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HIV epidemic, prevention technologies, and the new generations: trends and opportunities for epidemic response 艾滋病毒疫情、预防技术和新一代:疫情应对的趋势和机遇
Pub Date : 2023-12-08 DOI: 10.1590/0102-311XEN144223
Alexandre Grangeiro, Dulce Ferraz, Laio Magno, Eliana Miura Zucchi, Márcia Thereza Couto, Inês Dourado
Abstract: The United Nations has underscored the possibility of ending the HIV epidemic as a public health problem. However, an increase in the incidence among adolescents and youth has indicated a greater distance between HIV responses and the specificities of the new generations, which can maintain the epidemic for an extended period. Regards this matter, it is debated that the provision of a range of preventive methods, even if highly effective, and a conservatism that has internalized stigma within government policies, hinder the proper and essential dialogue between current preventive policies and the needs of the new generations. These generations are marked by a social representation of AIDS as a mild disease, by new gender and sexuality performances, and by the search for a more critical role in affective and sexual encounters, which includes frequent use of dating apps and substances. The hierarchy of the delivery of prevention methods is presented as a proposal for a new policy, prioritizing pre-exposure prophylaxis (PrEP) and addressing the social determinants of the HIV epidemic, including strategies to mitigate stigma. The importance of the participation of adolescents and youth in constructing the policy and the need for an intersectoral response are also reinforced.
摘要:联合国强调了终结艾滋病毒流行这一公共卫生问题的可能性。然而,青少年和青年发病率的增加表明,艾滋病毒防治措施与新一代的特点之间的差距更大,新一代的特点可以使这一流行病长期维持下去。关于这个问题,人们争论的是,提供一系列预防方法,即使非常有效,以及保守主义在政府政策中内化了耻辱,阻碍了当前预防政策与新一代的需要之间的适当和必要的对话。这几代人的特点是社会将艾滋病视为一种轻微疾病,表现出新的性别和性行为,并在情感和性接触中寻求更关键的角色,其中包括频繁使用约会应用程序和药物。提供预防方法的层次结构作为一项新政策的建议提出,优先考虑暴露前预防,并处理艾滋病毒流行的社会决定因素,包括减轻耻辱的战略。还强调了青少年和青年参与制定政策的重要性和部门间反应的必要性。
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引用次数: 6
Rethinking HIV prevention in young people: “hierarchization” or “deinstitutionalization”? 重新思考年轻人的艾滋病毒预防问题:是 "等级化 "还是 "非制度化"?
Pub Date : 2023-12-08 DOI: 10.1590/0102-311ent164823
Draurio Barreira, Tatianna Meireles Dantas de Alencar
bring
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引用次数: 2
Forty years of the Brazilian response to HIV: reflections on the need for a programmatic shift and policy as a common good 巴西应对艾滋病毒四十年:关于需要转变计划和政策作为共同利益的思考
Pub Date : 2023-12-08 DOI: 10.1590/0102-311xen199423
Alexandre Grangeiro, Dulce Ferraz, Laio Magno, Eliana Miura Zucchi, Márcia Thereza Couto, Inês Dourado
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引用次数: 0
Adverse effects of daily oral pre-exposure prophylaxis in men who have sex with men and transgender women: a systematic review and meta-analysis 男男性行为者和变性妇女每日口服暴露前预防药物的不良影响:系统回顾和荟萃分析
Pub Date : 2023-12-08 DOI: 10.1590/0102-311XEN089522
Marcos Pereira, C. Castro, Laio Magno, Tarcio de Almeida Oliveira, Fabiane Soares Gomes, Fabiane Maria Fernandes Neves, Pedro Rafael dos Santos do Nascimento, Inês Dourado
Abstract: The adverse effects of oral pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate are barriers to PrEP initiation and continuation. Although serious effects are rare and predictable, evidence for this assessment among men who have sex with men (MSM) and transgender women (TGW) is still limited. This study assesses the adverse effects of daily oral PrEP in MSM and TGW. This is a systematic review and meta-analysis of clinical trials and cohort studies on the use of daily oral PrEP selected from the PubMed/MEDLINE, Embase, LILACS, and Cochrane CENTRAL databases. Data extraction included adverse effects and changes in renal and hepatic markers. Random effects models were used to summarize the risk of adverse effects throughout the study. Heterogeneity was assessed using the Cochran’s Q test and the inconsistency test (I2). The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration recommendations. The search identified 653 references. Of these, 10 were selected. All studies assessed the eligibility of renal and hepatic markers. The use of daily oral PrEP was not associated with grade 3 or 4 adverse events (RR = 0.99; 95%CI: 0.83-1.18; I2 = 26.1%), any serious adverse event (RR = 1.04; 95%CI: 0.58-1.87; I2 = 88.4%), grade 3+4 creatinine level (RR = 0.66; 95%CI: 0.24-1.84; I2 = 79.9%), and grade 3 or 4 hypophosphatemia (RR = 0.56; 95%CI: 0.15-2.10). The certainty of the evidence ranged from high to moderate for the outcomes analyzed. Daily oral PrEP is safe and well tolerated by MSM and TGW. Adverse effects were minimal and evenly distributed between intervention and control.
