades (grupos de risco), sejam presos idosos (1,26% [9.489] das PPL no Brasil tem mais de 60 anos). Em poucas locais, as PPL idosas foram isoladas em algumas prisões, para se beneficiarem de um acompanhamento médico reforçado. Dada a impossibilidade de aplicação efetiva às PPL de medidas de prevenção fundamentais, é possível inferir que a pandemia nas prisões não poderá ser contida, mesmo que de maneira parcial, sem vacinação. Como são cidadãs e cidadãos brasileiros, as PPL, vivendo sob a responsabilidade do Estado, devem se beneficiar das mesmas estratégias de prevenção, especialmente o acesso às vacinas, tal como a população livre. Como disse a ministra inglesa Lucy Frazer: “As pessoas privadas de liberdade serão vacinadas, assim como a comunidade, como devem ser”. Assim, as lógicas sanitárias e éticas deveriam prevalecer e, por seu alto risco de infecção, essa população deve ser incluída entre os grupos prioritários para vacinação contra a COVID-19
Evaluation of IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ cytokines in HIV/HHV-8 coinfection
No full textImbalance in the immune response is one of the main pathogenic mechanisms of diseases related with human immunodeficiency virus (HIV)/human gammaherpesvirus 8 (HHV-8) coinfection, such as Kaposi's sarcoma (KS), primary effusion lymphoma (PEL), multicentric Castleman disease (MCD) and the Kaposi's sarcoma-associated herpesvirus inflammatory cytokine syndrome (KICS). However, significant changes in pro- and anti-inflammatory cytokine levels may be observed in HIV/HHV-8 individuals who are negative for KS, PEL, MCD, and/or KICS. In this study, serum levels of interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor nucrosis factor α (TNF-α) and interferon γ (IFN-γ) were assessed in 69 HIV and 48 HIV/HHV-8 individuals, all negatives for HHV-8-related diseases. The cytokines were measured by flow cytometry and analyzed by the Mann-Whitney test. The p < .05 and 95% confidence interval were considered in all analyzes. IL-4 (p = .0155), IL-6 (p = .0036), and IL-10 (p = .0036) levels were significantly higher in HIV/HHV-8 patients than in the HIV group. On the other hand, IL-2 (p = .2295), TNF-α (p = .1216) and IFN-γ (p = .1178) did not differ between the groups analyzed. To our knowledge, to date, this is the first report on significant differences in the levels of IL-4 and IL-6 in HIV versus HIV/HHV-8 individuals. Finally, these early findings are important as a prognostic tool and contribute to clarifying the HHV-8-host interaction
Deforestation effects on Attalea palms and their resident Rhodnius, vectors of Chagas disease, in eastern Amazonia
No full textAttalea palms provide primary habitat to Rhodnius spp., vectors of Trypanosoma cruzi. Flying from palms, these blood-sucking bugs often invade houses and can infect people directly or via food contamination. Chagas disease (CD) risk may therefore increase when Attalea palms thrive near houses. For example, Attalea dominate many deforested landscapes of eastern Amazonia, where acute-CD outbreaks are disturbingly frequent. Despite this possible link between deforestation and CD risk, the population-level responses of Amazonian Attalea and their resident Rhodnius to anthropogenic landscape disturbance remain largely uncharted. We studied adult Attalea palms in old-growth forest (OGF), young secondary forest (YSF), and cattle pasture (CP) in two localities of eastern Amazonia. We recorded 1856 Attalea along 10 transects (153.6 ha), and detected infestation by Rhodnius spp. in 18 of 280 systematically-sampled palms (33 bugs caught). Distance-sampling models suggest that, relative to OGF, adult Attalea density declined by 70-80% in CP and then recovered in YSF. Site-occupancy models estimate a strong positive effect of deforestation on palm-infestation odds (βCP-infestation = 4.82±1.14 SE), with a moderate decline in recovering YSF (βYSF-infestation = 2.66±1.10 SE). Similarly, N-mixture models suggest that, relative to OGF, mean vector density sharply increased in CP palms (βCP-density = 3.20±0.62 SE) and then tapered in YSF (βYSF-density = 1.61±0.76 SE). Together, these results indicate that disturbed landscapes may support between ~2.5 (YSF) and ~5.1 (CP) times more Attalea-dwelling Rhodnius spp. per unit area than OGF. We provide evidence that deforestation may favor palm-dwelling CD vectors in eastern Amazonia. Importantly, our landscape-disturbance effect estimates explicitly take account of (i) imperfect palm and bug detection and (ii) the uncertainties about infestation and vector density arising from sparse bug data. These results suggest that incorporating landscape-disturbance metrics into the spatial stratification of transmission risk could help enhance CD surveillance and prevention in Amazonia
Coletivo em silêncio: el encuentro que crea un cuerpo político y produce vida
