Prevalence and Spatial Autocorrelation of Tuberculosis in Indigenous People in Brazil, 2002-2022

Tuberculosis (TB) among indigenous populations in Brazil poses a multifaceted public health challenge influenced by geographical, social, institutional, economic, and cultural factors. This study scrutinized the prevalence and spatial distribution of TB among Brazilian indigenous communities from 2002 to 2022. Employing a cross-sectional and descriptive approach, we analyzed data from the Notifiable Diseases Information System (SINAN) and conducted spatial autocorrelation tests to identify clusters and outliers. The findings uncovered substantial disparities in TB prevalence between the North and Central-West regions, in contrast to the South and Southeast, mirroring social, economic, and cultural inequalities in Brazil. It is concluded that public health strategies should not only consider the epidemiological aspects of TB but also encompass social and environmental determinants, notably the impact of climate change. Holistic and context-sensitive approaches are imperative for addressing TB within indigenous communities, underscoring the need for adaptive and culturally sensitive interventions in the public health landscape.

Notifications of sexual violence against children and adolescents in Rio Grande do Sul, Brazil: a descriptive study, 2014-2018

OBJECTIVE

to describe characteristics of notifications of sexual violence against children and adolescents according to race/skin color and their distribution in the state of Rio Grande do Sul, Brazil, between 2014 and 2018.

METHODS

this was a descriptive study of data retrieved from the Notifiable Health Conditions Information System (SINAN). Frequency distributions, prevalence and statistical differences were analyzed using Pearson's chi-square test.

RESULTS

of the 8,716 notifications, most occurred in the state capital (48.2%) and related to female victims (82.2%) aged between 10 and 14 years (38.1%). There was a higher prevalence (370/100,000) and relative frequency of rape (84.5%), sexual exploitation (5.8%) and neglect/abandonment (4.6%) among victims of Black race/skin color (p-value < 0.05). Only 4.6% of notifications occurred in primary health care services.

CONCLUSION

notifications were more frequent among female pre-adolescents and prevalence was higher among Black people, who should be a priority target for protective measures. Surveillance of this form of violence needs to be strengthened in primary care.

Confronting the Infodemic and Fake News to End Stigma and Discrimination in HIV/AIDS: Promoting Zero Discrimination Practices in Brazil With Massive Open Online Course

INTRODUCTION

Overcoming misinformation is essential considering stigma and discrimination in the HIV/AIDS epidemic. This report presents the preliminary results of a health education strategy based on the massive open online course (MOOC) on Zero Discrimination in Brazil.

METHODS

Case study describing the development of the MOOC and its validation using the Delphi technique. Pre- and posttests were administered. People who enrolled from October 2021 to March 2022 were included in the study.

RESULTS AND DISCUSSION

MOOC was made available free of charge for mobile phones, tablets, and desktops and included a 90-hr study certificate. Over 6 months, there were n = 665 people enrolled from different regions, mainly from the health field or working in the public health system. The completion rate of people included in the study (26.62%; n = 177) was above the average for other MOOCs.

CONCLUSIONS

Initial results are promising but demand more extensive monitoring.

The global failure of facing the pandemic

The COVID-19 pandemic outbreak in late 2019 has had social, political, and economic consequences worldwide. However, its emergence was not a surprise. In 2015, a Panel organised by the World Health Organization highlighted the importance of learning about the crisis caused by the Ebola epidemic. In 1992, the Committee on Emerging Microbial Threats to Health of the US Institute of Medicine warned of the possibility of an emerging global microbial threat. In this text, we point out five arguments that reveal the global failure in facing the pandemic: (1) deficiency in the global alert system and the fragility of the International Health Regulations (IHR-2005), (2) problems of the international response to the pandemic, related to global health governance, (3) the dispersed global adoption of the elimination strategy (zero Covid) widely seen as a policy of restriction of freedom instead as a strategy of inequities reduction, (4) fragile control of the disease with a narrow reading of the associated problems, and (5) global setbacks in achieving the Sustainable Development Goals in the context of ongoing neoliberal national policies. Finally, we argue that overcoming the weaknesses discussed requires strengthening health systems in all their components and expanding social welfare policies.