摘要:口服富马酸替诺福韦二氧吡酯暴露前预防(PrEP)的不良反应是PrEP开始和持续的障碍。尽管严重的影响是罕见和可预测的,但在男男性行为者(MSM)和变性女性(TGW)中进行这种评估的证据仍然有限。本研究评估每日口服PrEP对MSM和TGW的不良影响。这是从PubMed/MEDLINE、Embase、LILACS和Cochrane CENTRAL数据库中选择的关于每日口服PrEP使用的临床试验和队列研究的系统综述和荟萃分析。数据提取包括不良反应和肾脏和肝脏标志物的变化。随机效应模型用于总结整个研究过程中不良反应的风险。采用Cochran’s Q检验和不一致性检验(I2)评估异质性。使用Cochrane Collaboration推荐评估偏倚风险和证据的确定性。搜索确定了653个参考文献。其中10人入选。所有的研究都评估了肾脏和肝脏标志物的合格性。每日口服PrEP与3级或4级不良事件无关(RR = 0.99;95%置信区间:0.83—-1.18;I2 = 26.1%),严重不良事件(RR = 1.04;95%置信区间:0.58—-1.87;I2 = 88.4%), 3+4级肌酐水平(RR = 0.66;95%置信区间:0.24—-1.84;I2 = 79.9%), 3级或4级低磷血症(RR = 0.56;95%置信区间:0.15—-2.10)。对于分析的结果,证据的确定性从高到中等。每日口服PrEP对MSM和TGW是安全且耐受性良好的。干预组和对照组的不良反应最小且分布均匀。
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引用次数: 0
Violence, discrimination, and sexual health practices among adolescent men who have sex with men, transgender women and travestis in three cities in Brazil 巴西三座城市中男男性行为者、变性妇女和男男性行为者青少年中的暴力、歧视和性健康做法
Pub Date : 2023-12-08 DOI: 10.1590/0102-311XEN142922
M. Ryngelblum, Alexandre Grangeiro, Eliana Miura Zucchi, Márcia Thereza Couto, Inês Dourado, Laio Magno, U. Tupinambás, Maria Fernanda Tourinho Peres
The HIV epidemic has a disproportionate impact on adolescent and young men who have sex with men (AMSM) and transgender women and travestis (ATGW), with an increased HIV prevalence over the last 10 years. Violence affects the lives of these populations, undermining their ability to self-care and making them more vulnerable to HIV infection. In this study, we aimed to examine the association between different types of victimization by violence and discrimination and sexual health practices of these adolescent populations in steady and casual relationships. We conducted a cross-sectional study using baseline data from the cohort of PrEP1519 project. We used the mean score of sexual health practices as our outcome and the cumulative score of discrimination (within family, community, education, religious, online and public spaces) and violence (physical, sexual and intimate partner) as our exposure variable. We performed linear regression analyses to estimate the association between exposure and outcome. We found that 90% of AMSM and 95% of ATGW experienced at least one form of violence in the three months prior to this study and about 45% of ATGW suffered sexual violence during the same period. Experiencing discrimination within healthcare settings (from facilities or providers) was negatively associated with sexual health practices. Discrimination and violence negatively affect sexual health practices. HIV prevention and care of AMSM and ATGW people should involve listening to their experiences and addressing discrimination and violence in this population.
