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Introduction: Globally, depression rates are high among men who have sex with men (MSM). Multiple factors may interact synergistically to increase this risk. This analysis assessed the prevalence of symptoms of depression among MSM in Brazil and synergistic effects of several factors. Methods: Cross-sectional study conducted in 12 cities using respondent-driven sampling. Sociodemographic and behavioral characteristics were collected. The PHQ-9 was used to screen for depression. Having moderate-severe depressive symptoms was compared to none-mild using logistic regression. The syndemic factor was a composite of hazardous alcohol use, sexual violence, and discrimination due to sexual orientation. Those with one to three of these factors were compared to those with none. Results: The weighted prevalence of moderate-severe depressive symptoms was 24.9% (95%CI = 21.8-28.8) and 16.2%, 22.9%, 46.0% and 51.0% when none, one, two, or three syndemic factors were present, respectively, indicating a dose-response effect. Perception of HIV risk, high level of HIV knowledge, known HIV infection, and health self-rated as poor or very poor were also associated with depressive symptoms. Conclusion: The prevalence of moderate-severe depressive symptoms among MSM in Brazil is high, and selected factors act synergistically in increasing their prevalence. Public health policies should consider holistic depression prevention and treatment interventions for this population.

Resumo O presente texto trata de refletir sobre a campanha de vacinação contra COVID-19 no Brasil à luz da consideração das evidências científicas no processo de tomada de decisão. O Brasil possui um dos maiores e mais completos programas de vacinação do mundo, o Programa Nacional de Imunizações (PNI). Infelizmente, no contexto atual, com as interferências políticas do governo federal, o PNI perdeu seu protagonismo na condução da campanha de vacinação contra a COVID-19. Apesar de ser uma campanha de vacinação com muito potencial e uma das mais aceitas pela população entre os países no mundo, apresentou muitos problemas e deixou diversas lacunas no cenário brasileiro. Nesse sentido, é fundamental que as evidências científicas de qualidade produzidas nesse período possam guiar uma remodelagem constante da estratégia de vacinação. Quatro pontos merecem ser destacados: 1) o intervalo entre as doses; 2) a intercambialidade entre vacinas; 3) a vacinação em adolescentes; e 4) a necessidade de melhores evidências para definir a estratégia de vacinação em certos grupos e faixas etárias. Abstract This paper reflects on the vaccination campaign against COVID-19 in Brazil in light of the consideration of scientific evidence in the decision-making process. Brazil has one of the largest and most complete vaccination programs in the world, the National Immunization Program (Programa Nacional de Imunizações or PNI). Unfortunately, in the current context, with the political interference of the federal government, the PNI lost its role in conducting the vaccination campaign against COVID-19. Despite being a vaccination campaign with a lot of potential and one of the most accepted by the population among countries in the world, it presented many problems and left several gaps in the Brazilian scenario. In this sense, it is essential that the quality scientific evidence produced during this period can guide a constant remodeling of the vaccination strategy. Four points deserve to be highlighted: 1) the interval between doses; 2) the interchangeability between vaccines; 3) vaccination in children and adolescentes; and 4) the need for better evidence to define the vaccination strategy in certain groups and age groups.

Resumo Objetivo Analisar a associação entre as desigualdades sociais e sanitárias, condições socioeconômicas, segregação espacial e letalidade por COVID-19 em Fortaleza, Ceará, Brasil. Métodos Estudo ecológico de casos confirmados e óbitos por COVID-19, tendo como unidades de análise os 119 bairros de Fortaleza. Calcularam-se os indicadores de incidência, mortalidade e letalidade aparente por COVID-19, entre 1º de janeiro e 8 de junho de 2020. Indicadores socioeconômicos foram extraídos do Censo Demográfico do Brasil de 2010. Foi realizada análise espacial e calculados índice global e local de Moran. Resultados Foram encontrados 22.830 casos confirmados, 2.333 óbitos e uma letalidade aparente de 12,7% (IC95% 11,6;13,9). Observaram--se autocorrelações espaciais significativas para letalidade aparente (I=0,35) e extrema pobreza (I=0,51), sobrepostas em diversos bairros da cidade. Conclusão A letalidade aparente por COVID-19 está associada a piores condições socioeconômicas e de saúde, demonstrando a relação entre desigualdades sociais e desfechos de saúde em tempos de pandemia. Resumen Objetivo Analizar la asociación entre las desigualdades sociales y sanitarias, condiciones socioeconómicas, segregación espacial y letalidad por COVID-19 en Fortaleza, Ceará, Brasil. Métodos Estudio ecológico de casos y defunciones confirmadas por COVID-19, se utilizaron, como unidades de análisis, 119 barrios de Fortaleza. Se calcularon los indicadores de incidencia, mortalidad y letalidad aparente por COVID-19, entre el 1 de enero y el 8 de junio de 2020. Los indicadores socioeconómicos se extrajeron del Censo Demográfico de Brasil 2010. Se realizó un análisis espacial y calculados los índices Global y Local de Moran. Resultados Se encontraron 22.830 casos confirmados, 2.333 muertes y una letalidad aparente de 12,7 (IC95% 11,6;13,9). Se observaron autocorrelaciones espaciales significativas para letalidad aparente (I=0,35) y extrema pobreza (I=0,51) que se sobreponen en diversos barrios de la ciudad. Conclusión La letalidad por COVID-19 está asociada con peores condiciones socioeconómicas y sanitárias, demostrando la relación entre desigualdades sociales y los resultados de salud en tiempos de pandemia. Abstract Objective To analyze the association among social and health inequalities, socioeconomic status, spatial segregation and Case Fatality Rate (CFR) due to COVID-19 in Fortaleza, the state capital of Ceará, Brazil. Methods This was an ecological study of confirmed cases and deaths due to COVID-19. The 119 neighborhoods of Fortaleza were used as units of analysis. Incidence, mortality and apparent CFR indicators due to COVID-19 were calculated between January 1 and June 8, 2020. Socioeconomic indicators were obtained from the 2010 Brazilian Demographic Census. Spatial analysis was performed and local and global Moran's indexes were calculated. Results There were 22,830 confirmed cases, 2,333 deaths and the apparent CFR was 12.7% (95% CI 11.6;13.9). Significant spatial autocorrelations between apparent CFR (I=0.35) and extreme poverty (I=0.51), overlapping in several neighborhoods of the city, were found. Conclusion The apparent CFR due to COVID-19 is associated with the worst socioeconomic and health status, which shows the relationship between social inequalities and health outcomes in times of pandemic.

OBJECTIVE To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals—some at explosive speed—especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners. RESUMO OBJETIVO Analisar a epidemia da covid-19 na região Nordeste do Brasil, uma das mais atingidas por essa virose. MÉTODOS Os dados oficiais para covid-19 dos estados do Nordeste são referentes ao período de março de 2020 a março de 2021. A análise para capitais e estados da série do acumulado semanal de casos e de óbitos confirmados foi feita com emprego do aplicativo JoinPoint Trend Analysis. RESULTADOS Em um ano, o Nordeste acumulou 22,9% dos casos e 21,5% dos óbitos do país pela covid-19. No início da pandemia, todos os estados apresentaram um crescimento sustentável de casos, primeiro nas capitais e depois interior. Em seguida, observam-se decréscimos em todos os estados e suas capitais, porém muitos permanecem com números elevados. Em meados do segundo semestre de 2020, o número de casos começa a crescer nos estados e suas capitais, alguns em velocidade explosiva, em especial no final de 2020 e início de 2021. Padrão similar é observado para os óbitos, os quais ultrapassaram ou aproximam-se do teto observado na primeira onda, na qual todas as capitais e estados do Nordeste adotaram intensas medidas de isolamento. Fortaleza, Recife e Teresina atingiram os maiores índices de isolamento de todas as capitais, perto de 0,60. Esse índice decresce, com tendência leve de crescimento até final de dezembro, voltando a decrescer. Com exceção de Fortaleza e Salvador, as demais capitais caíram para menos de 0,40. CONCLUSÃO O Nordeste brasileiro e o país estão em uma situação sanitária, social e econômica cada vez mais complexa. É necessário acelerar o processo de vacinação e manter as medidas não farmacológicas – constante uso de máscaras faciais, medidas de distanciamento e cuidados de higiene –, além de políticas de proteção aos trabalhadores que perderam as suas rendas e subsídios aos pequenos empresários.

Additional file 1. Complete data collection instrument.

Objectives: To estimate hypertension prevalence and associated factors among fe male correctional officers (FCO) in female Brazilian prisons. Methods: Cross-sectional, analytical study conducted in 15 female prisons in all five Brazilian regions between January 2014 and December 2015. The study population consisted of correctional officers with at least 6 months in the position. The sam pling included 40% of FCO present in the prison during data collection, yielding 295 FCOs. Data were collected via Audio Computer-Assisted Self-Interview. A physical examination of participants was conducted including blood pressure, weight, and waist and hip circumference. The Odds Ratio and confidence intervals for independ ent factors were estimated. Results: Hypertension prevalence in correctional officers was 37.9%, (95% CI 32.1- 44.0). Hypertension was associated with obesity (95% CI = 1.884-9.947), cardio vascular disease (95% CI = 3.348-16.724), and participation in the specific training course for the relevant position (95% CI = 1.413-9.564). Conclusions: While findings, except for the last factor, are not novel, this is the first such study conducted in Brazil. Hypertension prevalence among this pool of all female correctional officers is higher than in the average population, and FCOs associate this with the prison environment. Current training does not appear to ad dress this problem. Especially since prison populations are growing in Brazil, this problem needs to be addressed for the health of the FCOs and the prisoners in their care.

Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, of the Secretariat for Health Surveillance of the Brazilian Ministry of Health Universidade Federal de S?o Jo?o del-Rei. Divinopolis, MG, Brazil. Universidade Federal de Minas Gerais. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brazil. Fundacao Oswaldo Cruz. Instituto Aggeu Magalhaes. Recife, PE, Brazil. Universidade Federal da Bahia. Instituto de Sa?de Coletiva. Salvador, BA, Brasil. Faculdade de Ci?ncias Medicas Santa Casa de S?o Paulo. S?o Paulo, SP, Brazil. Tulane University. School of Public Health and Tropical Medicine. New Orleans, LA, USA / Universidade Federal do Ceara. Dept Community Hlth. Fortaleza, CE, Brazil. Universidade Federal do Ceara. Dept Community Hlth. Fortaleza, CE, Brazil. Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil. Funda??o Alfredo Mata. Manaus, AM, Brazil. Funda??o Oswaldo Cruz. Recife, PE, Brazil. Funda??o Oswaldo Cruz. Recife, PE, Brazil. Funda??o Oswaldo Cruz. Campo Grande, MS, Brazil / Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brazil. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil. Universidade de Brasilia. Brasilia, DF, Brazil. Universidade de Brasilia. Brasilia, DF, Brazil. Faculdade de Ci?ncias Medicas Santa Casa de S?o Paulo. S?o Paulo, SP, Brazil. Universidade Federal da Bahia. Salvador, BA, Brasil. Universidade Federal do Ceara. Project PI. Fortaleza, CE, Brazil. Centro Universit?rio Aut?nomo do Brasil. Curitiba, PR, Brazil. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brazil. Universidade Federal do Ceara. Fortaleza, CE, Brazil. Universidade Federal do Ceara. Fortaleza, CE, Brazil. Secretaria Sa?de Cear?. Fortaleza, CE, Brazil. Tulane University. New Orleans, LA, USA / Universidade Federal do Ceara. Fortaleza, CE, Brazil. University of California San Francisco. San Francisco, CA, USA. University of California San Francisco. San Francisco, CA, USA. Minist?rio da Sa?de. Departamento de Vigil?ncia, Preven??o e Controle das IST, do HIV/Aids e das Hepatites Virais. Brasilia, DF, Brazil. Minist?rio da Sa?de. Departamento de Vigil?ncia, Preven??o e Controle das IST, do HIV/Aids e das Hepatites Virais. Brasilia, DF, Brazil. Minist?rio da Sa?de. Departamento de Vigil?ncia, Preven??o e Controle das IST, do HIV/Aids e das Hepatites Virais. Brasilia, DF, Brazil. Universidade do Estado Bahia. Departamento de Ci?ncias da Vida. Salvador, BA, Brazil. 16IEC The aim of this study was to estimate the prevalence and factors associated with unprotected receptive anal intercourse (URAI), stratified by age (18-24 or 25 + years old), in a sample of 4,129 MSM recruited by respondent driven sampling in 12 Brazilian cities in 2016. The prevalence of URAI was higher among younger MSM (41.9% vs 29.7%) (p < 0.01). Multivariate analysis indicated that perception of risk, sexual identity, self-rated health status, and having commercial sex were associated with URAI among younger MSM. History of sexual violence, sex with younger partners, having 6 + partners and unprotected sexual debut were associated with URAI among older MSM. Marital status, having stable partner, and reporting sex with men only were associated with URAI in both groups. Despite access to condoms and lubricants, preventive efforts may not be reaching MSM effectively. Age specific intervention approaches, including stigma, discrimination, and perception of risk must be considered.

Introduction: High level of HIV/AIDS knowledge is required for an effective adoption of preventive strategies. Objective: To assess HIV/AIDS knowledge among men who have sex with men (MSM) in 12 Brazilian cities. Methods: Respondent-Driven Sampling method was used for recruitment. HIV/AIDS knowledge was assessed by Item Response Theory. Difficulty and discrimination parameters were estimated, and the knowledge score was categorized in three levels: high, medium, and low. Logistic regression was used for analysis. Results: Among 4,176 MSM, the proportion of high level of knowledge was 23.7%. The following variables were positively associated with high knowledge (p < 0.05): age 25+ years old, 12+ years of schooling, white skin color, having health insurance, having suffered discrimination due to sexual orientation, having had a syphilis test, and having received educational material in the previous 12 months. Exchanging sex for money was negatively associated. Conclusions: The proportion of only 23.7% of high HIV/AIDS knowledge was low. We should note that the only potential source of knowledge acquisition associated with high level of knowledge was receiving educational materials. Our study indicates the need for expansion of public prevention policies focused on MSM and with more effective communication strategies, including the development of knowledge that involves motivation and abilities for a safer behavior. Introdução: Alto nível de conhecimento sobre HIV/aids é necessário para uma efetiva adoção de estratégias preventivas. Objetivo: Avaliar o nível de conhecimento sobre HIV/aids entre homens que fazem sexo com homens (HSH) de 12 cidades brasileiras. Metodologia: O método Respondent-Driven Sampling foi utilizado para recrutamento. O conhecimento sobre HIV/aids foi avaliado por meio de 12 perguntas e analisados pela Teoria de Resposta ao Item. Foram estimados os parâmetros de dificuldade e discriminação e o escore de conhecimento categorizado em três níveis: alto, médio e baixo. Regressão logística foi utilizada para a análise. Resultados: Do total de 4.176 HSH, a proporção de alto nível de conhecimento foi de 23,7%. Estiveram associados positivamente (p < 0,05) com o alto conhecimento: idade 25+ anos, escolaridade 12+ anos, cor da pele branca, ter plano de saúde, ter sofrido discriminação devido à orientação sexual, ter realizado teste para sífilis e recebido material educativo nos últimos 12 meses. Ter recebido dinheiro por sexo esteve negativamente associado. Conclusões: A proporção de apenas 23,7% de alto nível de conhecimento sobre HIV/ aids foi baixa. Destaca-se que a única potencial fonte formal de aquisição de conhecimento associada com alto nível de conhecimento foi receber material educativo. Este estudo aponta a necessidade de expandir as políticas públicas de prevenção focadas no segmento HSH e com estratégias de comunicação mais eficazes, incluindo o desenvolvimento de conhecimento que envolva motivação e habilidade para um comportamento mais seguro.

Introdução: A discriminação por orientação sexual (DPOS) pode influenciar a vulnerabilidade ao HIV aumentando a exposição a comportamentos sexuais de risco entre homens que fazem sexo com homens (HSH). Objetivos: Examinar dados utilizando a análise de classes latentes (ACL) para identificar grupos de indivíduos com padrões específicos de DPOS. Métodos: Estudo transversal com entrevistados recrutados pelo processo amostral respondent driven sampling em 12 cidades brasileiras em 2016. A ACL foi usada para caracterizar o DPOS entre HSH com base em 13 variáveis do bloco de discriminação do questionário da pesquisa. As proporções de DPOS e das variáveis de interesse, bem como seus intervalos de confiança (95%) foram ponderados usando o estimador de Gile. Resultados: A maioria era de jovens, solteiros, com alguma religião, escolaridade média ou superior, cor da pele preta ou parda e com nível socioeconômico médio. Mais da metade referiu ter sido discriminado nos últimos 12 meses por sua orientação sexual (65%), mais de um terço referiu ter tido medo de andar em lugares públicos nos últimos 12 meses e em torno de um quinto dos participantes reportaram ter sofrido agressão física ou sexual na vida. A DPOS foi classificada em 4 classes latentes, “muito alta”, “alta”, “média” e “baixa”, com estimativas de 2,2%, 16,4%, 35,1% e 46,19%, respectivamente. Conclusão: Observou-se alta proporção de discriminação entre os HSH participantes deste estudo. A utilização da ACL discriminou de maneira parcimoniosa as classes de DPOS. Introduction: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). Objectives: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). Methods: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile’s Successive Sampling estimator. Results: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: “very high”, “high”, “moderate” and “low”, with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. Conclusion: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.

Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile’s successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS). Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy. A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities. A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7–20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4–21.7) were seropositive. HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0–14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-05-26T17:49:04Z No. of bitstreams: 1 Ines Dourado 3. 2016.pdf: 277312 bytes, checksum: ea4d3b8eab90f5797178f0722643e857 (MD5) Made available in DSpace on 2017-05-26T17:49:04Z (GMT). No. of bitstreams: 1 Ines Dourado 3. 2016.pdf: 277312 bytes, checksum: ea4d3b8eab90f5797178f0722643e857 (MD5) Diante das evidências de que os homens que fazem sexo com homens são afetados de forma desproporcional pelas infecções por HIV, investigamos os fatores de risco sociodemográficos, biológicos e de comportamentos sexuais associados à infecção por HIV, na cidade de Salvador, Bahia. Este trabalho é um recorte da pesquisa nacional "Comportamento, atitudes, práticas e prevalência de HIV e Sífilis entre homens que fazem sexo com homens em 10 cidades brasileiras", que foi do tipo corte transversal e selecionou participantes via técnica Respondent Driven Sampling . Devido à prevalência do HIV ser menor do que 10% e ao reduzido tamanho da amostra (383), utilizamos regressão logística exata nas análises para medir associação entre os fatores de risco e a infecção por HIV. A prevalência do HIV foi de 6,3% (IC95% 3,9 - 8,8), e após o ajuste do modelo final, os fatores de vulnerabilidade que se associaram à infecção por HIV foram: não fez teste de sífilis na vida (OR = 3,1: IC95% 1,3 - 7,3), ter mais de 8 parceiros sexuais (OR = 3,3; IC95% 1,4 - 8,1). Este estudo mostrou a alta prevalência do HIV na amostra, em comparação a população geral, bem como confirmou a importância da realização do teste de sífilis na vida no contexto da epidemia do HIV, sendo que essa detecção precoce permite uma aproximação das ações de prevenção para DST. São Paulo