A call for the urgent and definitive inclusion of gender identity and sexual orientation data in the Brazilian health information systems: what can we learn from the monkeypox outbreak?

Abstract In this document, we present to the scientific community a proposal on how to deal with the challenge imposed on surveillance and health actions in Brazil regarding monkeypox, including points and directions that have the potential to support learning and enable advances in the current scenario.

Pela urgente e definitiva inclusão dos campos de identidade de gênero e orientação sexual nos sistemas de informação em saúde do SUS: o que podemos aprender com o surto de monkeypox?

Resumo Neste documento trazemos um posicionamento para a comunidade científica e a sociedade civil acerca do desafio imposto à vigilância e às ações em saúde no Brasil relacionadas à monkeypox. Apresentamos pontos e encaminhamentos que podem subsidiar os aprendizados e os avanços a partir do atual cenário.

Descrição de medicamentos prescritos para a terapia hormonal em serviços de saúde especializados para transexuais e travestis no Rio Grande do Sul, 2020

Resumo Objetivo Descrever os medicamentos prescritos para o tratamento hormonal do processo transexualizador em estabelecimentos de saúde de atendimento especializado para pessoas transexuais e travestis no Rio Grande do Sul, Brasil. Métodos Estudo descritivo, com coleta de dados nesses estabelecimentos, no período maio-setembro/2020, utilizando-se instrumento elaborado pelos(as) pesquisadores(as). Obtiveram-se dados sobre o perfil de usuários(as) e características do cuidado farmacológico de tratamento hormonal. Resultados A pesquisa contemplou todos os sete serviços do estado. Para mulheres transexuais e travestis, medicamentos antiandrogênicos e espironolactona foram prescritos em todos os serviços. Apenas um estabelecimento não prescreveu ciproterona. Todos os estabelecimentos de saúde realizaram prescrição de medicamentos a base de estrógenos, com diferenças na via de administração; para homens transexuais, todos prescreveram andrógenos por via intramuscular. Conclusão A pesquisa aponta os medicamentos prescritos e sua diversidade, ratificando a necessidade da produção de informação para implementação das políticas de equidade no Sistema Único de Saúde.

Online-based intervention on LGBTI+ health promotion in Brazil: development and preliminary impacts

Background

Brazil reports public healthcare gaps concerning lesbian, gay, bisexual, transgender, and intersex (LGBTI+) people. Massive Open Online Courses (MOOCs) are online-based teaching interventions, however their use is still scarce in Brazil. We aim to describe the development and to analyze preliminary impacts of the first online-based intervention through MOOCs for LGBTI+ health promotion in Brazil.

Methods

We adopted mixed qualitative and quantitative approaches, based on participatory-action research: 1) to design the content and format of the MOOC, we conducted 10 focus groups during 2018 and 2019 with key stakeholders in three different Brazilian State capitals, identifying needs and challenges and linking it with guidelines of the National Policy for Comprehensive Health of LGBTI+ people; 2) based on step 1, we developed the MOOC, producing reading content, video-classes and multimedia; 3) we quantitatively analyzed, through a survey, its impact and reach after six months.

Results

The results showed that: a) focus groups were essentials to inform the priorities to design a tailored MOOC; b) the MOOC had 30 hours of autonomous learning activities divided into two modules, with problem-based evaluation; c) the first ten-month of the course had a total of 5,000 people enrolled with a completion rate of approximately 30%; d) 1,700 successfully completed the course; e) 582 participants joined the survey post-course evaluation and for 370 (63.6%) of them, this was the first training activity on LGBTI+ health.

Conclusions

Results point to a high interest in LGBTI+ health and high demand for training on this topic among health professionals. The MOOC format was successful and reliable in enabling the teaching-learning process.

Key messages

Participatory action research was able to inform the content of the first MOOC for LGBTI+ health in Brazil. The MOCC had high interest, and for the majority of concluding participants it was the first activity and formal education about LGBTI+ health.

