Epidemiologia e Servicos de Saude最新文献

Objective: To develop and validate a simulated scenario for post-suicide attempt care for a person undergoing gender transition.

Method: This was a methodological study conducted in two stages: (i) development of the scenario based on the literature and clinical simulation recommendations; (ii) validation by ten experts, through an online assessment using a Likert scale and suggestions. Descriptive analyses and content validity index were applied.

Results: : All items met the minimum acceptance criterion (≥0.70), and adjustments were made to incorporate a more inclusive approach and reflect the diversity of gender identities.

Conclusion: The study developed and validated a clinical simulation scenario for post-suicide attempt care for a person undergoing gender transition. The expert validation indicated agreement on the scenario's items, which can be applied in accessible training and qualification for healthcare professionals across different categories and contexts.

Objective: To describe the sociodemographic profile and access to social assistance and health services among trans people and travestis experiencing homelessness in Salvador, the capital city of Bahia state.

Methods: This was a cross-sectional study involving 24 (4.5%) participants who identified as trans people or travestis out of a total of 529 people, aged 18 or older, living in public spaces or institutional shelters included in the survey. Data were collected between 2021 and 2022, using structured questionnaires.

Results: The sample was predominantly comprised of trans women and travestis (n=18), young individuals (n=13), of Black race/skin color (n=22), single individuals (n=18) and those engaged in informal occupations (n=23), many of whom reported experiencing violence (n=17). Frequent barriers to accessing healthcare and social assistance services were found (n=15), including lack of documentation, delay in service provision and social/racial discrimination.

Conclusion: The findings highlight the heightened vulnerability of transgender people and travestis experiencing homelessness, who are subjected to multiple forms of discrimination and social exclusion.

Objective: To describe how transgenderism is studied in research on the health of older adults.

Methods: This was a systematic literature review, with searches conducted in September 2022 across the LILACS, MEDLINE/ PubMed, Embase, Web of Science and Scopus databases. The articles were selected independently by two reviewers. The risk of bias was assessed using the JBI Critical Appraisal Tools and data synthesis followed the Entreq and Swim protocols.

Results: A total of 15 studies were included, eight qualitative and seven quantitative, from 2014 to 2023. Most of them specifically analyzed the transgender population. The qualitative studies focused on individuals' perceptions and experiences, health care planning and support networks. The quantitative studies addressed gender characterization, health status (including mental health), and associations with social determinants.

Conclusion: Despite the different approaches, the studies addressed the subject in the context of accumulated stigmas and discrimination faced this population.

Objective: To identify the available evidence on the risk of developing cancer in transgender people undergoing hormone therapy.

Methods: This was a rapid systematic review conducted in the PubMed, Embase, Virtual Health Library, Cochrane Library and Epistemonikos databases. Screening and data extraction were performed by independent reviewers using the Rayyan platform. Data extraction was carried out by 3 independent reviewers. We used the Joanna Briggs Institute checklists specific to cohort and case-control studies to assess the methodological quality of the included studies.

Results: Five studies were included, 4 cohort studies and 1 case-control. The risk of transgender people developing cancer while on hormone therapy was identified by 2 studies and not identified in 3 studies.

Conclusion: Despite studies with large sample sizes and rigorous selection criteria, the literature does not present a consensus on the association between hormone therapy and the development of cancer in transgender people.

Objective: To analyse vaccination coverage and factors associated with incomplete polio vaccination in a cohort of children born in 2017-2018, in state capitals and interior region municipalities of Northeast Brazil.

Methods: Household survey of children aged ≤24 months conducted between 2020 and 2022. Vaccination coverage and dropout rates were estimated, as well as factors associated with incomplete vaccination, analyzed by calculating odds ratios (OR) and 95% confidence intervals (95%CI).

Results: : Among 12,137 children, vaccination coverage (4 doses) was 80.9% (95%CI 78.4;83.1); 8.4% were not vaccinated. Not having a vaccination card (OR=18.06; 95%CI 10.01;32.61) and use of private services (OR=1.46; 95%CI 1.23;1.74) were associated with incomplete vaccination. Higher dropout rates were found for the booster dose, especially in the highest stratum.

Conclusion: Low vaccination coverage, poor dose follow-up and high dropout rates were found for polio vaccines in the areas studied.

