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On January 2019, Brazil’s new far-right president Jair Bolsonaro was sworn into office. Bolsonaro’s administration supports downsizing the Brazilian Unified Health System (SUS), while increasing the size of the private health sector. The new administration might leave millions of Brazilians without medical care, including hundreds of thousands of people living with HIV/AIDS. Bolsonaro’s administration, allied with a highly conservative Congress and sharp decreases in federal funding for public health, education and research, could jeopardize key health and human rights strategies focused on women, LGBTQ + individuals, Indigenous populations, and people living with HIV/AIDS.

Trans women face disproportionate burden of adverse health outcomes, including mental health issues. Very little is known about suicidal behavior among trans women in low- and middle-income settings, such as Brazil. We aimed to estimate the prevalence of lifetime suicidal behavior and to identify its associated factors among Brazilian trans women. This was a cross-sectional study conducted among 345 trans women living in Rio de Janeiro, Brazil. We examined the prevalence of suicidal behavior (ideation and suicide attempt) and its associated factors using stepwise backward Poisson regression analysis with robust variance. Suicidal ideation was present among 47.25% of participants, and the prevalence of lifetime suicide attempt was 27.25%. Trans women with prior physical violence perpetrated by a family member had significantly higher prevalence of suicidal ideation (adjusted prevalence ratios [aPR]1.37), whereas those who reported sex work had lower prevalence ratio of suicidal ideation (aPR 0.76). Suicide attempt was significantly associated with living alone (aPR 1.48), physical violence by a casual partner (aPR 1.92), and sexual violence by a family member (aPR 1.69). Depression was significantly associated with both outcomes (aPR 1.90 for suicidal ideation and aPR 2.21 for suicide attempt). Suicidal behavior prevalence rates among Brazilian trans women were alarming and directly linked to violence and poor mental health. Effective mental health and public health policies addressing violence against trans women are urgently needed to prevent suicidal behavior among this highly vulnerable population.

Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children and young people (CYP) and a major cause of pain and disability. The vast majority of the world’s children and their families live in less resourced countries (LRCs) and face significant socioeconomic and healthcare challenges. Current recommendations for standards of care and treatment for children with JIA do not consider children living in less resourced countries. In order to develop appropriate recommendations for the care of CYP with JIA in less resourced countries a meeting of experienced pediatric rheumatologists from less resourced countries was convened with additional input from a steering group of international pediatric rheumatologists with experience in developing recommendations and standards of care for JIA. Following a needs assessment survey of healthcare workers caring for CYP with JIA in LRC, a literature review was carried out and management recommendations formulated using Delphi technique and a final consensus conference. Responses from the needs assessment were received from 121/483 (25%) practitioners from 25/49 (51%) less resourced countries. From these responses, the initial 84 recommendations were refined and expanded through a series of 3 online Delphi rounds. A final list of 90 recommendations was proposed for evaluation. Evidence for each statement was reviewed, graded, and presented to the consensus group. The degree of consensus, level of agreement, and level of evidence for these recommendations are reported. Recommendations arrived at by consensus for CYP with JIA in less resourced countries cover 5 themes: (1) diagnosis, (2) referral and monitoring, (3) education and training, (4) advocacy and networks, and (5) research. Thirty-five statements were drafted. All but one statement achieved 100% consensus. The body of published evidence was small and the quality of evidence available for critical appraisal was low. Our recommendations offer novel insights and present consensus-based strategies for the management of JIA in less resourced countries. The emphasis on communicable and endemic diseases influencing the diagnosis and treatment of JIA serves as a valuable addition to existing JIA guidelines. With increasing globalization, these recommendations as a whole provide educational and clinical utility for clinicians worldwide. The low evidence base for our recommendations reflects a shortage of research specific to less resourced countries and serves as an impetus for further inquiry towards optimizing care for children with JIA around the world.

Background Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. Methods This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. Results The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother’s name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. Conclusion With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.