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-05-26T18:56:32Z No. of bitstreams: 1 Ines Dourado 5. 2016.pdf: 76222 bytes, checksum: 5f2edc948cc28b0c8bf900f033da812c (MD5) Made available in DSpace on 2017-05-26T18:56:32Z (GMT). No. of bitstreams: 1 Ines Dourado 5. 2016.pdf: 76222 bytes, checksum: 5f2edc948cc28b0c8bf900f033da812c (MD5) Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic. Francisco Inácio Bastos Inês Dourado10

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-05-02T20:16:35Z No. of bitstreams: 1 artigo 26. 2016.pdf: 151225 bytes, checksum: d9a98b86d845ce6c087b08e1d2023164 (MD5) Made available in DSpace on 2017-05-02T20:16:35Z (GMT). No. of bitstreams: 1 artigo 26. 2016.pdf: 151225 bytes, checksum: d9a98b86d845ce6c087b08e1d2023164 (MD5) This study aimed to identify incentives and barriers to HIV testing in men who have sex with men (MSM). This was a cross-sectional study of MSM who had lived at least three months in greater metropolitan Fortaleza, Ceará State, Brazil, 2010. The study recruited 391 men ≥ 18 years of age who reported sexual relations with men in the previous six months, using Respondent Driven Sampling. Personal network and socio-demographic data were collected and HIV testing was offered, analyzed with RDSAT 6.0 and Stata 11.0. The majority were young (40.3%), had 5 to 11 years of schooling (57.3%), were single (85.1%), had low income (37.6%), and 58.1% had tested for HIV some time in life. Incentive to test: certainty of not being infected (34.1%) and the exposure to national campaign Fique Sabendo [Know your Status] (34%). Barriers: trust in partner(s) (21%) and fear of discrimination if tested positive (20.3%). Policies should be developed to ensure test confidentiality and communication campaigns focusing on information gaps and encouragement for testing. Rio de Janeiro

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-05-02T20:16:35Z No. of bitstreams: 1 artigo 26. 2016.pdf: 151225 bytes, checksum: d9a98b86d845ce6c087b08e1d2023164 (MD5) Made available in DSpace on 2017-05-02T20:16:35Z (GMT). No. of bitstreams: 1 artigo 26. 2016.pdf: 151225 bytes, checksum: d9a98b86d845ce6c087b08e1d2023164 (MD5) This study aimed to identify incentives and barriers to HIV testing in men who have sex with men (MSM). This was a cross-sectional study of MSM who had lived at least three months in greater metropolitan Fortaleza, Ceará State, Brazil, 2010. The study recruited 391 men ≥ 18 years of age who reported sexual relations with men in the previous six months, using Respondent Driven Sampling. Personal network and socio-demographic data were collected and HIV testing was offered, analyzed with RDSAT 6.0 and Stata 11.0. The majority were young (40.3%), had 5 to 11 years of schooling (57.3%), were single (85.1%), had low income (37.6%), and 58.1% had tested for HIV some time in life. Incentive to test: certainty of not being infected (34.1%) and the exposure to national campaign Fique Sabendo [Know your Status] (34%). Barriers: trust in partner(s) (21%) and fear of discrimination if tested positive (20.3%). Policies should be developed to ensure test confidentiality and communication campaigns focusing on information gaps and encouragement for testing. Rio de Janeiro

Mycobacterium leprae bacilli are mainly transmitted by the dissemination of nasal aerosols from multibacillary (MB) patients to susceptible individuals through inhalation. The upper respiratory tract represents the main entry and exit routes of M. leprae. Therefore, this study aimed to evaluate the sensitivity and specificity of real-time quantitative polymerase chain reaction (qPCR) in detecting M. leprae in nasal secretion (NS) and skin biopsy (SB) samples from MB and paucibacillary (PB) cases. Fifty-four NS samples were obtained from leprosy patients at the Dona Libânia National Reference Centre for Sanitary Dermatology in Ceará, Brazil. Among them, 19 MB cases provided both NS and SB samples. Bacilloscopy index assays were conducted and qPCR amplification was performed using specific primers for M. leprae 16S rRNA gene, generating a 124-bp fragment. Primer specificity was verified by determining the amplicon melting temperature (Tm = 79.5 °C) and detection limit of qPCR was 20 fg of M. leprae DNA. Results were positive for 89.7 and 73.3% of NS samples from MB and PB cases, respectively. SB samples from MB patients were 100% positive. The number of bacilli detected in NS samples were 1.39 × 103–8.02 × 105, and in SB samples from MB patients were 1.87 × 103–1.50 × 106. Therefore, qPCR assays using SYBR Green targeting M. leprae 16S rRNA region can be employed in detecting M. leprae in nasal swabs from leprosy patients, validating this method for epidemiological studies aiming to identify healthy carriers among household contacts or within populations of an endemic area.

Multilingual abstracts in the six official working languages of the United Nations. (PDF 697 kb)

Receiver Operating Curves (ROC) for ML Flow test in leprosy patients who developed RR, ENL and reaction-free. (DOC 715 kb)

Positivity to ML Flow test according to bacillary index (BI) and type of reaction. (DOC 43 kb)

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-05-12T19:50:46Z No. of bitstreams: 1 Art Per estrang. Mauricio L Barreto4. 2015.pdf: 275416 bytes, checksum: 8158d74f8ce46b38914f3852e027caab (MD5) Made available in DSpace on 2016-05-12T19:50:46Z (GMT). No. of bitstreams: 1 Art Per estrang. Mauricio L Barreto4. 2015.pdf: 275416 bytes, checksum: 8158d74f8ce46b38914f3852e027caab (MD5) Previous issue date: 2015-12 Several factors suggest that armadillos present an important risk for human leprosy infection. This study uses semi-structured interviews to better illustrate how human interaction with armadillos may increase the risk of leprosy transmission. The participants were all residents of the state of Ceará, in northeastern Brazil, all acknowledged contact with armadillos either through hunting, through cooking, or through consumption of its meat. This study raises important issues about contact between human beings and armadillos. The interviews provide evidence of numerous situations in which leprosy transmission via the armadillo is possible. At a minimum, people who hunt armadillos need to be made aware of the risk of infection. Basel

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-05-12T19:50:46Z No. of bitstreams: 1 Art Per estrang. Mauricio L Barreto4. 2015.pdf: 275416 bytes, checksum: 8158d74f8ce46b38914f3852e027caab (MD5) Made available in DSpace on 2016-05-12T19:50:46Z (GMT). No. of bitstreams: 1 Art Per estrang. Mauricio L Barreto4. 2015.pdf: 275416 bytes, checksum: 8158d74f8ce46b38914f3852e027caab (MD5) Previous issue date: 2015-12 Several factors suggest that armadillos present an important risk for human leprosy infection. This study uses semi-structured interviews to better illustrate how human interaction with armadillos may increase the risk of leprosy transmission. The participants were all residents of the state of Ceará, in northeastern Brazil, all acknowledged contact with armadillos either through hunting, through cooking, or through consumption of its meat. This study raises important issues about contact between human beings and armadillos. The interviews provide evidence of numerous situations in which leprosy transmission via the armadillo is possible. At a minimum, people who hunt armadillos need to be made aware of the risk of infection. Basel

