ODS/16 - Paz, justiça e instituições eficazes
URI Permanente desta comunidade
Objetivo: Promover sociedades pacíficas e inclusivas para o desenvolvimento sustentável, proporcionar o acesso à justiça para todos e construir instituições eficazes, responsáveis e inclusivas em todos os níveis.
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- ODS/16 - Paz, justiça e instituições eficazes
- ODS/16 - Paz, justiça e instituições eficazes
- ODS/16 - Paz, justiça e instituições eficazes
Submissões Recentes
Engaging stakeholders to level up COPD care in LMICs: lessons learned from the ""Breathe Well"" programme in Brazil, China, Georgia, and North Macedonia
(2024) FERNANDES, Genevie; WILLIAMS, Sian; ADAB, Peymane; GALE, Nicola; JONG, Corina de; SOUSA, Jaime Correia de; CHENG, Kk; CHI, Chunhua; COOPER, Brendan G.; DICKENS, Andrew P.; ENOCSON, Alexandra; FARLEY, Amanda; JOLLY, Kate; JOWETT, Sue; MAGLAKELIDZE, Maka; MAGHLAKELIDZE, Tamaz; MARTINS, Sonia; SITCH, Alice; STAMENOVA, Aleksandra; STAVRIKJ, Katarina; STELMACH, Rafael; TURNER, Alice; PAN, Zihan; PANG, Hui; ZHANG, Jianxin; JORDAN, Rachel E.
BackgroundEffective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned.Main bodyEach country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice.ConclusionStakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.
The relationship between internet gaming disorder and psychotic experiences: cyberbullying and insomnia severity as mediators
(2023) FEKIH-ROMDHANE, Feten; LAMLOUM, Eya; LOCH, Alexandre Andrade; CHERIF, Wissal; CHEOUR, Majda; HALLIT, Souheil
BackgroundThe nature of the relationship between Internet Gaming Disorder (IGD) and psychosis is unclear so far. There is evidence that greater time spent in playing video games may expose players to both insomnia and a toxic online environment with widespread cyberbullying. These two possible consequences of IGD may, in turn, be associated with greater psychotic experiences (PE). Based on this theoretical framework, the present study proposed to contribute the body of the knowledge in this area, by testing the possible indirect effects of insomnia severity, cyber-victimization and cyberbullying in the cross-sectional association between IGD and PE in a sample of Tunisian university students.MethodWe conducted a cross-sectional study over 4 months (February-May 2022). The Arabic versions of the Brief Symptom Inventory, the Internet Gaming disorder-20 Test, the Insomnia Severity Index, and the Revised Cyber Bullying Inventory-II were administered to a total of 851 students (mean age = 21.26 +/- 1.68 years, 53.7% females).ResultsWe found that 25% of students were at risk of IGD, and 1.8% had an IGD. The results of the mediation analysis showed that insomnia severity fully mediated the association between IGD and paranoid ideation. Higher IGD was significantly associated with more insomnia severity, which was, in turn, significantly associated with more paranoid ideation. Cyberbullying partly mediated the association between IGD and psychoticism. Higher IGD scores were significantly associated with more cyberbullying, which was, in turn, significantly associated with more psychoticism. Finally, greater IGD was significantly and directly associated with higher psychoticism.ConclusionOur findings suggest that insomnia and cyberbullying may be regarded as potential targets for youth mental health promotion, as well as community-focused prevention and early intervention in psychosis. More particular attention should be devoted to the huge potential for engaging in cyberbullying among online gamers. Sleep deprivation should be prevented, assessed and treated in heavy gamers.
Requirements for Brazilian Outpatient Centers of Excellence in Hidradenitis Suppurativa: Consensus
(2023) BELLEI, Ericles Andrei; SHIROZAKI, Miriam Emi Makinodan; PUGLIA, Ana Lia Pradella; CARVALHO, Andre Vicente Esteves de; RIQUENA, Barbara; VALLILO, Camilla Carlini; BARROS, Danilo de; TAMASHIRO, Erika Yumi; CINTRA, Gabriela; DUARTE, Gleison Vieira; RIVITTI-MACHADO-MACHADO, Maria Cecilia da Matta; MAGALHAES, Renata Ferreira; NASCIMENTO, Ricardo Figueiredo do; TUNALA, Roberto; SILVA, Roberto da; CESAR, Wagner Guimaraes Galvao; THIES, Felipe Garutti
Background: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research. Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages. Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education. Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.
Dimensions of harassment at school: dialogs about gender with young high school students in Sao Paulo/Brazil
(2023) SILVA, Cristiane Goncalves da; LEITE, Vanessa Jorge; PONTES, Julia Clara de
In this article, we discuss uses of ""harassment"" as a category employed by young students from public high schools to make sense of violence and gender discrimination experiences that occur in and out of school. The analysis is based on fieldwork records produced within the scope of a multicenter, mixed -methods research carried out in nine schools located in Sao Paulo. Harassment appears as a polysemic category that, by naming violence, helps to face gender and generation hierarchies and inequalities. We infer that the young girls have questioned norms and attitudes that feed gender inequalities in schools; in addition, they have denounced the silence or inadequacy of the institution in facing the problem. This enables to identify convergences with a new sensibility regarding violence against women that globalized feminist discourses have brought to the surface.
Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) MEDEIROS, Danielle Souto de; MAGNO, Laio; GUIMARAES, Mark Drew Crosland; GRANGEIRO, Alexandre; EUSTORGIO FILHO, Marcos; SOARES, Fabiane; GRECO, Dirceu; WESTIN, Mateus; FERRAZ, Dulce; ZUCCHI, Eliana Miura; DOURADO, Ines
Purpose: This study aimed at describing the prevalence of symptoms of depression among 15-19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. Methods: This is a cross-sectional study of baseline data among 730 aMSM and 56 aTGWrecruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of >= 22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. Results: Our findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12-2.70), sexual violence (aOR = 1.79; 95% CI = 1.07-2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23-2.38) were independently associated with severe symptoms of depression in aMSM. Discussion: The high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis. (c) 2023 Society for Adolescent Health and Medicine.
When Ethics and the Law Collide: A Multicenter Demonstration Cohort Study of Pre-Exposure Prophylaxis Provision to Adolescent Men Who Have Sex With Men and Transgender Women in Brazil
(2023) ZUCCHI, Eliana Miura; FERGUSON, Laura; MAGNO, Laio; DOURADO, Ines; GRECO, Dirceu; FERRAZ, Dulce; TUPINAMBAS, Unai; GRANGEIRO, Alexandre
Purpose: To explore legal and ethical challenges related to adolescents' participation in human immunodeficiency virus (HIV) research that may affect their best interests. Methods: We analyzed the ethical principles and legal aspects of the participation of 15-17-year-old men who have sex with men and transgender women in the pre-exposure prophylaxis (PrEP) 1519 study, a PrEP demonstration cohort study in three Brazilian cities. The analyses of ethics review committees' (ERCs) evaluations and court decisions followed ethical and human rights principles. An HIV vulnerability score was created, and descriptive statistics and multivariate logistic regression were performed using data from 347 participants. Results: The ERCs evaluated the benefits and risks of research participation, all finding that the benefits outweighed the risks. ERCs deferred responsibility for decisions about waiving parental consent to the judiciary. State courts reached different decisions about waiving parental consent, reflecting variation in recognition of adolescents' evolving capacities and the adolescent as a subject of sexual rights and the primary agent capable of deciding on their health and best interests. The most vulnerable adolescent participants were found in sites where the blanket waiver was in place. Discussion: Judicializing the ethical review process is detrimental to fulfilling the ethical principle of justice and vulnerable adolescents' access to health research. ERCs must be sufficiently independent and autonomous and have the capacity to respect, protect, and help fulfill the rights of participants while ensuring the generation of adequate evidence to inform public health practice. (c) 2023 Society for Adolescent Health and Medicine.
Violence, discrimination, and sexual health practices among adolescent men who have sex with men, transgender women and travestis in three cities in Brazil
(2023) RYNGELBLUM, Marcelo; GRANGEIRO, Alexandre; ZUCCHI, Eliana Miura; COUTO, Marcia Thereza; DOURADO, Ines; MAGNO, Laio; TUPINAMBAS, Unai; PERES, Maria Fernanda Tourinho
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 discrimi-nati on (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. Discrimi-nation and violence negatively affect sexual health practices. HIV prevention and care of AMSM and ATGW people should involve listening to their experi-ences and addressing discrimination and violence in this population.
Air Pollution and Health - A Science-Policy Initiative
(2019) ANDRADE, Maria de Fatima; ARTAXO, Paulo; MIRAGLIA, Simone Georges El Khouri; GOUVEIA, Nelson; KRUPNICK, Alan J.; KRUTMANN, Jean; LANDRIGAN, Philip J.; LANGERMAN, Kristy; MAKONESE, Tafadzwa; MATHEE, Angela; PIKETH, Stuart; RITZ, Beate; SALDIVA, Paulo H. N.; SAMET, Jonathan; SCHIKOWSKI, Tamara; SCHNEIDER, Alexandra; SMITH, Kirk R.; TRAIDL-HOFFMANN, Claudia; WIEDENSOHLER, Alfred; WRIGHT, Caradee; BOYD, David Richard; FOLTESCU, Valentin; FULLER, Richard; JAROSINSKA, Dorota; MCGLADE, Jacqueline Myriam; SHINDELL, Drew; SCHEUENSTUHL, Marcos Cortesao Barnsley; BORIGHT, John P.; BULANI, Siyavuya; HAMBURG, Margaret; HAPPE, Kathrin; NISSEN, Jan; SCHEER, Isabel
Air pollution is a major, preventable and manageable threat to people's health, well-being and the fulfillment of sustainable development. Air pollution is estimated to contribute to at least 5 million premature deaths each year across the world. No one remains unaffected by dirty air, but the adverse impacts of air pollution fall most heavily upon vulnerable populations, such as children, women, and people living in poverty - groups to whom States have special obligations under international human rights law. The National Academies of Sciences and Medicine of South Africa, Brazil, Germany and the United States of America are calling upon government leaders, business and citizens to take urgent action on reducing air pollution throughout the world - to the benefit of human health and well-being, to the benefit of the environment and as a condition towards sustainable development. Air pollution is a cross-cutting aspect of many UN Sustainable Development Goals.