Objective: To estimate prevalence of the full vaccination schedule for children 12 to 24 months old and to analyze associated factors.

Methods: Survey with cluster sampling carried out in Vitória, Espírito Santo, Brazil, between December 16, 2020, and January 4, 2021. Children born in Vitória in 2017 and 2018 were included. We estimated the prevalence of vaccination schedules. Poisson regression was used to verify association with full vaccination coverage.

Results: We included 788 children. Full vaccination coverage was found to be 57% taking a 95% confidence interval (95%CI 50.98;62.98). Prevalence of full vaccination coverage was lowest when private services were used for immunization (prevalence ratio [PR] 0.67; 95%CI 0.51;0.86) and when mothers had ≥ 4 children (PR 0.55; 95%CI 0.32;0.94).

Conclusion: We found low vaccination coverage and a drop in booster doses. Use of private services for immunization and number of children were associated with incomplete vaccination coverage.

Objective: To analyze the representation of access pathways to the transsexualizing process in Brazil and the main barriers faced by transgender people.

Method: A scoping review of the literature was conducted. Searches took place in January 2024, with articles and reviews that addressed access to the transsexualizing process being eligible, while books, chapters, conferences, editorial documents, and studies describing surgical procedures were excluded.

Results: A total of 776 articles were found, of which 9 were included. 66% of the studies analyzed were field research involving interviews. The findings highlight the 5 stages of the transsexualizing process: care at primary healthcare centers, referral, multidisciplinary follow-up, surgical procedure, and local care for individuals.

Conclusion: The studies focused on the barriers to accessing the transsexualizing process, rather than on the access pathways themselves, highlighting a gap in the understanding of the access itineraries to the process. rather than on the access pathways themselves, highlighting a gap in understanding the itineraries to the process.

Objective: To estimate vaccination coverage and analyze factors associated with full vaccination among children up to 15 months old in the city of Natal-RN, Brazil.

Methods: Population-based survey with data recorded on children's vaccination cards and interviews conducted in 2020 and 2021. Analysis of factors associated with complete vaccination was performed by calculating prevalence ratios (PR) and 95% confidence intervals (95%CI) using Poisson regression.

Results: Among 688 children studied, vaccination coverage was 45.4% (95%CI 37.2;53.9) and 15.5% (95%CI 10.6;22.2) for valid and on-time doses, respectively. Higher vaccination coverage was associated with females (PR=1.08; 95%CI 0.78;1.48) and socioeconomic strata C and D (PR=1.44; 95%CI 1.03;2.02).

Conclusions: The results demonstrate that the city of Natal has low vaccination coverage for all immunobiologicals.

Objective: The study aims to describe the violence perceived by transvestigender people in Brazil, linking it to primary healthcare.

Methods: Fourteen transvestigender people in Brazil were interviewed through 2 focus groups and 8 interviews, conducted between December 2021 and April 2022. Data analysis was performed using a phenomenological-hermeneutic approach.

Results: The statements were categorized into the following themes: "the unintentional nature of violence", "violence in health services" and "the family as a producer of violence". These categories show that the phenomenon of violence extends beyond intentional acts directed at a person, as originally conceptualized by the World Health Organization.

Conclusion: The transvestigender population experiences both intentional and unintentional violence, which impacts their physical and emotional well-being. Primary healthcare can serve as an ally in addressing these forms of violence by ensuring comprehensive care.

Objective: To describe HIV prevention strategies and gender-based discrimination among adolescent travestis and transgender women.

Methods: This was a cross-sectional study involving 148 adolescent travestis and transgender women aged 15 to 19 years in Salvador, Bahia state, São Paulo, São Paulo state, and Belo Horizonte, Minas Gerais state, conducted between February 2019 and March 2023. Fisher's exact test was performed to assess differences between prevention strategies and gender-based discrimination within healthcare services.

Results: 18.9 % reported engaging in receptive anal sex using condom in the past 6 months; 62.2% had undergone HIV test at least once in their lifetime; and 88.5% had started pre-exposure prophylaxis (PrEP) for HIV. Adolescents aged 15 to 17 years with previous experiences of discrimination in healthcare services had undergone fewer HIV tests in their lifetime or had started PrEP less frequently.

Conclusion: There is an urgent need for the implementation of public policies that eradicate gender-based discrimination and expand access to HIV prevention.