Distribution of calbindin, parvalbumin and calretinin in the lateral geniculate nucleus and superior colliculus in Cebus apella monkeys

We studied the distribution of the calcium-binding proteins calbindin, parvalbumin and calretinin, in the superior colliculus and in the lateral geniculate nucleus of Cebus apella, a diurnal New World monkey. In the superior colliculus, these calcium-binding proteins show different distribution patterns throughout the layers. After reaction for calretinin one observes a heavy staining of the neuropil with few labeled cells in superficial layers, a greater number of large and medium-sized cells in the stratum griseum intermediale, and small neurons in deep layers. The reaction for calbindin revealed a strong staining of neuropil with a large number of small and well stained cells, mainly in the upper half of the stratum griseum superficiale. Intermediate layers were more weakly stained and depicted few neurons. There were few immunopositive cells and little neuropil staining in deep layers. The reaction for parvalbumin showed small and medium-sized neurons in the superficial layers, a predominance of large stellate cells in the stratum griseum intermediale, and medium-sized cells in the deep layers. In the lateral geniculate nucleus of Cebus, parvalbumin is found in the cells of both the P and M pathways, whereas calbindin is mainly found in the interlaminar and S layers, which are part of the third visual pathway. Calretinin was only found in cells located in layer S. This pattern is similar to that observed in Macaca, showing that these calcium-binding proteins reveal different components of the parallel visual pathways both in New and Old World monkeys.

Distribution of calbindin-28kD and parvalbumin in V1 in normal adult Cebus apella monkeys and in monkeys with retinal lesions

Several proteins have their normal patterns of distributions altered by monocular visual deprivation. We studied the distribution of the calcium-binding proteins calbindin-28kD (Cb) and parvalbumin (Pv) in V1 in normal adult Cebus apella monkeys and in monkeys with monocular retinal lesions. In normal monkeys, the interblobs regions in layers 2/3 and the layer 4B are intensely labeled for Cb, while Pv reaction showed a complementary labeling pattern with a stronger staining in layers 4A, 4C and in the blob regions in layers 2/3. In monkeys with monocular retinal lesion, the laminar distribution of these proteins was differentially affected, although both reactions resulted in stronger labeling in non-deprived ocular dominance columns. While Cb reaction resulted in stronger labeling in layers 1 through 5, Pv labeling was heavier in layers 2/3, 4A and 4C. There was a clear reduction in the intensity of neuropil staining for both Pv and Cb in deprived ocular dominance columns with little or no reduction in number of labeled cells. This reduction could thus be attributed to activity-dependent changes at synapses level.

Temporal and Spatial Analysis Techniques as Potential Tools for Combating the HIV Epidemic among Young Brazilian Amazonian People: An Ecological Study

BACKGROUND

The main goal of this study was to analyze the HIV epidemic temporally and spatially among young people living in Pará, Brazil, from 2007 to 2018.

METHODS

For the temporal analysis, we employed an integrated autoregression of moving averages model associated with the seasonal trend using the LOESS decomposition method, which allowed for predictions to be made. In the spatial analysis, the techniques of autocorrelation, spatial and spatio-temporal risk analysis, and geographically weighted regression were used.

RESULTS

During the study period, there were 8143 notifications of HIV/AIDS cases. The temporal prediction indicated a trend of growth in the incidence rate in the 20-24-year-old group from January 2019 to December 2022 and a trend of stability in the 15- to 19-year-old and 25- to 29-year-old groups. There was a territorial expansion of the HIV epidemic in Pará. Novo Progresso and the Metropolitan Region of Belém (RMB) were the zones with the highest spatial and spatio-temporal risk for HIV. Social determinants including the Basic Education Development Index, the number of physicians per 10,000 inhabitants, and the municipal high school abandonment rate in the municipalities were associated with the risk of HIV/AIDS among young people in Pará.