OBJECTIVE To analyze if the distribution of specialized care services for HIV/AIDS is associated with AIDS rates. METHODS Ecological study, for which the distribution of 10 specialized care services in the Ceara state, Northeastern Brazil, was obtained, and the mean rates of the disease were estimated per mesoregion. We evaluated 7,896 individuals who had been diagnosed with AIDS, were aged 13 years or older, lived in Ceara, and had been informed of their condition between 2001 and 2011. Maps were constructed to verify the relationship between the distribution of AIDS cases and institutionalized support networks in the 2001-2006 and 2007-2011 periods. BoxMap and LisaMap were used for data analysis. The Voronoi diagram was applied for the distribution of the studied services. RESULTS Specialized care services concentrated in AIDS clusters in the metropolitan area. The Noroeste Cearense and west of the Sertoes Cearenses had high AIDS rates, but a low number of specialized care services over time. Two of these services were implemented where clusters of the disease exist in the second period. The application of the Voronoi diagram showed that the specialized care services located outside the metropolitan area covered a large territory. We identified one polygon that had no services. CONCLUSIONS The scenario of AIDS cases spread away from major urban areas demands the creation of social support services in areas other than the capital and the metropolitan area of the state; this can reduce access barriers to these institutions. It is necessary to create specialized care services for HIV/AIDS in the Noroeste Cearense and north of Jaguaribe. OBJETIVO Analisar se a distribuição dos serviços de assistência especializada em HIV/aids está associada às taxas de aids. MÉTODOS Estudo ecológico, pelo qual foi obtida a distribuição de 10 serviços de assistência especializada em HIV/aids, no estado do Ceará. As taxas médias da doença foram calculadas por mesorregião. Estudaram-se 7.896 indivíduos notificados com aids, com idade igual ou superior a 13 anos, residentes no Ceará, no período de 2001 a 2011. Construíram-se mapas para verificar relação entre distribuição dos casos de aids e das redes institucionalizadas de apoio nos períodos de 2001 a 2006 e 2007 a 2011. Utilizou-se BoxMap e LisaMap para análise dos dados. Aplicou-se o diagrama de Voronoi para os serviços estudados. RESULTADOS Verificou-se concentração dos serviços de assistência especializada nosclusters de aids na Região Metropolitana do estado. O Noroeste Cearense e o oeste dos Sertões Cearenses apresentaram elevadas taxas de aids, porém baixa quantidade de serviços especializados ao longo do tempo. Houve implantação de dois serviços especializados no segundo período onde existem aglomerados da doença. A aplicação do Diagrama de Voronoi mostrou que os serviços localizados fora da Região Metropolitana abrangem grande extensão territorial. Foi identificado polígono sem nenhum serviço. CONCLUSÕES O cenário de interiorização dos casos de aids demanda a necessidade de criação de serviços de apoio social além da capital e da Região Metropolitana do estado, a fim de diminuir as barreiras de acesso a essas instituições. É necessário criar serviços de assistência especializada em HIV/aids no Noroeste Cearense e no norte do Jaguaribe.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-04-22T14:06:19Z No. of bitstreams: 1 Artigo per nac. Ines Dourado 3. 2015.pdf: 214579 bytes, checksum: 179f7fe5c3253556bc4923a41fc14b55 (MD5) Made available in DSpace on 2016-04-22T14:06:20Z (GMT). No. of bitstreams: 1 Artigo per nac. Ines Dourado 3. 2015.pdf: 214579 bytes, checksum: 179f7fe5c3253556bc4923a41fc14b55 (MD5) Previous issue date: 2015 As redes sociais e de contato sexual entre homens que fazem sexo com homens (HSH) têm um papel importante na compreensão da ocorrência de doenças sexualmente transmissíveis (DST) e HIV, devido ao potencial de circulação de agentes infecciosos nestas estruturas. Dados da cidade de Salvador, Bahia, Brasil, que integraram a pesquisa Comportamento, Atitudes, Práticas e Prevalência de HIV e Sífilis entre Homens que Fazem Sexo com Homens em 10 Cidades Brasileiras foram coletados em 2008/2009 numa amostra de 383 HSH por meio da técnica Respondent Driven Sampling (RDS). Análise de redes sociais foi utilizada para investigar as redes de amigos e parceiros sexuais. Também foi avaliada a relação entre o número de conexões (grau), o número de parceiros sexuais e as características sociodemográficas. As redes apresentaram estruturas que facilitam a transmissão do HIV. Porém, estas redes podem ser exploradas para a disseminação de informações sobre a prevenção do HIV e DST, visto que a proximidade e similaridade dos HSH nessas redes podem influenciar comportamentos e atitudes positivas para a prevenção. Rio de Janeiro

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-05-16T19:47:54Z No. of bitstreams: 1 Art Per Estrang Ines Dorado. 2015.pdf: 337355 bytes, checksum: a467ab788e9194123bed190f75c77d50 (MD5) Made available in DSpace on 2016-05-16T19:47:54Z (GMT). No. of bitstreams: 1 Art Per Estrang Ines Dorado. 2015.pdf: 337355 bytes, checksum: a467ab788e9194123bed190f75c77d50 (MD5) Previous issue date: 2015 We estimated the prevalence of sexual violence (SV) experience among men who have sex with men (MSM) in Brazil and identified its associated risk factors. We recruited 3859 MSM through respondent driven sampling. A multivariable hierarchical analysis was performed using an ecological model. The prevalence of having ever experienced SV was 15.9 % (95 % confidence interval [CI] 14.7-17.1). SV experience was independently associated with discrimination due to sexual orientation (odds ratio [OR] 3.05; 95 % CI 2.10-4.42), prior HIV testing (OR 1.81; 95 % CI 1.25-2.63), ≤14 years at first sex (OR 1.86; 95 % CI 1.28-2.71), first sex with a man (OR 1.89; 95 % CI 1.28-2.79), presenting STI symptoms (last year) (OR 1.66; 95 % CI 1.12-2.47), and having suicidal ideas (last 6 months) (OR 2.08; 95 % CI 1.30-3.35). The high levels of SV against MSM in Brazil place them at a markedly higher risk of SV than the general population. Homophobic prejudice is the strongest determinant of SV and urgently needs to be included at the forefront of the national response to SV. Germany)

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-04-22T14:06:19Z No. of bitstreams: 1 Artigo per nac. Ines Dourado 3. 2015.pdf: 214579 bytes, checksum: 179f7fe5c3253556bc4923a41fc14b55 (MD5) Made available in DSpace on 2016-04-22T14:06:20Z (GMT). No. of bitstreams: 1 Artigo per nac. Ines Dourado 3. 2015.pdf: 214579 bytes, checksum: 179f7fe5c3253556bc4923a41fc14b55 (MD5) Previous issue date: 2015 As redes sociais e de contato sexual entre homens que fazem sexo com homens (HSH) têm um papel importante na compreensão da ocorrência de doenças sexualmente transmissíveis (DST) e HIV, devido ao potencial de circulação de agentes infecciosos nestas estruturas. Dados da cidade de Salvador, Bahia, Brasil, que integraram a pesquisa Comportamento, Atitudes, Práticas e Prevalência de HIV e Sífilis entre Homens que Fazem Sexo com Homens em 10 Cidades Brasileiras foram coletados em 2008/2009 numa amostra de 383 HSH por meio da técnica Respondent Driven Sampling (RDS). Análise de redes sociais foi utilizada para investigar as redes de amigos e parceiros sexuais. Também foi avaliada a relação entre o número de conexões (grau), o número de parceiros sexuais e as características sociodemográficas. As redes apresentaram estruturas que facilitam a transmissão do HIV. Porém, estas redes podem ser exploradas para a disseminação de informações sobre a prevenção do HIV e DST, visto que a proximidade e similaridade dos HSH nessas redes podem influenciar comportamentos e atitudes positivas para a prevenção. Rio de Janeiro

A pesquisa qualitativa tem sido amplamente empregada na área da saúde, tornando-se extremamente popular nos últimos 30 anos. Desde o final dos anos 80, mais e mais profissionais e pesquisadores da saúde tem se envolvido em pesquisa qualitativa. Alguns autores argumentam que chamar esta metodologia de “qualitativa” é um equívoco, uma vez que todas as pesquisas seriam, pelo menos parte, qualitativas. Afinal, quando os epidemiologistas ou bioestatísticos contam alguma coisa, esta categoria é “algo” qualitativo.

No decorrer dos últimos 30 anos aepidemia de aids trouxe consequências muito devastadoras para famílias,comunidades e países, sendo um dos maiores desafios para a saúde pública. Maisde 7.000 pessoas são infectadas com o vírus diariamente, e uma pessoa morre acada 20 segundos de uma doença relacionada à aids. A doença é atualmente a 5ªcausa de morte entre adultos e a principal causa entre as mulheres com idadesentre 15 e 49 anos.

Investigación cualitativa y la salud se ha vuelto extremadamente popular en los últimos 30 años. Desde la década de 80, más y más trabajadores e investigadores de la salud han participado en la investigación cualitativa. Discriminar una "investigación cualitativa" de la investigación cuantitativa, sin embargo, es un término equivocado, ya que toda la investigación es por lo menos parte cualitativa. Después de todo, cuando los epidemiólogos o bioestadísticos cuentan algo, esa categoría es un "algo" cualitativa. Investigación cualitativa y la salud se ha vuelto extremadamente popular en los últimos 30 años. Desde la década de 80, más y más trabajadores e investigadores de la salud han participado en la investigación cualitativa. Discriminar una "investigación cualitativa" de la investigación cuantitativa, sin embargo, es un término equivocado, ya que toda la investigación es por lo menos parte cualitativa. Después de todo, cuando los epidemiólogos o bioestadísticos cuentan algo, esa categoría es un "algo" cualitativa.

Texto completo: acesso restrito. p.427–435 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-03-10T12:28:58Z No. of bitstreams: 1 Ligia R. F. S. Kerr.pdf: 272392 bytes, checksum: 19340979d01afaff31f6f7cd92b3e75b (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2015-06-02T14:00:24Z (GMT) No. of bitstreams: 1 Ligia R. F. S. Kerr.pdf: 272392 bytes, checksum: 19340979d01afaff31f6f7cd92b3e75b (MD5) Made available in DSpace on 2015-06-02T14:00:24Z (GMT). No. of bitstreams: 1 Ligia R. F. S. Kerr.pdf: 272392 bytes, checksum: 19340979d01afaff31f6f7cd92b3e75b (MD5) Previous issue date: 2013 Objective: To conduct the first national biological and behavioral surveillance survey for HIV among MSM in Brazil. Design: A cross-sectional surveillance study utilizing Respondent Driven Sampling (RDS) in 10 cities, following formative research. Planned sample: 350 MSM reporting sex with another man in the last 12 months, at least 18 years of age, and residing in the city of the study. Methods: Conventional RDS recruitment. Results were calculated for each city using RDSAT 5.6. For the national estimate, a new individual weight using a novel method was calculated. The 10 cities were aggregated, treated as strata and analyzed using STATA11.0. Self-reported HIV status and logistic regression was used to impute missing values for serostatus, an important issue for RDSAT. Results: A total of 3859 MSM were interviewed. Sample was diverse, most self-identified as mulatto or black, were social class C or below, and had relatively low levels of education. More than 80% reported more than one partner in the last 6 months. Only 49% had ever tested for HIV. HIV prevalence among MSM ranged from 5.2 to 23.7% in the 10 cities (3.7–16.5% without imputation) and was 14.2% for all cities combined with imputation. The overall prevalence was two and three times higher than that estimated for female sex workers and drug users, respectively, in Brazil. Half of those who tested HIV positive were not aware of their infection. Conclusion: The AIDS epidemic in Brazil is disproportionately concentrated among MSM, as has been found in other countries. Renewed efforts to encourage testing, prevention and treatment are required.