No full textPaula Gorini Oliveira da Universidade do Estado do Rio de Janeiro, do Centro de Educação e Humanidades, da Faculdade de Comunicação Social teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Feminismos: perspectivas em comunicação e informação em saúde, parte 1 v. 15 n.2 (2021)Este ensaio é um recorte de uma pesquisa mais ampla, a pesquisa de tese que observa a produção do corpo político como parte da manifestação das lutas contemporâneas. Nesse recorte, apresenta-se um relato de experiência, a partir de minha observação participante em um coletivo feminista de arte e educação, de luta antipunitivista e pelo desencarceramento – o Coletivo em Silêncio. A narrativa do trabalho apresenta também depoimentos, poesias e entrevistas concedidas à autora por mulheres atingidas pelo sistema prisional e de justiça, mulheres que foram historicamente e socialmente estigmatizadas como pessoas que não servem à sociedade e por isso podem ser descartadas. Este trabalho, que assume um caráter ensaístico, procura tornar evidentes estratégias de resistência através de práticas comunicativas e da expressão artística, e, por fim, criar espaço para que as falas dessas mulheres ressoem e possam ser escutadas.Fundação de Amparo à Pesquisa do Estado do Rio de JaneiroThis essay is an excerpt from a broader research, the thesis research that looks at the production of the political body as part of the manifestation of contemporary struggles. In this framework, a narrative of experiences is presented, based on my participant observation in a feminist collective of art and education, concerned with anti-punitive and de-incarceration agenda – Coletivo em Silêncio. The narrative also includes testimonies, poetry and interviews with women who were affected by the prison and justice system, women who were historically and socially stigmatized as people who don’t fit into the society and, therefore, can be discarded. This essay seeks to give visibility for practices of communication and artistic expression as strategies of resistance and, finally, set up spaces for those speeches to be resonated and heard.Este ensayo es un extracto de una investigación más amplia, la investigación de tesis que analiza la producción del cuerpo político como parte de la manifestación de las luchas contemporáneas. En esta sección se presenta un relato de experiencia, basado en la observación participante en un colectivo feminista de arte y educación, anti-punitivo y contra el encarcelamiento – Coletivo em Silêncio. La narrativa de esta obra también incluye testimonios, poesía y entrevistas dadas a la autora por mujeres afectadas por el sistema penitenciario y judicial, mujeres que fueron histórica y socialmente estigmatizadas como personas que no sirven a la sociedad y, por tanto, pueden ser descartadas. El trabajo, que asume un carácter ensayístico, busca evidenciar estrategias de resistencia a través de la comunicación y la expresión artística y, finalmente, criar espacios para que sus discursos resuenen y puedan ser escuchados
Outcome of SARS‑CoV‑2 infection in 121 patients with inborn errors of immunity: a cross‑sectional study
No full textPurpose: There is still scarce data on SARS-CoV-2 infection in patients with Inborn Errors of Immunity (IEI) and many unresolved questions. We aimed to describe the clinical outcome of SARS-CoV-2 infection in Brazilian IEI patients and identify factors influencing the infection. Methods: We did a cross-sectional, multicenter study that included patients of any age affected by IEI and SARS-CoV-2 infection. The variables studied were sex, age, type of IEI, comorbidities (number and type), treatment in use for IEI, clinical manifestations and severity of SARS-CoV-2 infection. Results: 121 patients were included: 55.4% female, ages from six months to 74 yo (median age = 25.1 yo). Most patients had predominantly antibody deficiency (n = 53). The infection was mostly asymptomatic (n = 21) and mild (n = 66), and one child had multisystem inflammatory syndrome (MIS-C). We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection. The number of comorbidities was higher in severe cases, particularly bronchiectasis and cardiopathy. There were no severe cases in hereditary angioedema patients. Six patients aged 2 to 74 years died, three of them with antibody deficiency. Conclusion: The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population. However, the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy)
Dried blood spot sampling as an alternative for the improvement of hepatitis B and C diagnosis in key populations
No full textBACKGROUND
To achieve the elimination of hepatitis B and C, there is an urgent need to develop alternative strategies to increase the access of diagnosis, particularly among key populations such as people living with human immunodeficiency virus (HIV), individuals with coagulopathies and chronic kidney disease (CKD) patients.
AIM
To evaluate the use of dried blood spot (DBS) in the detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers.
METHODS
A total of 430 individuals comprised of people living with HIV, coagulopathies and CKD provided paired serum and DBS samples. HBsAg, anti-HBc and anti-HCV were tested in those samples using a commercial electrochemiluminescence. Demographic and selected behavioral variables were evaluated to assess possible association with HBV and HCV positivity.