CONCLUSIONS

To eliminate HIV among young people in Pará, the access to treatment, diagnosis, and preventive healthcare services should be expanded. Sexual and reproductive health education should be reinforced in schools and communities. Furthermore, it is necessary to promote social equity and fight HIV stigma.

Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target

INTRODUCTION

This study aimed to identify factors associated with late diagnosis and clinically monitor newly diagnosed HIV/AIDS patients.

METHOD

Retrospective study, based on secondary data from a specialized unit at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the University of Sao Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data of newly diagnosed HIV patients between 2015 and 2019. Data analysis was undertaken using inferential statistical tests.

RESULTS

A total of 314 individuals were newly diagnosed with HIV/AIDS, 86.6% (272) had a late diagnosis and 53.8% (169) were diagnosed very late. Using the adjusted odds ratio, we observed that bisexual and MSM patients were less likely to have a late diagnosis compared to straight patients. Individuals who entered through the emergency department and Outpatient Clinic had a lower chance of having a very late diagnosis compared to those diagnosed in the ward/inpatient unit. Having a higher education and university education were protective factors against having a very late diagnosis of HIV infection compared to elementary school education only. In addition, male patients were more likely to have a very late diagnosis compared to female patients.

CONCLUSIONS

This study evidenced a high prevalence of late and very late diagnoses. Therefore, attention should be directed towards factors related to late and very late presentation.

Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study

OBJECTIVE

To analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques.

DESIGN

Ecological study.

SETTINGS

This study was conducted in Brazil SAMPLE: A total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0-23 months and born from mothers living in Brazil were included in this study.

PRIMARY OUTCOME MEASURES

The CS incidence rates were calculated by triad (2007-2010, 2011-2014 and 2015-2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan.

RESULTS

From 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk.

CONCLUSION

This study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.

The association between knowledge about HIV and risk factors in young Amazon people

OBJECTIVES

analyze the association between the level of HIV knowledge among young people from Amazonas region, their sociodemographic profile and infection risk factors.

METHODS

cross-sectional analytical study, which used a structured questionnaire containing questions about sociodemographic, behavioral aspects and HIV knowledge. Data were grouped by sex and underwent ordinal and binary logistic regression analysis.

RESULTS

the students had an HIV knowledge deficit, associated with a low educational level of their parents and low family income. The most frequent risk factors were lack of knowledge on the part of female students regarding proper male condom use, their infrequent use in sexual relations and failure to do HIV testing. There was an association between level of knowledge and use of dating apps by female students.

CONCLUSIONS

there was no association between level of knowledge and the preponderant risk factors, but the students' knowledge deficit rendered them more vulnerable to infection.

Análise espaço-temporal da epidemia do HIV em idosos num estado amazônico brasileiro

Resumo Objetivo Analisar espaço-temporalmente a incidência do vírus da imunodeficiência humana (HIV) e da síndrome da imunodeficiência adquirida (Aids) entre idosos no estado do Pará, Brasil, nos anos de 2007 a 2018. Método Estudo ecológico utilizando notificações de casos de HIV/Aids em idosos provenientes do Sistema de Informação de Agravos de Notificação. A taxa de incidência do HIV/Aids foi analisada temporalmente pelo método de joinpoint e espacialmente pelas técnicas de autocorrelação de Moran, de varredura e de regressão espacial. Resultados 2.639 notificações de HIV/Aids foram elegíveis para o estudo, sendo 1.725 (65,4%) em homens e 914 (34,6%) em mulheres. No período do estudo houve aumento de 2.422,5% na taxa de incidência de HIV nos homens e de 1.929,8% nas mulheres, sendo o oposto, observado para a taxa de incidência de Aids que aumentou 77,6% nas mulheres e 40,7% nos homens. O método joinpoint revelou tendência crescente para a taxa de incidência de HIV (APC=30%, p=0,00) e de estabilidade para taxa de incidência de Aids (APC=3,0%, p=0,2). Os municípios mais impactados pela epidemia do HIV foram os do meridional sudeste paraense com moderada associação (R2=0,65) ao seu crescimento populacional. A análise de varredura espaço-temporal apontou Belém como zona de risco para o HIV/Aids (RR=3,93, p=0,00; 2017-2018) Conclusão Enquanto a incidência de Aids em idosos paraenses permaneceu estável no período de 2007 a 2018, a de HIV tendeu a crescer. O maior impacto da epidemia ocorreu nos municípios do sudeste paraense com associação ao crescimento populacional, e Belém apresentou risco espaço-temporal para o HIV/Aids.