To analyse the effectiveness and safety of adalimumab in a group of patients with juvenile idiopathic arthritis (JIA) who had failed treatment with etanercept and/or infliximab in a single paediatric rheumatology clinic. Patients with JIA with active polyarthritis refractory to metotrexate (MTX) (>=20 mg/m²/week) for at least 3 months and to etanercept (up to 1 mg/kg twice weekly) and/or infliximab (up to 10 mg/kg every 4 weeks) for at least 6 months were included. All patients received adalimumab 24 mg/m²/week concomitantly with MTX 7.5-10 mg/week. Evaluation of efficacy included improvement as defined by the ACR paediatric 30 criteria, 50% and 70% improvement and remission. Six patients were included. Three patients met improvement criteria; 50% and 70% improvement occurred in two children. Improvement was sustained for 12, 24 and 36 months, respectively. Remission occurred in one patient. Adalimumab was discontinued due to lack of efficacy in three patients. No side effects were observed. Adalimumab appears to be effective and safe in patients with JIA refractory to other anti-TNF agents. Further controlled studies are needed in order to assess efficacy of adalimumab in children with refractory JIA.

Dasyophthalma includes five species of medium-sized butterflies, all endemic from the Atlantic Forest of Brazil. All known species are univoltine and are dayflying, differently from other Brassolini that are mostly crepuscular. In despite of recent advances little is known about their natural history. Three out of the five species are included in the Brazilian Red List of threatened fauna and are of conservation concern. The present study provides for the first time a phylogenetic assessment of all Dasyophthalma species based on a molecular approach based on three loci. Also, the taxonomic status of D. rusina delanira was revised based on molecular data. In addition, up-to-date distributional data and conservation aspects of the threatened species from the genus are presented and discussed. The molecular phylogenetic analysis supports the monophyly of Dasyophthalma , with Dynastor darius as its sister-group, and, combined with a genetic divergence analysis, supported Dasyophthalma delanira stat. rest. as a valid name to species-level, sister-group to D. geraensis (and not a subspecies of D. rusina ). The geographical range (extent of occurrence and area of occupancy) for all five species are presented, showing that these are very restricted for D. delanira stat. rest. and D. geraensis , following the distributions of the high-altitude forests. As much biological information about the genus is lacking, the present study can serve as a starting point for future studies on Dasyophthalma , adding information that can be crucial for future conservation actions and essential to assure the future of the threatened species in this genus.

Objective to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. Method an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. Results the city’s rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R $ 0.02 in the neighborhood’s per capita income for every unit of incidence. Conclusion cumulative incident rates of COVID-19 are influenced by one’s neighborhood of residency, suggesting that access to testing is uneven. Objetivo analizar la relación entre la renta per cápita y la incidencia acumulada de COVID-19 en los barrios del municipio de Rio de Janeiro. Método estudio ecológico utilizando los barrios como unidades de análisis. Fueron calculadas las tasas de incidencia acumuladas por cada 100 000 habitantes y la mediana de las posibles variables mezcladas (sexo, raza/color y edad). El análisis múltiple contó con la técnica de regresión cuantílica, estimándose los coeficientes de regresión de la variable renta por cada cinco percentiles en el intervalo entre los percentiles 10 y 90, con el fin de verificar la relación entre la renta alquiler y la incidencia. Resultados la tasa municipal fue de 36,58 casos nuevos por 100 000 habitantes. En general, se observaron las mayores tasas de la enfermedad en las regiones de renta alta. El análisis múltiple coincidió con esta observación, ya que la renta per cápita tuvo efecto en todos los percentiles analizados, con un coeficiente de regresión medio de 0,02 (valor de p <0,001; R2 32,93). Es decir, para cada unidad de incidencia aumenta R$ 0,02 la renta per cápita del barrio. Conclusión las tasas de incidencia acumuladas de COVID-19 se ven influidas por la renta del barrio de residencia de los casos, lo que sugiere que el acceso a los exámenes se produce de forma desigual. Objetivo analisar a relação entre renda per capita e incidência acumulada de COVID-19 nos bairros do município do Rio de Janeiro. Método estudo ecológico utilizando os bairros como unidades de análise. Foram calculadas as taxas de incidência acumulada por 100 mil habitantes e a mediana de possíveis variáveis confundidoras (sexo, raça/cor e idade). A análise múltipla contou com técnica de regressão quantílica, estimando-se os coeficientes de regressão da variável renda a cada cinco percentis no intervalo entre os percentis dez e 90, a fim de verificar a relação entre renda e incidência. Resultados a taxa municipal foi de 36,58 casos novos por 100 mil habitantes. Em geral, as maiores taxas da doença foram observadas nas regiões de elevada renda. A análise múltipla coadunou com esta observação, já que a renda per capita apresentou efeito em todos os percentis analisados, tendo coeficiente de regressão mediano de 0,02 (p-valor <0,001; R2 32,93), ou seja, que a cada unidade de incidência elevam-se R$0,02 na renda per capita do bairro. Conclusão as taxas de incidência acumulada de COVID-19 são influenciadas pela renda do bairro de residência dos casos, sugerindo que o acesso aos exames esteja ocorrendo de modo desigual.