Texto completo. Acesso restrito. p. 1288-1295 Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-06-12T18:35:05Z No. of bitstreams: 1 555555555.pdf: 186896 bytes, checksum: e206361cd5f76b42377371f162a09c4b (MD5) Made available in DSpace on 2013-06-12T18:35:05Z (GMT). No. of bitstreams: 1 555555555.pdf: 186896 bytes, checksum: e206361cd5f76b42377371f162a09c4b (MD5) Previous issue date: 2013 The aim of this study was to assess factors associated with unprotected receptive anal intercourse (URAI) in a sample of MSM recruited by respondent driven sampling in Brazil. Among 3,449 participants, 36.5 % reported URAI. Final logistic model indicated that living with a male partner, illicit drug use, having stable partnership, having sex with men only, having few friends encouraging condom use, and high self-perceived risk for HIV infection were characteristics independently associated with URAI. Intervention strategies should focus on the role of anal sex practices on HIV transmission, address illicit drug use, stigma and expansion of HIV testing and care. Salvador

p. 209-213 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2014-04-24T14:27:32Z No. of bitstreams: 1 Maurício Lima Barreto.pdf: 309292 bytes, checksum: 875893a79fdbacccb571c4631d28558c (MD5) Made available in DSpace on 2014-04-24T14:27:33Z (GMT). No. of bitstreams: 1 Maurício Lima Barreto.pdf: 309292 bytes, checksum: 875893a79fdbacccb571c4631d28558c (MD5) Previous issue date: 2012 Human beings are the main reservoir of the causative agent of leprosy, Mycobacterium leprae. In the Americas, nine-banded armadillos (Dasypus novemcinctus) also act as a reservoir for the bacillus. In the state of Ceará (CE), which is located in Northeast Brazil and is an endemic area of leprosy, there are several species of armadillos, including D. novemcinctus and Euphractus sexcinctus (six-banded armadillo). Contact between humans and armadillos occur mainly through hunting, cleaning, preparing, cooking and eating. This study identified M. leprae DNA in the two main species of armadillos found in Northeast Brazil. A total of 29 wild armadillos (27 D. novemcinctus and 2 E. sexcinctus) were captured in different environments of CE countryside. Samples from the ear, nose, liver and spleen from each of these animals were tested by a nested M. leprae-specific repetitive element polymerase chain reaction assay. The samples that tested positive were confirmed by DNA sequencing. M. leprae was detected in 21% (6/29) of the animals, including five D. novemcinctus and one E. sexcinctus. This is the first Brazilian study to identify the presence of a biomarker of M. leprae in wild armadillos (D. novemcinctus and E. sexcinctus) in a leprosy hyperendemic area where there is continuous contact between humans and armadillos.

Texto completo: acesso restrito. p. 186-192 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2014-03-11T12:19:38Z No. of bitstreams: 1 Ines Dourado.pdf: 258569 bytes, checksum: c730996c31a2608e9d3ef80a11f5975c (MD5) Made available in DSpace on 2014-03-11T12:19:38Z (GMT). No. of bitstreams: 1 Ines Dourado.pdf: 258569 bytes, checksum: c730996c31a2608e9d3ef80a11f5975c (MD5) Previous issue date: 2011 Background: There are few studies on HIV subtypes and primary and secondary antiretroviral drug resistance (ADR) in community-recruited samples in Brazil. We analyzed HIV clade diversity and prevalence of mutations associated with ADR in men who have sex with men in all five regions of Brazil. Methods: Using respondent-driven sampling, we recruited 3515 men who have sex with men in nine cities: 299 (9.5%) were HIV-positive; 143 subjects had adequate genotyping and epidemiologic data. Forty-four (30.8%) subjects were antiretroviral therapy-experienced (AE) and 99 (69.2%) antiretroviral therapy-naïve (AN). We sequenced the reverse transcriptase and protease regions of the virus and analyzed them for drug resistant mutations using World Health Organization guidelines. Results: The most common subtypes were B (81.8%), C (7.7%), and recombinant forms (6.9%). The overall prevalence of primary ADR resistance was 21.4% (i.e. among the AN) and secondary ADR was 35.8% (i.e. among the AE). The prevalence of resistance to protease inhibitors was 3.9% (AN) and 4.4% (AE); to nucleoside reverse transcriptase inhibitors 15.0% (AN) and 31.0% (AE) and to nonnucleoside reverse transcriptase inhibitors 5.5% (AN) and 13.2% (AE). The most common resistance mutation for nucleoside reverse transcriptase inhibitors was 184V (17 cases) and for nonnucleoside reverse transcriptase inhibitors 103N (16 cases). Conclusions: Our data suggest a high level of both primary and secondary ADR in men who have sex with men in Brazil. Additional studies are needed to identify the correlates and causes of antiretroviral therapy resistance to limit the development of resistance among those in care and the transmission of resistant strains in the wider epidemic.

Texto completo: acesso restrito. p. 153-156 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2014-03-11T12:10:38Z No. of bitstreams: 1 Inês Dourado.pdf: 122433 bytes, checksum: 2a364fd975c25ce6aa852812ce5249fe (MD5) Made available in DSpace on 2014-03-11T12:10:38Z (GMT). No. of bitstreams: 1 Inês Dourado.pdf: 122433 bytes, checksum: 2a364fd975c25ce6aa852812ce5249fe (MD5) Previous issue date: 2011 Introduction: The aim of this study was to evaluate the reliability of self-reported HIV among men who have sex with men (MSM) in Brazil. Methods: MSM 18 years of age or older were recruited to a multicenter study using respondent-driven sampling. We compared self-report of the HIV test with a rapid HIV test using the kappa coefficient. Results: A total of 3859 MSM were recruited, and 39% reported ever having an HIV test; their results were reported and they agreed to a new test. Agreement between self-report and the test was very good (kappa = 0.88). Conclusion: Our results suggest that self-report of HIV infection is a reliable indicator among MSM.

Made available in DSpace on 2016-07-07T12:35:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2011. Added 1 bitstream(s) on 2016-07-07T12:44:43Z : No. of bitstreams: 1 ISSN0104-8058-2011-21-03-140-146.pdf: 995846 bytes, checksum: b7332abc12cad65c6290209a4d936208 (MD5) As pacientes com carcinoma de mama localmente avançado da mama são candidatas à quimioterapia neoadjuvante. A grande maioria delas apresenta resposta parcial ao tratamento, isto é, redução da dimensão do tumor. Entretanto, a taxa de resposta patológica completa é de apenas 24%, mesmo nos esquemas mais efetivos, como na associação de antraciclina com taxano. Um dos benefícios da quimioterapia neoadjuvante é a possibilidade da cirurgia conservadora da mama, e um dos desafios é avaliar com exatidão o grau de resposta tumoral ao tratamento. A resposta clínica é determinada por meio de exames físicos e de imagem, os quais não são suficientes para predizer com acurácia o tamanho do tumor ou a resposta patológica completa em relação ao exame padrão-ouro, que é o histopatológico da peça cirúrgica. Além disso, é necessário considerar que após a quimioterapia neoadjuvante pode ocorrer fragmentação do tumor, originando-se lesões residuais multifocais, de difícil detecção aos métodos de imagem. Em estudos sobre a quimioterapia neoadjuvante, observou-se que não há uniformidade no tipo de exame utilizado para a avaliação clinicopatológica da resposta tumoral; não há descrição exata sobre a metodologia utilizada na marcação pré-operatória do tumor, e nem sempre toda a área tumoral pré-quimioterapia neoadjuvante é ressecada, fato que dificulta a avaliação exata da resposta a este tipo de quimioterapia. Portanto, resta a dúvida: em quais circunstâncias a cirurgia conservadora da mama após a quimioterapia neoadjuvante está bem indicada? Neste artigo, discute-se as diferentes formas de marcação do tumor, a avaliação da resposta patológica e sua importância, principalmente quando se pretende realizar a cirurgia conservadora no carcinoma de mama localmente avançado. Patients with locally advanced breast carcinoma are candidates for the neoadjuvant chemotherapy. The majority of them have partial response to treatment, i.e., reduction in tumor size; however, the rate of pathological complete response is of only 24%, even with the association of anthracycline and taxane. One benefit of the neoadjuvant chemotherapy is the possibility of breast-conserving surgery, and the challenge is the accurate assessment of the tumor response degree to treatment. Clinical response is determined by physical exam and imaging studies, which are not sufficient to predict accurately the tumor size or the pathological complete response in relation to the golden-standard test, which is the surgical histopathology. Moreover, it is necessary to consider that after the neoadjuvant chemotherapy there may be tumor fragmentation, originating multifocal lesions, which are difficult to be detected by imaging methods. In studies regarding neoadjuvant chemotherapy, there is no uniformity in the type of test used for clinical and pathological assessments of tumor response, and there is no exact description of the methodology used in the preoperative markup of the tumor bed, which is not always resected after the neoadjuvant chemotherapy. This is a fact that hinders the accurate assessment of response to the neoadjuvant chemotherapy. Therefore, the question is: under which circumstances a breast-conserving surgery after neoadjuvant chemotherapy is well indicated? This article has discussed the different ways of tumor marking, the evaluation of pathological response and its importance, especially considering breast-conserving treatment of locally advanced breast carcinoma. Hospital de Câncer de Barretos, Barretos, SP, Brasil Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Ginecologia e Obstetrícia, Botucatu, SP, Brasil Universidade de São Paulo (USP), Faculdade de Medicina (FMUSP), São Paulo, SP, Brasil Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Ginecologia e Obstetrícia, Botucatu, SP, Brasil