FATORES ASSOCIADOS A SINTOMAS DEPRESSIVOS E CAPACIDADE FUNCIONAL EM IDOSOS

Objetivo: identificar a prevalência e fatores associados a sintomas depressivos e capacidadefuncional em idosos.Método: estudo analítico, de corte transversal, realizado com 100 idosos em Unidade Básica deSaúde do norte do Brasil. Aplicou-se a Escala de Depressão Geriátrica, escalas de Katz e de Lawtone Brody. Os dados foram analisados por meio dos testes Qui-quadrado de Pearson, CorrelaçãoLinear de Pearson e t de Student com nível de significância estatística valor de p-valor <0,05.Resultados: a prevalência de sintomas depressivos foi de 22%, sendo maior em idosos comautopercepção ruim da saúde, sedentários e não participantes de grupos de convivência. Adependência nas atividades instrumentais da vida diária foi de 46% com associação a sintomasdepressivos e idade avançada.Conclusão: o uso de instrumentos para detecção precoce de sintomas depressivos e incapacidadefuncional permite a estratificação de risco e prevenção do agravamento dessas condições de vidado idoso.

HIV epidemic among Brazilian women who have sex with women: An ecological study

The influences of public policies fighting HIV among women who have sex with women is scarcely studied. This study aimed to analyse the time series of human immunodeficiency virus (HIV) epidemic, between 2007 and 2020, among Brazilian women who have sex with women, in order to evaluate the effect of Brazilian policies for fighting HIV in this subpopulation compared to women who have sex with men (WSM). This ecological study employed HIV and acquired immunodeficiency syndrome (AIDS) new cases among women who have sex strictly with women (WSW), women who have sex with men and women (WSMW), and WSM reported to the Sistema de Informação de Agravos de Notificação from 2007 to 2020. Crude Brazilian and regional annual age-adjusted HIV/AIDS population-level incidence rates were calculated for WSW, WSMW and WSM. The rates were then analyzed using the Joinpoint regression model. A total of 102,890, 757, and 1,699 notifications of WSW, WSMW, and WSM living with HIV/AIDS were reported during the study period, respectively. South Brazilian region had the greatest HIV/AIDS incidence rates among WSM and bisexual women while the North region had the greatest incidence among WSW. In the WSM population, the temporal trends showed at least one stable or an increasing trend period from 2007 to 2013 or 2014, followed by one decreasing trend in all Brazilian regions. While among the WSMW most of the regions had a stable trend period from 2007 to 2020, in WSW group most of the trends had only one decreasing period. The decreasing trends were faster in WSM than in WSW. These results suggest a low efficiency of Brazilian policies for fighting HIV among WSW and WSMW and show the necessity of implementing new policies specific to this population.

Factors associated with low knowledge about sexually transmitted infections in subnormal agglomerate, in the Brazilian Amazon

BACKGROUND

Populations living in subnormal agglomerates in urban areas are more vulnerable to infections, including sexually transmitted infections (STIs). In these groups, inadequate knowledge about sexually transmitted infections can further increase the risk of contracting STIs.

AIM

We investigated the factors associated with low knowledge about STIs in a peripheral population in the Brazilian Amazon.