The (in)visible Brazilians: A perspective review on the need for brain health and dementia research with Brazilian immigrants in the United States
(2023) SIMON, Sharon Sanz; BRUCKI, Sonia Maria Dozzi; FONSECA, Luciana Mascarenhas; BECKER, Jacqueline; CAPPI, Carolina; MARQUES, Andrea Horvath; HEYN, Patricia C.; GONCALVES, Priscila Dib; MARTINS, Silvia S.; BUSATTO, Geraldo; SUEMOTO, Claudia Kimie; NITRINI, Ricardo; CARAMELLI, Paulo; YASSUDA, Monica Sanches; MIOTTO, Eliane Correa; GRINBERG, Lea Tenenholz; RENTERIA, Miguel Arce; ALEGRIA, Margarita; STERN, Yaakov; RIVERA-MINDT, Monica; BERTOLA, Laiss
Introduction: The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group-specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities. It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population.Methods: We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles.Results: This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S-residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials.Conclusions: The recommendation and research efforts proposed should help to pave the way for the development of community-engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally-informed intervention to the U.S.-residing Brazilian communities.
Exploring the mediation of DNA methylation across the epigenome between childhood adversity and First Episode of Psychosis-findings from the EU-GEI study
(2023) ALAMEDA, Luis; LIU, Zhonghua; SHAM, Pak C.; AAS, Monica; TROTTA, Giulia; RODRIGUEZ, Victoria; FORTI, Marta Di; STILO, Simona A.; KANDASWAMY, Radhika; ARANGO, Celso; ARROJO, Manuel; BERNARDO, Miguel; BOBES, Julio; HAAN, Lieuwe de; DEL-BEN, Cristina Marta; GAYER-ANDERSON, Charlotte; SIDELI, Lucia; JONES, Peter B.; JONGSMA, Hannah E.; KIRKBRIDE, James B.; CASCIA, Caterina La; LASALVIA, Antonio; TOSATO, Sarah; LLORCA, Pierre-Michel; MENEZES, Paulo Rossi; OS, Jim van; QUATTRONE, Diego; RUTTEN, Bart P.; SANTOS, Jose Luis; SANJUAN, Julio; SELTEN, Jean-Paul; SZOKE, Andrei; TARRICONE, Ilaria; TORTELLI, Andrea; VELTHORST, Eva; MORGAN, Craig; DEMPSTER, Emma; HANNON, Eilis; BURRAGE, Joe; DWIR, Daniella; ARUMUHAM, Atheeshaan; MILL, Jonathan; MURRAY, Robin M.; WONG, Chloe C. Y.
AbtractStudies conducted in psychotic disorders have shown that DNA-methylation (DNAm) is sensitive to the impact of Childhood Adversity (CA). However, whether it mediates the association between CA and psychosis is yet to be explored. Epigenome wide association studies (EWAS) using the Illumina Infinium-Methylation EPIC array in peripheral blood tissue from 366 First-episode of psychosis and 517 healthy controls was performed. Adversity scores were created for abuse, neglect and composite adversity with the Childhood Trauma Questionnaire (CTQ). Regressions examining (I) CTQ scores with psychosis; (II) with DNAm EWAS level and (III) between DNAm and caseness, adjusted for a variety of confounders were conducted. Divide-Aggregate Composite-null Test for the composite null-hypothesis of no mediation effect was conducted. Enrichment analyses were conducted with missMethyl package and the KEGG database. Our results show that CA was associated with psychosis (Composite: OR = 1.68; p = p < 0.001; neglect: OR = 2.27; p = <0.001). None of the CpG sites significantly mediated the adversity-psychosis association after Bonferroni correction (p < 8.1 x 10(-8)). However, 28, 34 and 29 differentially methylated probes associated with 21, 27, 20 genes passed a less stringent discovery threshold (p < 5 x 10(-5)) for composite, abuse and neglect respectively, with a lack of overlap between abuse and neglect. These included genes previously associated to psychosis in EWAS studies, such as PANK1, SPEG TBKBP1, TSNARE1 or H2R. Downstream gene ontology analyses did not reveal any biological pathways that survived false discovery rate correction. Although at a non-significant level, DNAm changes in genes previously associated with schizophrenia in EWAS studies may mediate the CA-psychosis association. These results and associated involved processes such as mitochondrial or histaminergic disfunction, immunity or neural signalling requires replication in well powered samples. The lack of overlap between mediating genes associated with abuse and neglect suggests differential biological trajectories linking CA subtypes and psychosis.