“Semente para Luta”: ativismos, direito à saúde e enfrentamentos de pessoas LGBTI na pandemia da covid-19

Resumo Este trabalho investiga como a saúde de pessoas lésbicas, gays, bissexuais, travestis, transexuais e intersexuais (LGBTI) tem sido afetada no contexto da pandemia da covid-19, por meio da percepção de ativistas da sociedade civil organizada, no Estado do Rio Grande do Sul (RS), Brasil. Realizou-se uma análise qualitativa, que reporta dados preliminares de um estudo maior sobre a Política Nacional de Saúde LGBTI. O levantamento foi feito entre maio e julho de 2020, com a aplicação de entrevistas realizadas online. O enfoque se deu sobre as percepções, as experiências individuais e coletivas de ativistas sobre a temática da saúde LGBTI, em meio ao atravessamento da pandemia da covid-19. Constataram-se efeitos sobre a mobilização comunitária; o acesso aos serviços de saúde; a saúde mental; e as situações de violência e proteção social. Conclui-se que as intervenções coletivas de pessoas LGBTI são fundamentais em contextos de crise sanitária e dão suporte à garantia do direito à saúde e preservação de políticas públicas a esta população.

Vigilância da violência no Rio Grande do Sul: panorama da qualidade e da quantidade das informações no Sistema de Informação de Agravos de Notificação (SINAN) de 2014 a 2018

Objetivo: analisar o padrão e a qualidade da informação relacionada à violência no estado do Rio Grande do Sul segundo a raça/cor, a identidade de gênero, a orientação sexual, a população em situação de rua e a população indígena. Método: estudo  ecológico e descritivo dos casos notificados no SINAN entre 2014 e 2018 no estado do Rio Grande do Sul, que totalizou no período um registro de 104.797 casos de violência. Resultado: A completude dos dados tem sido gradativamente melhorada ao longo do quinquênio dentro das classes de excelente e bom. Os campos de orientação sexual e identidade de gênero, inseridos em 2014 na ficha de notificação de violência interpessoal e autoprovocada demandam aumento de qualificação. Conclusão: Percebe-se, mediante a análise das notificações no SINAN, que ainda há muito a se avançar para o aprimoramento da vigilância das violências, em especial na qualificação dos campos de orientação sexual, identidade de gênero e motivação da violência. Sugere-se a necessidade de expansão da notificação das violências em municípios silenciosos e na rede intersetorial e a ampliação da qualificação de profissionais de saúde na compreensão da violência como um problema de saúde e a importância de qualificar a ficha de notificação. É mister a melhoria da ficha e do instrutivo de violência interpessoal e autoprovocada no SINAN e a sua adoção como estratégia para o fortalecimento do papel central do SUS no enfrentamento intersetorial e interseccional da violência.

Territories Under Siege: Risks of the Decimation of Indigenous and Quilombolas Peoples in the Context of COVID-19 in South Brazil

The current health, political, and environmental crisis ongoing in Brazil and the advances of the impacts of COVID-19 in traditional populations (as indigenous and quilombolas) are not yet prioritized in the scientific production about the novel coronavirus. We performed spatial correlation analysis to map the clusters and outliers of COVID-19 in South of Brazil to identify indigenous and quilombolas communities impacted right now in the pandemic. We show that communities located nearby metropolitan areas and mid-sized cities are the most impacted by the COVID-19 and the advance of the transmission to inner states may intensify the ongoing historical process of elimination of indigenous and quilombolas people. We call for a global response to the indigenous and quilombolas situation in Brazil, pointing to the need of more analysis in the country;

Profile of notification of violence against Lesbian, Gay, Bisexual, Transvestite and Transsexual people recorded in the National Information System on Notifiable Diseases, Brazil, 2015-2017

OBJECTIVE

This study aimed to describe the profile of notifications of violence against LGBT people in Brazil, from 2015 to 2017.

METHODS

This is a cross-sectional descriptive study with secondary data on records of violence against LGBT people. The study population included individuals aged 10 and older with homosexual or bisexual orientation as well as transvestites or transgender identities.

RESULTS

Throughout the study period, 24,564 reports of violence were recorded. Regarding the victim's profile, 69.1% were 20 to 59 years old, 50.0% were black, 46.6% were transsexual or transvestites and 57.6% were homosexual, of which 32.6% were lesbian and 25.0%, gay. In all age groups, the most frequent nature of violence was physical violence (75.0%). The probable author was male in 66.2% of the cases, being intimate partners the most frequent aggressors (27.2%), followed by strangers (16.5%).