METHODS

This cross-sectional study was conducted in Belém, in the Amazon region that has a high percentage of subnormal agglomerates in an urban area and a high incidence of STIs. Random sampling was adopted which resulted in a sample of 320 participants. To assess knowledge about STIs, the self-administered Sexually Transmitted Disease Knowledge Questionnaire was used. To assess aspects of vulnerability, a questionnaire was constructed which is linked to individual, social, and programmatic factors. The chi-square test, G test, and ordinal regression analyses were all performed.

FINDINGS

The sample of this study was composed of 320 participants. The mean age of the participants was 46.09 years. 37.5% (120), 50.6% (162), and 11.9% (38) showed low, medium, and high knowledge, respectively. Multiple analysis revealed that the factors associated with higher chance of having smaller knowledge about sexually transmitted infections were single/separated/divorced/widow(er) marital status (AOR: 1.80, CI: 1.15-2.84, P = 0.01); income equal to or less than one minimum wage (1.98, CI: 1.21-3.17, P = 0.00); equal to or over than 52 years old (AOR: 1.99, CI: 1.25-3.17, P = 0.00); lack of guidance by a health professional (AOR: 1.59, CI: 1.01-2.51, P = 0.04). Our results show that this community suffer from suboptimal levels of knowledge on STIs, which are linked to individual, social, and programmatic factors. Characterising the risk and vulnerabilities factors allows for carrying out appropriate interventions for populations living in subnormal agglomerates in urban area.

Sífilis congênita em região da amazônia brasileira: análise temporal e espacial

Objetivo: Analisar a tendência temporal e distribuição espacial da sífilis congênita em uma região da Amazônia brasileira. Metodologia: Estudo ecológico realizado com casos de sífilis congênita em crianças menores de um ano de idade no Pará empregando dados do Sistema de Informação de Agravo de Notificação e do Sistema de Informações sobre Nascidos Vivos, 2007 a 2017. Aplicou-se análise de autocorrelação espacial de Moran e análise temporal pelo método joinpoint. Resultados: A taxa de incidência bruta e média de sífilis congênita para o período do estudo foi de 3,8 e 0,345 (x1.000 nascidos vivos), respectivamente. A incidência de sífilis congênita apresentou tendência crescente com variação percentual anual de 12,0% (IC 9,8–14,8; p=0,000). A sífilis congênita apresentou expansão territorial, com as maiores taxas nos municípios do nordeste, sudeste e sudoeste paraense. Conclusão: A sífilis congênita apresentou tendência crescente contínua no Pará e expansão territorial. Nossos resultados sugerem ineficácia do acompanhamento de pré-natal.

Integrative review on the incidence of HIV infection and its socio-spatial determinants

OBJECTIVES

to identify the socio-spatial determinants associated with the incidence of infection by the human immunodeficiency virus (HIV) described in national and international literature.

METHODS

integrative literature review that included original articles indexed in the LILACS, PUBMED, CINAHL, and Scopus databases, from 2015 to 2019. The synthesis of the articles was done in a descriptive manner in two categories according to the type of approach.

RESULTS

13 articles were selected, with a predominance of ecological studies. Regions with deficient access to health services, high population density, higher rates of poverty, intense migratory flow, border areas, as well as precarious socioeconomic conditions, and risk behaviors are associated with higher rates of infection.

FINAL CONSIDERATIONS

the influence of regional inequalities on the incidence of HIV infection is revealed, confirming the relevance of spatial analysis techniques for mapping the distribution of diseases and identifying risk areas.