Este estudo procurou estimar a prevalência de transtornos do comportamento alimentar (TCA) e identificar fatores de risco entre adolescentes do sexo feminino em Fortaleza (Ceará, Brasil). Realizou-se um estudo seccional com 652 estudantes secundaristas (14-20 anos) usando-se o Teste de Investigação Bulímica de Edimburgo (BITE). Aplicou-se um modelo de regressão logística. Cerca de um quarto das participantes apresentou padrão alimentar de risco e práticas de controle de peso; em 1,2% encontraram-se indícios de TCA instalado. Medo de engordar foi relatado por 62%, independentemente de estudarem em colégios públicos ou particulares (p>0,05), mas uso de práticas de risco foi superior naquelas procedentes de escolas particulares (p0.05), but the use of risk practices was higher among private schools students (p

Acesso restrito:Texto completo. p.490-495 Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2012-05-04T10:49:06Z No. of bitstreams: 1 __ac.els-cdn.com_S003592...68fcd1c5b92c814cda17eaf7d131a.pdf: 90187 bytes, checksum: fd399cb83d5e7697fc31928ae102cc69 (MD5) Made available in DSpace on 2012-05-04T10:49:07Z (GMT). No. of bitstreams: 1 __ac.els-cdn.com_S003592...68fcd1c5b92c814cda17eaf7d131a.pdf: 90187 bytes, checksum: fd399cb83d5e7697fc31928ae102cc69 (MD5) Previous issue date: 2010 The seroprevalence rates of IgM anti-phenolic glycolipid-I (PGL-I) antibodies in four study groups with differing exposure to Mycobacterium leprae in Ceará, Brazil were investigated between March 2005 and August 2006. The first three groups in a high prevalence area included 144 cases of leprosy, their 380 contacts and 317 participants with no known leprosy contact. The fourth group in a low prevalence area consisted of 87 participants with no known leprosy contact living in an area in which no cases of leprosy had been reported in the previous 6 months. Seropositivity and levels of IgM antibodies to PGL-I were investigated using ELISA. The seropositivity levels of anti-PGL-I among the different clinical forms of leprosy cases were 61% for lepromatous, 25% for tuberculoid and 27% indeterminate. The levels of anti-PGL-I antibodies in the endemic area differentiated leprosy cases from noncases. However, the seropositivity was similar among contact cases (15.8%) and no known leprosy contact cases from high (15.1%) and low (13.8%) prevalence areas. The seropositivity of both contacts and no known contacts was much higher than previously reported among no known contacts in other endemic areas. The study indicates that anti-PGL-I antibodies are not useful as immunological markers of household leprosy contacts and no known leprosy contacts in endemic areas.

Background: Amongst chronic diseases, end-stage renal disease (ESRD) deserves special attention in the context of health-related quality oflife (HRQOL). ESRD affects quality of Ufe more intensely than heart failure, diabetes, chronic lung disease, arthritis and cáncer In addition, patients who perceive ¡ow HRQOL withdraw from dialysis treatment more commonly Aim: To identify clinical and laboratory variables associated with health-related quality oflife (HRQOL) in hemodialysis (HD) patients. Patients and methods: We included 174 chronic HD patients from a single unit aged 18 years and older who never received a kidney allograft and survived the first three months of treatment. We used the Khan índex to assess comorbidity and the Medical Outcomes Study 36-Item Short Form Health Survey Questionnaire (SF-36) to measure HRQOL. Resulte: Amongst the eight domains of HRQOL, physical role had the lowest score (35.0±43.0) and social function the highest (64.3±27.7). In the multivariate analysis, age was associated with seven of eight domains, excepting bodily pain. Albumin was associated with five of eight domains. Time on dialysis, hemoglobin and calcium-phosphorus product were associated with physical function, bodily pain and vitality, respectively. Conclusions: Age and albumin were the main variables associated with quality life, and the calcium-phosphorus product was associated with a strategic domain: vitality. Attention to albumin and ageing effects, control ofthe calcium-phosphorus product and improvement of physical conditioning are necessary to achieve better HRQOL. Antecedentes: La enfermedad renal terminal afecta la calidad de vida relacionada a salud más que la insuficiencia cardíaca, la diabetes, enfermedad pulmonar crónica y cáncer. Los pacientes que tienen una baja calidad de vida, se retiran de los tratamientos dialíticos con más frecuencia. Objetivo: Identificar variables clínicas y de laboratorio asociadas a la calidad de vida relacionada a salud, en pacientes en hemodiálisis crónica. Pacientes y método: Se estudiaron 174 pacientes en hemodiálisis crónica, mayores de 18 años y que nunca hubieran recibido un trasplante renal. Se utilizó el índice de Khan para evaluar comorbilidades y el cuestionario SF-36 (36-Item Short Form Health Survey Questionnaire) para evaluar calidad de vida relacionada a salud. Resultados: De los ocho dominios que comprende el cuestionario, el rol físico obtuvo el puntaje más bajo (35.0±43.0) y la función social, el más alto (64.3±27.7). En el análisis multivariado, la edad estaba asociada con siete de los ocho dominios, exceptuando dolor corporal. La albúmina estaba asociada con cinco de los ocho dominios. El tiempo en diálisis, la hemoglobina y el producto calcio-fósforo se asociaron con función física, dolor corporal y vitalidad, respectivamente. Conclusiones: La edad y albúmina fueron las variables más asociadas a calidad de vida. El producto calcio-fósforo se asoció a vitalidad, un dominio estratégico. Para mejorar la calidad de vida, se debe prestar atención a la albúmina y los efectos del envejecimiento, se debe controlar el producto calcio-fósforo y mejorar la condición física.

p.1173-1185 Submitted by Rigaud Andréa (andrearigaud16@yahoo.com.br) on 2011-10-31T18:30:06Z No. of bitstreams: 1 19.pdf: 501448 bytes, checksum: 0bf49fcb1d0f6a3f2a428184179ccd8e (MD5) Made available in DSpace on 2011-10-31T18:30:07Z (GMT). No. of bitstreams: 1 19.pdf: 501448 bytes, checksum: 0bf49fcb1d0f6a3f2a428184179ccd8e (MD5) Previous issue date: 2007-05 A distribuição geográfica dos agravos à saúde e sua relação com potenciais fatores de risco vêm abrindo um vasto campo para a investigação epidemiológica. O presente estudo visa a identificar padrões de distribuição espacial dos componentes neonatal (TMIN) e pós-neonatal (TMIP) da taxa de mortalidade infantil (TMI) dos municípios do Ceará, Brasil, e discute os principais fatores sócio-econômicos, demográficos e de atenção à saúde que contribuíram para dependência espacial destes componentes. Trata-se de um estudo ecológico transversal, utilizando regressão linear múltipla, cuja análise espacial desses componentes foi obtida através do índice de Moran. Conclui-se que as condições de assistência à gravidez, ao parto e ao recém-nascido somadas a uma melhor distribuição de renda são decisivas para a sobrevivência no primeiro mês de vida, enquanto que a má alimentação, imunização, saneamento, educação e situação econômica são possíveis determinantes da mortalidade pós-neonatal. Reconhece-se a importância que as ações de atenção seletiva à saúde exercem para o declínio da TMI. No entanto, mudanças estruturais e intersetoriais são as que irão gerar a sustentabilidade necessária para levar esse indicador ao nível dos países desenvolvidos. Rio de Janeiro

Texto completo: acesso restrito. p. 6842-6844 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-14T16:54:14Z No. of bitstreams: 1 1-s2.0-S0264410X07008365-main.pdf: 99181 bytes, checksum: b0a58ca36d13b7e68d369176fcb088c0 (MD5) Made available in DSpace on 2014-01-14T16:54:14Z (GMT). No. of bitstreams: 1 1-s2.0-S0264410X07008365-main.pdf: 99181 bytes, checksum: b0a58ca36d13b7e68d369176fcb088c0 (MD5) Previous issue date: 2007 Background: BCG vaccine protects against leprosy. Objectives: Estimate BCG protection against leprosy by age by age. Methods: A case control study with 226 cases of leprosy and 857 controls. BCG vaccination was ascertained via examination of BCG scars. Protection is presented for three age groups. Results: BCG protection against leprosy was 86% (95% CI: 77–92%) in the age group 18–29; 54% (95% CI: −37% to 85%) in the age group 30–39 and 32% (95% CI: −3% to 56%) in those aged 40 or more. Conclusions: BCG efficacy against leprosy may well last for three decades and possibly even longer. BCG vaccination must have contributed to worldwide reduction in leprosy incidence.

Texto completo: acesso restrito. p. 261-267 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-29T15:00:25Z No. of bitstreams: 1 apc%2E2006%2E0116.pdf: 78456 bytes, checksum: 8361c0e0e8cb4c1fa6dd00249f183518 (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2014-01-30T14:37:22Z (GMT) No. of bitstreams: 1 apc%2E2006%2E0116.pdf: 78456 bytes, checksum: 8361c0e0e8cb4c1fa6dd00249f183518 (MD5) Made available in DSpace on 2014-01-30T14:37:22Z (GMT). No. of bitstreams: 1 apc%2E2006%2E0116.pdf: 78456 bytes, checksum: 8361c0e0e8cb4c1fa6dd00249f183518 (MD5) Previous issue date: 2007 In Brazil, an increasing proportion of new HIV infections and AIDS cases involve women of reproductive age. To describe the reproductive desire of women with HIV/AIDS and to identify factors associated with the desire for motherhood, a cross-sectional study was carried out in the referral hospital for infectious diseases in Ceará State, northeast Brazil. In total, 229 women were included in data analysis. Median age was 32 years (interquartile range, 26–37), and 63% had a monthly family income of less than 210 USD. Forty-nine percent were using a contraceptive method, and 37% wished to undergo tubal ligation. Sixty-four percent of the latter women were motivated by the fear of having an HIV-positive child. Forty percent of the participants wanted to have a child. In the multivariate regression analysis, variables independently associated with women's desire to have a child were: younger age (in years, odds ration [OR] = 0.94; 95% confidence interval [CI]: 0.90–0.98), number of children (OR = 0.73; 95% CI: 0.57–0.96), and partner's desire for a child (OR = 3.35; 95%CI: 1.75–6.39). Having a partner who did not know about the woman's positive serostatus was negatively associated with the woman's desire for a child (OR = 0.17; 95% CI: 0.04–0.69). No variable related to clinical status was significantly associated with the outcome variable. Our data showed that many unsterilized HIV-positive women in northeast Brazil, at whatever stage of illness, have a desire for children. We recommend that nondirective counseling, consisting of helping women evaluate their own feelings, goals and needs with respect to reproductive options be provided.