CONCLUSION

This study expands knowledge of violence against LGBT people in Brazil, reinforces the need to report these events and improve quality of information on individual's sexual orientation and gender identity in order to produce evidence to support actions to tackle this problem.

Health and Sexual Rights: Design, Development, and Assessment of the Massive Open Online Course on Lesbian, Gay, Bisexual, Transgender, and Intersex Health Promotion in Brazil

Background: Massive Open Online Courses (MOOCs) are a teaching format with universal access and the potential and viability to be implemented by health professionals. Despite their proven success in providing high-quality continuing education, usage and offerings of this technology are still scarce in Brazil. Materials and Methods: This article describes the development of an online-based education strategy (MOOC) on the topic of health policies aimed at the Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI+) population and analyzes its performance and reach after 6 months. Results: This introductory MOOC course on LGBTI+ health included an assortment of multimedia material and consisted of 30 h of autonomous learning activities divided into two modules, with problem-based evaluation strategies. During its 6-month promotion period, the course had a total of 3,000 people enrolled with a completion rate of ∼20%. Conclusions: Results point to a high interest in LGBTI+ health and high demand for training on this topic among health professionals. This was the first course of its kind administered in Brazil. The MOOC format was successful and reliable in enabling the teaching-learning process.

Protein M and Fibronectin-Binding Proteins are Not Sufficient to Promote Internalization of Group a Streptococci into Hela Cells

Infection by group A streptococci is often associated with highly invasive diseases resulting in sepsis and shock. Recently, this species has renewed interest in the mechanism by which some strains are better able to invade mucosal epithelia and to penetrate into the bloodstream than are others. In this work we have evaluated the invasive ability of eight group A Streptococcus pyogenes strains isolated either from patients with severe invasive diseases, or with pharyngitis, or from healthy carrier. Five out of the eight strains studied were efficiently internalized within HeLa cells and, of these, four produced the M6 protein. A recombinant S.gordonii strain constitutively expressing the M6 protein failed to invade HeLa cell monolayers, suggesting that the expression of the M6 protein is not sufficient to allow the non-invasive S.gordonii to be internalized within Hela cells. As fibronectin-binding proteins have been implicated as primary adhesins in host-parasite interactions, we assayed the adhesiveness and the invasiveness of five invasive GAS strains in competition experiments where HeLa cells were infected with bacteria in the presence of purified fibronectin. The results obtained indicated that fibronectin moderately inhibits bacterial adhesion, while it does not affect internalization. These results indicate that other factors, together with fibronectin-binding proteins, participate in the adhesion of streptococci, and that fibronectin-mediated adhesion does not seem to be important in the internalization process of streptococci within HeLa cells.

Modulation of actA gene expression in Listeria monocytogenes by iron

This study analysed the invasiveness of Listeria monocytogenes into enterocyte-like Caco-2 cells in which iron depletion was achieved by picolinic acid treatment. Both entry and intracellular multiplication varied depending on the endogenous iron content of bacterial and eukaryotic cells. The behaviour within enterocytes was correlated with a 10-fold increased transcription of the actA gene observed in bacterial cells grown under conditions of iron stress.

A novel gene encoding a sulfur-regulated outer membrane protein in Thiobacillus ferrooxidans

Thiobacillus ferrooxidans is a Gram-negative chemolithotrophic bacterium able to oxidize ferrous iron, elemental sulfur and inorganic sulfur compounds. The oxidation of sulfur by T. ferrooxidans resulted in an expression of some outer membrane proteins (OMPs) at a level higher than that observed during ferrous iron oxidation. Among these OMPs, a protein with a molecular mass of 54 kDa was purified and 18 amino acids of the N-terminal sequence determined. Using a 54 bp PCR generated DNA product as a probe for the protein, we isolated a 4.5 kb Pst I DNA chromosomal fragment containing the corresponding gene. Sequencing 2169 bp of this fragment revealed the open reading frame codifying for the protein, consisting of 467 amino acids and a molecular mass of 49,674 Da. The mature protein was produced by the removal of a 32 amino acid signal peptide-like sequence from the N-terminus of a 499 amino acid peptide. Although no significant homology with any known protein has been found and its physiological role remains unclear, its high expression on sulfur substrates suggests a role in sulfide mineral oxidation.