Seroprevalence of Chlamydia trachomatis and Associated Factors among Vulnerable Riverine in the Brazilian Amazon

Due to social and individual conditions and access to health services, Amazonian riverside populations are highly vulnerable to sexually transmitted infections, including Chlamydia trachomatis. The aim is to estimate the seroprevalence of Chlamydia trachomatis and analyze the associated factors among riverside dwellers in a capital city in the Brazilian Amazon. A cross-sectional study was carried out with residents of the Combu Island, Belém. The study sample was calculated using the population survey technique in the EPI INFO. Only people aged 18 and over were included. ELISA serology was performed to detect antibodies against Chlamydia trachomatis. For data collection, a form containing vulnerability factor questions was applied. Binary regression analysis was performed using the Minitab 20 program. The study sample consisted of 325 participants. The prevalence of IgG/IgM antibodies against Chlamydia trachomatis was 22.2% and 5.5%, respectively. In the multiple regression, only participants with a broken condom were more likely to have antibodies against the bacteria (OR: 1.90; 95% CI: 1.01; 3.37; p = 0.046). Seroprevalence was associated with condom breakage. This factor demonstrates that despite having an attitude towards condom use, probably, they may have inadequate knowledge about the correct practice of introduction.

Variational studies and replica symmetry breaking in the generalization problem of the binary perceptron

We analyze the average performance of a general class of learning algorithms for the nondeterministic polynomial time complete problem of rule extraction by a binary perceptron. The examples are generated by a rule implemented by a teacher network of similar architecture. A variational approach is used in trying to identify the potential energy that leads to the largest generalization in the thermodynamic limit. We restrict our search to algorithms that always satisfy the binary constraints. A replica symmetric ansatz leads to a learning algorithm which presents a phase transition in violation of an information theoretical bound. Stability analysis shows that this is due to a failure of the replica symmetric ansatz and the first step of replica symmetry breaking (RSB) is studied. The variational method does not determine a unique potential but it allows construction of a class with a unique minimum within each first order valley. Members of this class improve on the performance of Gibbs algorithm but fail to reach the Bayesian limit in the low generalization phase. They even fail to reach the performance of the best binary, an optimal clipping of the barycenter of version space. We find a trade-off between a good low performance and early onset of perfect generalization. Although the RSB may be locally stable we discuss the possibility that it fails to be the correct saddle point globally.

Temporal trend and spatial analysis of the HIV epidemic in young men who have sex with men in the second largest Brazilian Amazonian province

Background

After 40 years of its starting, the HIV epidemic in Brazilian Amazon region remains on an increasing trend. The young men who have sex with men (MSM) have been the most impacted by the HIV in the last decade. However, much more than attributing the risk behavior to HIV uniquely to the individual, behaviors are shaped by social determinants of health (SDH). Despite the problem, there is a scarcity of studies evaluating the impact of SDH on HIV among young MSM and none of them were done in the Northern of Brazil. Therefore, the main goal of this study was to analyse the HIV epidemic among Brazilian Amazonian young MSM using temporal trends and spatial analysis.

Methods

We conducted an ecological study using reported cases of HIV/AIDS in young MSM living in Pará, the second larger Brazilian Amazonian province, between 2007 and 2018. Data were obtained from the Information System for Notifiable Diseases. For the temporal analysis, we employed a Seasonal and Trend decomposition using Loess Forecasting model (STLF), which is a hybrid time-series forecast model, that combines the Autoregressive-Integrated Moving Average (ARIMA) forecasting model with the Seasonal-Trend by Loess (STL) decomposition method. For the spatial analysis, Moran’s spatial autocorrelation, spatial scan, and spatial regression techniques were used.

Results

A total of 2192 notifications were included in the study. Greater variabilities in HIV/AIDS population-level diagnosis rates were found in the festive months. The HIV/AIDS population-level diagnosis rates exhibited an upward trend from 2013 and this trend is forecasted to continue until 2022. Belém, the capital of Pará, presented the highest spatial risk for HIV/AIDS and was the only city to present spatiotemporal risk from 2014 to 2018. The geographic variation of the HIV epidemic was associated with the number of men with formal jobs, the average salary of men, and the percentage of people over 18 years old with elementary education.

Conclusion

The upward trend of HIV/AIDS population-level diagnosis rate forecasted until 2022 and the variability of the epidemic promoted by the SDH brings an alert and subsidies to health authorities to implement more efficient and focalized public policies against HIV among young MSM in Pará.