Texto completo: acesso restrito. p. 261-267 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-29T15:00:25Z No. of bitstreams: 1 apc%2E2006%2E0116.pdf: 78456 bytes, checksum: 8361c0e0e8cb4c1fa6dd00249f183518 (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2014-01-30T14:37:22Z (GMT) No. of bitstreams: 1 apc%2E2006%2E0116.pdf: 78456 bytes, checksum: 8361c0e0e8cb4c1fa6dd00249f183518 (MD5) Made available in DSpace on 2014-01-30T14:37:22Z (GMT). No. of bitstreams: 1 apc%2E2006%2E0116.pdf: 78456 bytes, checksum: 8361c0e0e8cb4c1fa6dd00249f183518 (MD5) Previous issue date: 2007 In Brazil, an increasing proportion of new HIV infections and AIDS cases involve women of reproductive age. To describe the reproductive desire of women with HIV/AIDS and to identify factors associated with the desire for motherhood, a cross-sectional study was carried out in the referral hospital for infectious diseases in Ceará State, northeast Brazil. In total, 229 women were included in data analysis. Median age was 32 years (interquartile range, 26–37), and 63% had a monthly family income of less than 210 USD. Forty-nine percent were using a contraceptive method, and 37% wished to undergo tubal ligation. Sixty-four percent of the latter women were motivated by the fear of having an HIV-positive child. Forty percent of the participants wanted to have a child. In the multivariate regression analysis, variables independently associated with women's desire to have a child were: younger age (in years, odds ration [OR] = 0.94; 95% confidence interval [CI]: 0.90–0.98), number of children (OR = 0.73; 95% CI: 0.57–0.96), and partner's desire for a child (OR = 3.35; 95%CI: 1.75–6.39). Having a partner who did not know about the woman's positive serostatus was negatively associated with the woman's desire for a child (OR = 0.17; 95% CI: 0.04–0.69). No variable related to clinical status was significantly associated with the outcome variable. Our data showed that many unsterilized HIV-positive women in northeast Brazil, at whatever stage of illness, have a desire for children. We recommend that nondirective counseling, consisting of helping women evaluate their own feelings, goals and needs with respect to reproductive options be provided.

OBJECTIVES Respondent-driven sampling (RDS) is a new data collection methodology used to estimate characteristics of hard-to-reach groups, such as the HIV prevalence in drug users. Many national public health systems and international organizations rely on RDS data. However, RDS reporting quality and available reporting guidelines are inadequate. We carried out a systematic review of RDS studies and present Strengthening the Reporting of Observational Studies in Epidemiology for RDS Studies (STROBE-RDS), a checklist of essential items to present in RDS publications, justified by an explanation and elaboration document. STUDY DESIGN AND SETTING We searched the MEDLINE (1970-2013), EMBASE (1974-2013), and Global Health (1910-2013) databases to assess the number and geographical distribution of published RDS studies. STROBE-RDS was developed based on STROBE guidelines, following Guidance for Developers of Health Research Reporting Guidelines. RESULTS RDS has been used in over 460 studies from 69 countries, including the USA (151 studies), China (70), and India (32). STROBE-RDS includes modifications to 12 of the 22 items on the STROBE checklist. The two key areas that required modification concerned the selection of participants and statistical analysis of the sample. CONCLUSION STROBE-RDS seeks to enhance the transparency and utility of research using RDS. If widely adopted, STROBE-RDS should improve global infectious diseases public health decision making.

To characterize the effect syndemics conditions on HIV prevalence among men who have sex with men in Brazil. This is an excerpt from the research “National study of behaviors, attitudes, practices and prevalence of HIV, Syphilis and Hepatitis B and C among men who have sex with men”. Cross-sectional study, carried out between June and December 2016, in 12 Brazilian cities. The population consisted of MSM aged 18 years or over and who lived or studied in one of the participating cities. A national sample of 4,176 individuals was obtained, following the Respondent Driven Sampling (RDS) technique. For the classification of syndemics, the following criteria were considered: if there is the presence of two or more diseases or health conditions concentrated in a specific group; social factors that create conditions for two or more diseases or health conditions to be concentrated in a group; the concentration of these health conditions result in an adverse interaction of diseases with biological, social or behavioral elements. The Complex Analysis Survey tool in StataTR 14.0 was used with each city treated as its own stratum to weight the final results. There was a higher proportion of HIV positive results among MSM in the age group over 25 years (31.0%; 95%CI 25.6 – 37.0; p

The prison population is considered a fundamental group for the control of leprosy, since prisons are places that present environmental and social conditions that favor transmission and illness. This study aimed to estimate the prevalence of leprosy in Brazilian female prisoners and to identify factors associated with the disease. Methods: This cross-sectional study explored the prevalence and factors associated with leprosy among Brazilian female prisoners and was carried out between 2014 and 2015 in 15 Brazilian female prisons. Data from 1327 women were collected through Computer-Assisted Self-Interview and dermatological and neurological examination to identify suspected leprosy. Results: The mean age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and the lifetime self-reported prevalence was 7.5%. The variables associated with self-reported leprosy throughout life were: women imprisoned once, twice as likely to have leprosy (95%CI: 1.2 - 3.5); white women were 1.4 times more likely to have leprosy than non-white women (95% CI: 1.1 - 1.8); women who knew someone with leprosy were 1.9 times more likely to have leprosy (95%CI: 1.1 - 3.3); and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people (95% CI: 1.1 - 5.9). Conclusions: A lifetime self-report of leprosy among female inmates in Brazil was more than 100 times higher than that found in a Brazilian cohort of the general population. These values show the extreme vulnerability of this population generated by pre-incarceration poverty, as well as the potential for transmission in prison. A população carcerária é considerada um grupo fundamental para o controle da hanseníase, uma vez que as prisões são locais que apresentam condições ambientais e sociais que favorecem a transmissão e o adoecimento. Este estudo objetivou estimar a prevalência de hanseníase em presidiárias brasileiras e identificar fatores associados à doença. Métodos: Este estudo transversal explorou a prevalência e os fatores associados à hanseníase entre presidiárias brasileiras e foi realizado entre 2014 e 2015 em 15 presídios femininos brasileiros. Os dados de 1327 mulheres foram coletados por meio de Auto-Entrevista Assistida por Computador e exame dermatológico e neurológico para identificar lesões suspeitas de hanseníase. Resultados: A média de idade foi de 33,4 anos. A suspeita de hanseníase foi identificada em 5,1% das mulheres na prisão, e a prevalência autorreferida ao longo da vida foi de 7,5%. As variáveis que se associaram à hanseníase autorreferida ao longo da vida foram: mulheres presas uma vez com duas vezes mais chances de ter hanseníase (IC95%: 1,2 - 3,5); mulheres brancas tinham 1,4 vezes mais chance de ter hanseníase do que mulheres não brancas (IC 95%: 1,1 - 1,8); mulheres que conheciam alguém com hanseníase tinham 1,9 vezes mais chance de ter hanseníase (IC95%: 1,1 - 3,3); e mulheres que compartilhavam uma cela com 11 ou mais mulheres tinham 2,5 vezes mais chance de ter hanseníase do que mulheres que compartilhavam uma cela com duas ou menos pessoas (IC 95%: 1,1 - 5,9). Conclusões: A autorrelato de hanseníase ao longo da vida entre presidiárias no Brasil foi mais de 100 vezes maior do que a encontrada em uma coorte brasileira da população geral. Esses valores mostram a extrema vulnerabilidade dessa população gerada pela pobreza pré-reclusão, bem como potencial de transmissão na prisão.