艾滋病毒流行病对发生男男性行为的青少年和青年男子以及变性妇女和男女同性恋者的影响尤为严重,在过去十年中艾滋病毒流行率有所上升。暴力影响到这些人群的生活,削弱了他们的自我照顾能力,使他们更容易感染艾滋病毒。在这项研究中,我们旨在研究在稳定和随意的关系中,这些青少年群体中不同类型的暴力和歧视受害与性健康实践之间的关系。我们使用PrEP1519项目队列的基线数据进行了横断面研究。我们使用性健康实践的平均得分作为结果,使用歧视(家庭、社区、教育、宗教、网络和公共空间)和暴力(身体、性和亲密伴侣)的累积得分作为暴露变量。我们进行了线性回归分析来估计暴露与结果之间的关系。我们发现90%的AMSM和95%的ATGW在研究前的三个月内至少经历过一种形式的暴力,大约45%的ATGW在同一时期遭受过性暴力。在卫生保健环境中(来自设施或提供者)遭受歧视与性健康行为呈负相关。歧视和暴力对性健康做法产生负面影响。艾滋病毒的预防和护理应该包括倾听他们的经历,并解决这一人群中的歧视和暴力问题。
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引用次数: 0
Adaptação transcultural e evidências de validade psicométricas da Family Health Scale para o português brasileiro 巴西葡萄牙语家庭健康量表的跨文化适应性和心理测量有效性证据
Pub Date : 2023-12-08 DOI: 10.1590/0102-311XPT048823
Evanizia Pinheiro de Oliveira, José Cláudio Garcia Lira Neto, I. Barreto, Ana Clara Pereira Resende da Costa, Roberto Wagner Freire de Freitas Júnior, Danilo Ferreira de Sousa, Márcio Flávio Moura de Araújo
Resumo: Os objetivos deste estudo foram realizar a tradução e adaptação transcultural da Family Health Scale (Escala de Saúde Familiar) para a língua portuguesa brasileira e analisar evidências de validade psicométricas dessa escala. Os 32 itens sobre a saúde familiar foram adaptados transculturalmente. Para a mensuração das evidências de validade do conteúdo, utilizou-se o cálculo do índice de validade de conteúdo das características semântica, idiomática, cultural e conceitual de cada item e da escala. Um pré-teste para identificação de evidência de validade foi realizado com 40 famílias. Em outro momento, a aplicação do instrumento foi executada com 354 famílias, em uma cidade no Nordeste do Brasil. O índice de concordância entre os juízes variou de 0,84, para os itens da escala, a 0,98, para a escala total, conforme o coeficiente de Kendall. As evidências de validade psicométricas mostram-se adequadas, conforme alfa de Cronbach. A maior parte das famílias teve um grau de saúde moderado, conforme aplicação da escala. Assim, a Family Health Scale, versão brasileira, apresentou equivalência conceitual, semântica, cultural e operacional em relação aos itens originais e propriedades psicométricas satisfatórias para a aplicação direcionada à população brasileira, atestando eficácia e segurança de sua utilização.