Identification of Listeria monocytogenes by colony hybridization test using the virulence-associated hly and inlA genes as probes

We developed a method of identification of Listeria monocytogenes based on colony hybridization with nonradioactively labeled DNA probes, represented by the hly and inlA virulence-associated genes. The procedure described in this paper results simple, rapid, specific and reproducible. Since it can be performed in a short time, the above technique can be applied to detect L. monocytogenes from different source and constitutes a noteworthy and alternative tool to identify this gram-positive pathogenic bacterium.

Iron availability affects entry of Listeria monocytogenes into the enterocytelike cell line Caco-2

The influence of iron on the entry of Listeria monocytogenes into Caco-2 cells was studied. Iron availability was found to modify the surface hydrophobicity and protein profile of L. monocytogenes, with the result that cell invasion strongly increased upon bacterial growth in iron-rich medium. The enhanced invasive capability of iron-overloaded L. monocytogenes cells correlates to the higher-level expression of the inlAB virulence genes, which were positively iron regulated at the transcriptional level.

Listeria monocytogenes infection of Caco-2 cells: role of growth temperature

The aim of the present study was to evaluate the role of temperature in the virulence of Listeria monocytogenes, a Gram-positive facultative intracellular food-borne pathogen. The capacity of bacteria grown at 37, 25 and 4 degrees C to develop haemolytic activity, to enter the Caco-2 enterocyte-like cell line and to multiply intracellularly was investigated. We demonstrated that L. monocytogenes penetration was not significantly influenced by the growth temperature of cultures and that bacteria grown at low temperature were capable of synthesizing internalin and, during the infection process, of restoring the haemolytic phenotype which is normally lacking in the extracellular environment at 4 and 25 degrees C. It can be concluded that L. monocytogenes, frequently present in numerous environmental sources and also in refrigerated food products, produces at low temperature, the virulence factors necessary to invade intestinal cells.

The effect of iron on the invasiveness of Escherichia coli carrying the inv gene of Yersinia pseudotuberculosis

The effect of growth in iron-excess or iron-limitation conditions on the invasiveness for HeLa cells of Escherichia coli HB101 carrying plasmid pRI203 which bears the invasion gene of Yersinia pseudotuberculosis was examined. Iron-limitation reduced adhesion and the number of organisms internalised by HeLa cells by about 100-fold. The reduced adhesion of iron-starved bacteria correlated with reduced hydrophobicity and the reduced invasiveness appeared to depend on the plasmid copy number, which was 3.5-fold less than in bacteria grown in iron excess.

Influence of lactoferrin on the entry process of Escherichia coli HB101 (pRI203) in HeLa cells

Lactoferrin (Lf) is an iron-binding protein which plays an important role in the host defense systems of different mucosal surfaces including the intestinal mucosa. In the present research the role of apo-Lf and iron-saturated Lf in the invasion process of enteroinvasive bacteria, grown in iron stress or excess, was investigated. As enteroinvasive bacterium, Escherichia coli HB101 strain harboring a plasmid which contains the chromosomal inv gene from Yersinia pseudotuberculosis was utilized. The product of this gene (invasin) enables this microorganism to invade human epithelial cultured cells (HeLa). The results obtained showed that apo-Lf and iron-saturated Lf added at physiological concentration during the infection exerted a significant inhibition of adhesion (3.2 x 10(5) instead 3.4 x 10(6) adherent bacteria grown in iron excess; 1.6 x 10(3) instead of 2.3 x 10(4) adherent bacteria grown in iron-limited medium) and internalization (4.0 x 10(5) instead of 3.7 x 10(6) internalized bacteria grown in iron excess; 2.1 x 10(3) instead 2.8 x 10(4) internalized bacteria grown in iron-limited medium). It has also been demonstrated that in these experimental conditions Lf binds to HeLa cell membrane as well as to bacterial outer membrane. It is likely that this binding interfere with the early events of interaction between bacteria and eukaryotic cells. This inhibiting effect of Lf on the invasion efficiency of E. coli HB101 (pRI203) could be related to the cationic nature of the molecule, although other mechanisms cannot be ruled out.