RESULTS
Using DBS, HBsAg prevalence varied from 3.9% to 22.1%, anti-HBc rates varied from 25.5% to 45.6% and anti-HCV positivity ranged from 15.9% to 41.2% in key populations. Specificities of HBV and HCV tests using DBS varied from 88.9% to 100%. The HBsAg assay demonstrated the best performance in CKD and coagulopathy individuals and the anti-HCV test had a sensitivity and specificity of 100% in people living with HIV. Accuracy of HBV and HCV detection in DBS varied from 90.2% to 100%. In the CKD group, HBsAg positivity was associated with infrequent use of condoms, and anti-HBc positivity was associated with sharing nail cutters/razors/toothbrushes. Anti-HCV reactivity was positively associated with a history of transplantation and length of time using hemodialysis in both specimens. In people living with HIV, only the male gender was associated with anti-HBc positivity in serum and DBS.
CONCLUSION
DBS with electrochemiluminescence are useful tools for the diagnosis and prevalence studies of hepatitis B and C among key populations and may increase the opportunity to foster prevention and treatment
Fragilidad entre ancianos y percepción de problemas en indicadores de atributos de la atención primaria en salud: resultados del ELSI-Brasil
No full textO presente trabalho objetivou examinar a associação entre a síndrome de fragilidade e a percepção de problemas em indicadores de atributos da atenção primária à saúde (APS) entre idosos brasileiros. É um estudo transversal envolvendo 5.432 participantes, com 60 anos ou mais, da primeira onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), realizado entre 2015 e 2016. A fragilidade, variável independente, foi definida com base no marco teórico do fenótipo de fragilidade, e os indicadores de problemas em atributos da APS, variáveis dependentes, foram obtidos baseando-se em perguntas relacionadas ao uso de serviços de saúde. Acesso, longitudinalidade, coordenação, integralidade, orientação familiar e adequação cultural foram os atributos avaliados. Utilizou-se modelos de regressão logística ajustados por fatores predisponentes, facilitadores e de necessidade de uso de serviços de saúde para a análise dos dados. Entre os participantes, 55,1% eram do sexo feminino, 57,9% tinham entre 60 e 69 anos e 51,8% referiram multimorbidade. Idosos frágeis e pré-frágeis representaram 13,4% e 54,5% da amostra, respectivamente. Resultados da análise multivariada mostraram que os idosos frágeis em comparação com os robustos apresentaram mais chances de apontar problemas de acesso (OR = 1,45; IC95%: 1,08-1,93), longitudinalidade (OR = 1,54; IC95%: 1,19-2,00) e integralidade (OR = 1,45; IC95%: 1,14-1,85), além de maior número de problemas em atributos da APS (OR = 1,38; IC95%: 1,05-1,82, para 5 ou mais). O estudo sugere a ocorrência de iniquidades na assistência prestada pela APS brasileira aos idosos frágeis, particularmente no âmbito dos atributos acesso, longitudinalidade e integralidade.This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness
TRIATODEX, an electronic identification key to the Triatominae (Hemiptera: Reduviidae), vectors of Chagas disease: Development, description, and performance
No full textCorrect identification of triatomine bugs is crucial for Chagas disease surveillance, yet available taxonomic keys are outdated, incomplete, or both. Here we present TriatoDex, an Android app-based pictorial, annotated, polytomous key to the Triatominae. TriatoDex was developed using Android Studio and tested by 27 Brazilian users. Each user received a box with pinned, number-labeled, adult triatomines (33 species in total) and was asked to identify each bug to the species level. We used generalized linear mixed models (with user- and species-ID random effects) and information-theoretic model evaluation/averaging to investigate TriatoDex performance. TriatoDex encompasses 79 questions and 554 images of the 150 triatomine-bug species described worldwide up to 2017. TriatoDex-based identification was correct in 78.9% of 824 tasks. TriatoDex performed better in the hands of trained taxonomists (93.3% vs. 72.7% correct identifications; model-averaged, adjusted odds ratio 5.96, 95% confidence interval [CI] 3.09–11.48). In contrast, user age, gender, primary job (including academic research/teaching or disease surveillance), workplace (including universities, a reference laboratory for triatomine-bug taxonomy, or disease-surveillance units), and basic training (from high school to biology) all had negligible effects on TriatoDex performance. Our analyses also suggest that, as TriatoDex results accrue to cover more taxa, they may help pinpoint triatomine-bug species that are consistently harder (than average) to identify. In a pilot comparison with a standard, printed key (370 tasks by seven users), TriatoDex performed similarly (84.5% correct assignments, CI 68.9–94.0%), but identification was 32.8% (CI 24.7–40.1%) faster on average–for a mean absolute saving of ~2.3 minutes per bug-identification task. TriatoDex holds much promise as a handy, flexible, and reliable tool for triatomine-bug identification; an updated iOS/Android version is under development. We expect that, with continuous refinement derived from evolving knowledge and user feedback, TriatoDex will substantially help strengthen both entomological surveillance and research on Chagas disease vectors