摘要本研究的目的是对巴西葡萄牙语家庭健康量表进行翻译和跨文化适应,并分析该量表的心理测量效度证据。关于家庭健康的32个项目进行了跨文化调整。为了测量内容效度的证据,我们计算了每个项目和量表的语义、习惯语、文化和概念特征的内容效度指数。对40个家庭进行了预测试以确定效度证据。在另一个时刻,该仪器的应用在巴西东北部一个城市的354个家庭中进行。根据肯德尔系数,法官之间的一致性指数从量表项目的0.84到总量表的0.98不等。根据Cronbach’s alpha,心理测量效度的证据是足够的。根据量表的应用,大多数家庭的健康状况适中。因此,巴西版的家庭健康量表在概念上、语义上、文化上和操作上与原始项目具有等价性,并对针对巴西人口的应用具有令人满意的心理测量特性,证明了其使用的有效性和安全性。
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引用次数: 0
Human rights, vulnerability, and critical reflection on HIV/AIDS prevention in the syndemic context 人权、脆弱性和在综合症背景下对艾滋病毒/艾滋病预防工作的批判性思考
Pub Date : 2023-12-08 DOI: 10.1590/0102-311XEN186423
Vera Silvia Facciolla Paiva, José Ricardo Ayres
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引用次数: 2
Unsupervised natural language processing in the identification of patients with suspected COVID-19 infection 识别疑似 COVID-19 感染者的无监督自然语言处理技术
Pub Date : 2023-12-04 DOI: 10.1590/0102-311XEN243722
Rildo Pinto da Silva, Juliana Tarossi Pollettini, Antonio Pazin Filho
Patients with post-COVID-19 syndrome benefit from health promotion programs. Their rapid identification is important for the cost-effective use of these programs. Traditional identification techniques perform poorly especially in pandemics. A descriptive observational study was carried out using 105,008 prior authorizations paid by a private health care provider with the application of an unsupervised natural language processing method by topic modeling to identify patients suspected of being infected by COVID-19. A total of 6 models were generated: 3 using the BERTopic algorithm and 3 Word2Vec models. The BERTopic model automatically creates disease groups. In the Word2Vec model, manual analysis of the first 100 cases of each topic was necessary to define the topics related to COVID-19. The BERTopic model with more than 1,000 authorizations per topic without word treatment selected more severe patients - average cost per prior authorizations paid of BRL 10,206 and total expenditure of BRL 20.3 million (5.4%) in 1,987 prior authorizations (1.9%). It had 70% accuracy compared to human analysis and 20% of cases with potential interest, all subject to analysis for inclusion in a health promotion program. It had an important loss of cases when compared to the traditional research model with structured language and identified other groups of diseases - orthopedic, mental and cancer. The BERTopic model served as an exploratory method to be used in case labeling and subsequent application in supervised models. The automatic identification of other diseases raises ethical questions about the treatment of health information by machine learning.
covid -19后综合征患者受益于健康促进计划。它们的快速识别对于这些程序的成本效益使用是重要的。传统的识别技术表现不佳,特别是在流行病中。利用一家私人医疗保健提供者支付的105,008份事先授权,应用主题建模的无监督自然语言处理方法,对疑似感染COVID-19的患者进行了描述性观察研究。共生成6个模型:3个使用BERTopic算法,3个使用Word2Vec模型。BERTopic模型自动创建疾病组。在Word2Vec模型中,需要对每个主题的前100例进行人工分析,以定义与COVID-19相关的主题。BERTopic模型每个主题超过1000个授权,没有单词治疗,选择了更严重的患者- 1987个先前授权(1.9%)中每个先前授权的平均成本为10,206雷亚尔,总支出为2,030万雷亚尔(5.4%)。与人类分析相比,它的准确率为70%,对潜在利益病例的准确率为20%,所有这些病例都需要进行分析,以纳入健康促进计划。与使用结构化语言的传统研究模式相比,它有重要的病例损失,并确定了其他类型的疾病——骨科、精神和癌症。BERTopic模型作为一种探索性方法,用于案例标注和随后在监督模型中的应用。其他疾病的自动识别引发了关于机器学习处理健康信息的伦理问题。
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引用次数: 0
A questão das urgências: uma porta para os direitos humanos em saúde 紧急情况问题:通向卫生领域人权的大门
Pub Date : 2023-12-04 DOI: 10.1590/0102-311xpt168123
José Ricardo de C. M. Ayres
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引用次数: 0
Para uma sociologia do câncer 迈向癌症社会学
Pub Date : 2023-12-04 DOI: 10.1590/0102-311xpt161023
Ana Beatriz Caetano Vieira, Gracielle Soares Silva Ruas, Nelson Filice de Barros
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引用次数: 0
期刊
Cadernos de Saúde Pública
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