eprosy, a disease caused by the bacillus Mycobacterium leprae, is still resistant to strategies for its elimination as a public health problem in the world. Studies with spatial analysis techniques and social networks have been used to increase knowledge and understanding of the dynamics of disease transmission in hyperendemic areas. The general objective of this study was to analyze the pattern of spatial distribution and the social network structure of leprosy cases in children under 15 years old in Sobral - Ceará, from 2014 to 2015. This is a descriptive and cross-sectional study, with use of spatial analysis and Social Network Analysis (SNA) techniques, conducted in Sobral, a municipality in the state of Ceará. The research population consisted of people under 15 years of age with leprosy (index cases), identified in public health services based on spontaneous demand or by active search in households in areas of hyperendemicity, and also in the screening of leprosy cases in public schools in the municipality and their household contacts (HC) and non-household contacts (NHC). For data collection, in addition to a questionnaire applied to the participants, clinical examination of the skin, skin smear and biopsy of the lesion were performed for positive cases. A rapid test for the detection of specific antibodies against M. leprae was requested for all respondents. Nine new cases of leprosy in children under 15 years of age diagnosed between August 2014 and September 2015 and a total of 151 contacts were studied, of which 36 were HC and 115 NHC. Each index case had 10 to 29 contacts, including HC and NHC. Next, each HC reported having regular contact with six to thirty people and each NHC reported having regular contact with six to 23 people. The contacts named by the HC and NHC formed the indirect contacts (IC) of the index cases and were not interviewed. In the spatial analysis, it was found that the index cases and their non-household contacts were concentrated in poor and hyperendemic areas of the municipality. The spatial analysis also revealed a grouping of subclinical infection in a radius of 102 meters, suggesting that transmission home is not related to proximity to seropositive individuals. At SNA, index cases and their contacts generated a network of 664 people with 1,497 connections between them, including indirect contacts. The index cases and their social contacts constitute nine subnetworks, with people strongly connected to each other and with precarious socioeconomic conditions. Index cases, household and social contacts with reports of leprosy and/or subclinical infection caused by M. leprae, stood out in the social network due to the high values of centrality of degree and intermediation they presented. The study showed that leprosy is present in both household and non-household contacts and that they live in sub- networks with characteristics of a “small world” network, with low socioeconomic status and little education. The investigation of contacts must extend beyond the home, based on the case's social networks. A hanseníase, doença causada pelo bacilo Mycobacterium leprae, permanece ainda, resistente às estratégias para sua eliminação como um problema de saúde pública no mundo. Estudos com técnicas de análise espacial e de redes sociais vêm sendo utilizados para ampliar o conhecimento e a compreensão da dinâmica da transmissão da doença em áreas hiperendêmicas. O objetivo geral deste estudo foi analisar o padrão da distribuição espacial e a estrutura de rede social dos casos de hanseníase em menores de 15 anos em Sobral - Ceará, no período de 2014 a 2015. Trata-se de uma pesquisa descritiva e transversal, com emprego de técnicas de análise espacial e Análise de Rede Social (ARS), conduzida em Sobral, município do estado do Ceará. A população da pesquisa foi composta de menores de 15 anos com hanseníase (casos índice), identificados nos serviços públicos de saúde a partir de demanda espontânea ou por busca ativa nos domicílios de áreas de hiperendemicidade e, ainda, na triagem de casos de hanseníase em escolas públicas do município e dos seus contatos domiciliares (CD) e contatos não domiciliares (CND). Para a coleta de dados, além de um questionário aplicado aos participantes, fez-se exame clínico da pele, esfregaço cutâneo e biópsia da lesão para os casos positivos. Foi solicitado um teste rápido para a detecção de anticorpos específicos contra o M. leprae para todos os entrevistados. Foram estudados nove casos novos de hanseníase em menores de 15 anos diagnosticados entre agosto de 2014 e setembro de 2015 e um total de 151 contatos, dos quais 36 eram CD e 115 CND. Cada caso índice apresentou 10 a 29 contatos, incluindo CD e CND. Na sequência, cada CD relatou ter contato regular com seis a trinta pessoas e cada CND relatou ter contato regular com seis a 23 pessoas. Os contatos nomeados pelos CD e CND, formaram os contatos indiretos (CI) dos casos índice e não foram entrevistados. Na análise espacial, constatou-se que os casos índice e seus contatos não domiciliares concentraram-se em áreas pobres e hiperendêmicas do município. A análise espacial, revelou, ainda, um agrupamento de infecção subclínica em um raio de 102 metros, sugerindo que a transmissão não domiciliar está relacionada à proximidade com indivíduos soropositivos. Na ARS, os casos índice e seus contatos geraram uma rede de 664 pessoas com 1.497 ligações entre eles, incluindo os contatos indiretos. Os casos índice e seus contatos sociais constituem nove sub-redes, com pessoas fortemente conectadas entre si e com condições socioeconômicas precárias. Casos índice, contatos domiciliares e sociais com relato de hanseníase e/ ou com a infecção subclínica causada pelo M. leprae, destacaram-se na rede social pelos altos valores da centralidade de grau e de intermediação que apresentaram. O estudo mostrou que a hanseníase está presente tanto nos contatos domiciliares como nos contatos não domiciliares e que estes vivem em sub-redes com características de rede de “mundo pequeno”, com baixa condição socioeconômica e pouca escolaridade. A investigação dos contatos deve se estender para além do domicílio, pautando-se nas redes sociais do caso.

The Zika epidemic in the 2015-2016 period was a public emergency with personal, social, economic and political repercussions that strongly affected maternal and child health in Brazil. This led to recommendations by health authorities to postpone pregnancy and a general decrease in the birth rate in the country. Currently, the disease is no longer an emergency, but its effects continue to be felt and Zika remains an important public health issue. The aim of the present study is to understand the decision to get pregnant by women in the context of a Zika virus (ZIKV) epidemic in the light of the recommendations of health authorities. The research was developed in a qualitative approach. 51 face-to-face interviews were carried out with women of childbearing age in the city of Fortaleza, Ceará, Brazil, using an open semi-structured research guide based on the methodology Rapid Ethnographic Assessment (REA). The guide contained topics based on initial pilot interviews and a review of the scientific literature. The sampling was intentional and attempted to include a diversity of women from different social classes, ages and reproductive stages. The average profile of the sample was women aged 20 to 29 years, with complete high school, mixed race, married, with children and with some type of paid activity. The results demonstrate the multidimensional character of decision-making to become pregnant and, in contradiction to the broader national demographic evidence, the Zika epidemic did not affect the intention to become pregnant, knowledge, the use of contraceptives or other methods of family planning. It was also identified, inconsistent use of family planning methods and ambivalence in relation to the use of contraceptives, suggesting a complex socio-cultural panorama where these women are inserted. Despite recommendations from health authorities to provide health professionals with advice on the risks of pregnancy during the Zika epidemic, this action was never implemented by the state. The declarative one-dimensional recommendation to avoid pregnancy appears to be insufficient to address this complex decision. The inadequacy of the health system's response to prevention highlights the need for careful development of integrated and comprehensive interventions, in addition to thorough planning in the implementation of health policies and actions not only for Zika, but also for other possible epidemics. A epidemia de Zikano período 2015-2016 foi uma emergência pública com repercussões pessoais, sociais, econômicas e políticas que afetou fortemente a saúde materno-infantil no Brasil. Isso levou a recomendações das autoridades em saúde para adiar a gravidez e uma diminuição geral na taxa de natalidade no país. Atualmente a doença não é mais uma emergência, mas seus efeitos continuam sendo sentidos e a zika permanece como uma importante questão de saúde pública. O objetivo do presente estudo é compreender a decisão de engravidar das mulheres em contexto de epidemia Zika vírus (ZIKV) frente às recomendações das autoridades de saúde. A pesquisa foi desenvolvida com uma abordagem qualitativa, sendo realizadas 51 entrevistas face a face com mulheres em idade fértil na cidade de Fortaleza, Ceará, Brasil, utilizando um guia de pesquisa semiestruturado aberto e baseado na metodologia Avaliação Etnográfica Rápida (REA). O guia continha tópicos embasados em entrevistas-piloto iniciais e uma revisão da literatura científica. A amostragem foi intencional e tentou incluir uma diversidade de mulheres de classes sociais, idades e estágio reprodutivo diferentes. Participaram do estudo mulheres com faixa etária de 20 a 29 anos, com ensino médio completo, cor parda, casadas, com filhos e com algum tipo de atividade remunerada. Os resultados demonstram o caráter multidimensional da tomada de decisão para engravidar e, em contradição com as evidências demográficas nacionais mais amplas, a epidemia de Zika não afetou a intenção de engravidar, o conhecimento, o uso de anticoncepcionais ou outros métodos de planejamento familiar. Também foi identificado, uso inconsistente de métodos de planejamento familiar e a ambivalência em relação ao uso de anticoncepcionais, sugerindo um panorama sociocultural complexo no qual essas mulheres estão inseridas. Apesar das recomendações das autoridades em saúde para que houvesse aconselhamento sobre os riscos da gravidez durante a epidemia de Zika pelos profissionais de saúde, essa ação nunca foi operacionalizada por parte do estado. Assim, a recomendação unidimensional declarativa para evitar a gravidez parece ser insuficiente para abordar essa decisão complexa. A inadequação da resposta do sistema de saúde à prevenção destaca a necessidade de um desenvolvimento cuidadoso de intervenções integradas e abrangentes, além de um planejamento minucioso na implementação de políticas e ações em saúde não apenas para Zika, mas também para outras possíveis epidemias.

Brazil has the third largest prison population in the world. In 2016, the female prison population reached a total of 42,000, representing an increase of 656% compared to that recorded in the early 2000s. The objective was to analyze the sexual and reproductive characteristics of women prisoners in Brazil; Draw the sociodemographic and prison profile of women incarcerated in Brazil; Characterize the sexual and reproductive health of women incarcerated in Brazil; Compare the sexual and reproductive characteristics of women incarcerated with the general female population in Brazil. Cross-sectional study, carried out from a section of two national health surveys, one in the female prison population and female prison staff conducted in eight Brazilian states and the Federal District (DF) between 2014 and 2015, in 15 female prison units located in the five regions of Brazil and the second survey was the Survey of Knowledge, Attitudes and Practices (PCAP) in the year 2013. The sample consisted of 1327 women in closed or semi-open regime and 5.543 women from the general population. The collection of the prison was carried out by the Audio Computer-Assisted Self-Interviewing and the PCAP was through a questionnaire self-filled by tablets. Data analysis was performed using STATA version 15 where the Odds Ratio (OR) and respective confidence intervals (95% CI) with a p value