LEARNHIV: development and validation of a mobile application for primary health care nurses focused on HIV care/prevention

INTRODUCTION

Human immunodeficiency virus (HIV) infection is a relevant public health problem is worldwide. From the change in the health care of people living with HIV (PLHIV) in Primary Health Care (PHC), nurses gained autonomy in their workflow, which requires a significant technological arsenal for the planning, organization and functioning of services. It is believed that the development of a mobile application for the care/prevention of HIV will contribute to the strengthening of care, resulting in greater autonomy and empowerment of nurses in Primary Health Care.

OBJECTIVE

To develop and validate a content script for a mobile application for nurses in PHC containing information about PLHIV management/care in PHC.

METHODS

This is a methodological study developed in three phases: exploratory study, content elaboration process and validation by the 16 judges.

RESULTS

The application was evaluated and validated satisfactorily in terms of content and appearance, with an average Content Validity Index (CVI) of 0.99 (99%), Item Content Validity Index (I-CVI) and Medium Content Validity (S-IVC/AVE) also obtained satisfactory levels.

CONCLUSIONS

The construction of the prototype of an application called LearnHIV, is considered a valid instrument in terms of content and appearance, according to the judges.

TRIAL REGISTRATION

None because it is not an intervention study.

AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis

Despite considerable therapeutic advances in the care of people living with human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) and an overall reduction of 47% in the AIDS mortality rate in the last decade, the AIDS-mortality rates remains high. The social determinants of health (SDH) have a direct influence on the dynamics of this phenomenon. However, changes in SDH caused by the implemented policies against HIV have been poorly investigated. Moreover, the Brazilian rainforest has had the highest and continuously increasing AIDS mortality rate in Brazil since the 1980s. In this study, AIDS mortality in a province of the Brazilian rainforest was examined by using temporal and spatial analyses.

METHODS

In this ecological study, data from 2007 to 2018 were extracted from the Mortality Information System provided by the State Department of Public Health of Pará. For the temporal analysis, the integrated autoregressive model of moving average (ARIMA) and locally weighted polynomial regression (STLF) were used to forecast AIDS mortality from 2019 to 2022. For the spatial analysis, spatial autocorrelation and geographically weighted regression (GWR) analyses were employed.

RESULTS

The samples consisted of 6,498 notifications for AIDS-related deaths. From 2007 to 2013, the AIDS mortality rates showed an upward trend, followed by a stabilization until 2018 and an upward forecasted trend from 2019 to 2022. High mortality rates and high-high clusters were found in economic pole municipalities. Furthermore, AIDS mortality risk was directly associated with per capita income and demographic density, except in the southwestern region of Pará, which exhibited an inverse association with population density.

CONCLUSION

Although the policies against HIV may have contributed to the stabilization of AIDS mortality rates from 2013 in Pará, the upward forecasted trend until 2022 raises an alert and concern to health authorities to provide reinforcement of the policies. The geographic variability of AIDS mortality promoted by SDH provides subsidies to health authorities to implement SDH-focused strategies for AIDS mortality reduction.

Spatial variability of mother-to-child human immunodeficiency virus transmission in a province in the Brazilian Rainforest: An ecological study

The mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a serious public health problem in the Brazilian Rainforest. This study aimed to spatially analyze this type of infection between 2007 and 2018 in Pará, which is the second-largest Brazilian state in the Brazilian Rainforest and also has the highest MTCT of HIV in Brazil. We analyzed the incidence rates of HIV (including the acquired immunodeficiency syndrome (AIDS) by MTCT as the main route of infection in children younger than 13 years old and whose mothers live in Pará. We employed spatial autocorrelation, spatial scanning, and geographic-weighted spatial regression techniques. In the period of this study, 389 new HIV/AIDS were noted, with territorial expansion of the incidence rates in the municipalities in northern and southern Pará having the highest rates. São Francisco do Pará had high spatial risk and high-spatiotemporal risk clusters comprising municipalities in western and south-western Pará between 2013 and 2016. The spatial variability of HIV/AIDS incidence rates was found to be common in the number of men and women with formal jobs; unemployed ≥18 years old people; elementary school pupils; and families enrolled in the "Single Registry for Social Programs". The social equity approach in Pará guarantee pregnant women access to preventive, diagnostic and treatment health services and their children should be supported to eliminate the MTCT of HIV in Pará.

Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon

Background

There was a high proportion of pregnant women who were attending prenatal care who were not tested for syphilis or tested but not treated, among priority countries. The coverage for prenatal care visits, syphilis screening, and treatment are priority indicators for monitoring of the elimination of syphilis. The aim was to determine the factors associated with gestational syphilis among postpartum women who were in a prenatal care program in the Brazilian Amazon.

Methods

An unmatched case-control study was conducted at the hospital in Brazil. Data collection was carried out from November 2020 to July 2021 during hospitalization using a pretested structured questionnaire. The criteria for selection of cases and control followed the guidelines established by the Ministry of Health of Brazil; postpartum women with a laboratory diagnosis based on treponemal and/or nontreponemal tests, symptoms of syphilis or asymptomatic, treatment or not treated, and in a prenatal care program. Gestational syphilis cases were identified as women who tested positive for syphilis, and those who tested negative were controls, at minimally one prenatal care visit, childbirth, and/or the puerperium. The sample size encompassed 59 cases and 118 controls (1: 2 ratio of cases to controls). Data were analyzed using Minitab 20^® and BioEstat 5.3^® software. The odds ratio was calculated by multiple logistic regression.

Results

One hundred and seventy-seven postpartum women were included in the study, 59 cases and 118 controls. Among all participants, 95.5% (169) were tested for syphilis in any trimester during pregnancy and at the delivery and 4.5% (8) were tested in the maternity only, at the time childbirth and/or puerperium. The final multiple logistic regression model evidenced that cases had higher odds compared to controls if they had past history of sexually transmitted infections (AOR: 55.4; p: 0.00), difficulty talking about condom use with their sexual partner (AOR: 4.92; p: 0.01), one to six prenatal care visits (AOR: 4.93; p: 0.01), had not received a sexually transmitted infections test result in the maternity hospital (AOR: 4.09; p: 0.04), lower monthly income (AOR: 4.32; p: 0.04), or one to three miscarriages (AOR: 4.34; p: 0.01).

Conclusion

The sociodemographic, programmatic, obstetric, and sexual factors are associated with gestational syphilis among postpartum women.

Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon

Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.

Spatial analysis of HIV detection rates among Brazilian young men, 2007-2021

The main goal of this study was to spatially analyze the HIV epidemic scenario in young men in Brazil, 2007-2021. We used secondary data obtained from the Brazilian Information System for Notifiable Diseases. Individuals aged 15-29 years with permanent residence in Brazil who were diagnosed with HIV during the study period were included in the analysis. Municipality HIV age-adjusted detection rates were analyzed through spatial distribution, autocorrelation, and spatiotemporal risk analyses. During the study period, 108,392 HIV cases were reported in young Brazilian men. The HIV epidemic increased territorially in the northern, northeastern, midwestern, and southeastern regions but decreased in the southern region. Although the number of clusters comprising municipalities with high HIV detection rates (hotspots) decreased, new ones appeared, expanded, or stopped changing size. Hotspots and spatio-temporal risk zones (spatial areas with increased HIV detection in a specific period) comprised economically developed municipalities with high demographic density surrounded by less developed municipalities. The period of the spatiotemporal risk zones was between 2008 and 2021. Our study showed that HIV detection rates continue to increase among young Brazilian men, and health authorities should reinforce efforts mainly in capitals and surrounded municipalities in the north, northeast, southeast, and midwest regions.