ABSTRACT Objective: To analyze the new roles of community health workers as outlined in the 2017 National Primary Care Policy (PNAB) from the perspectives of both nurses and community health workers. Methods: This qualitative study involved nurses and community health workers from Family Health teams, conducted through semi-structured interviews via videoconference between August 2021 and April 2022. The data were analyzed using thematic content analysis. Results: We identified professionals who argued that the new roles for community health workers aim to increase their autonomy and professional recognition. Others highlighted concerns about the loss of originality in their work and the potential for the illegal practice of nursing or nursing technician duties. Final Considerations: The 2017 PNAB emphasizes task execution for these workers, contributing to the mechanization of activities, reinforcing the biomedical model, and undermining the role of community health workers in promoting health within Primary Care. RESUMEN Objetivo: Analizar las nuevas atribuciones de los agentes comunitarios de salud preconizadas por la Política Nacional de Atención Básica (PNAB) de 2017 desde la perspectiva de los enfermeros y los agentes comunitarios de salud. Métodos: Se trata de un estudio cualitativo con enfermeros y agentes comunitarios de salud de equipos de Salud de la Familia, mediante entrevistas semiestructuradas realizadas por videoconferencia entre agosto de 2021 y abril de 2022. Los datos fueron analizados a través del análisis de contenido temático. Resultados: Identificamos profesionales que defendieron que las atribuciones de los agentes comunitarios de salud buscan aumentar la autonomía y el reconocimiento profesional de estos trabajadores. Otros señalaron la pérdida de la originalidad del trabajo y el ejercicio ilegal de la profesión de enfermero o técnico de enfermería. Consideraciones Finales: La PNAB-2017 asigna a estos trabajadores un énfasis en la ejecución de tareas, contribuyendo a la mecanización de las acciones, reforzando el modelo biomédico y desfigurando el papel del agente comunitario en la promoción de la salud en la Atención Primaria. RESUMO Objetivo: Analisar as novas atribuições dos agentes comunitários de saúde preconizadas pela Política Nacional de Atenção Básica (PNAB) de 2017 sob a ótica dos enfermeiros e dos agentes comunitários de saúde. Métodos: Estudo qualitativo com enfermeiros e agentes comunitários de saúde de equipes de Saúde da Família, por meio de entrevistas semiestruturadas entre agosto de 2021 e abril de 2022. Os dados foram submetidos à análise de conteúdo temática. Resultados: Identificamos profissionais que defenderam que as atribuições dos agentes comunitários visam o aumento da autonomia e valorização profissional desses trabalhadores. Outros apontaram para a perda da originalidade do trabalho, para o exercício ilegal da profissão de enfermeiro ou de técnico de enfermagem. Considerações Finais: A PNAB-2017 atribui a esses trabalhadores uma ênfase na execução de tarefas, contribuindo para a mecanização das ações, reforçando o modelo biomédico e descaracterizando o papel do agente comunitário na promoção da saúde na Atenção Primária.

Background Diagnosis of Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is currently based on a set of criteria proposed in 1999 modified from Marshall’s criteria. Nevertheless no validated evidence based set of classification criteria for PFAPA has been established so far. The aim of this study was to identify candidate classification criteria PFAPA syndrome using international consensus formation through a Delphi questionnaire survey. Methods A first open-ended questionnaire was sent to adult and pediatric clinicians/researchers, asking to identify the variables thought most likely to be helpful and relevant for the diagnosis of PFAPA. In a second survey, respondents were asked to select, from the list of variables coming from the first survey, the 10 features that they felt were most important, and to rank them in descending order from most important to least important. Results The response rate to the first and second Delphi was respectively 109/124 (88%) and 141/162 (87%). The number of participants that completed the first and second Delphi was 69/124 (56%) and 110/162 (68%). From the first Delphi we obtained a list of 92 variables, of which 62 were selected in the second Delphi. Variables reaching the top five position of the rank were regular periodicity, aphthous stomatitis, response to corticosteroids, cervical adenitis, and well-being between flares. Conclusion Our process led to identification of features that were felt to be the most important as candidate classification criteria for PFAPA by a large sample of international rheumatologists. The performance of these items will be tested further in the next phase of the study, through analysis of real patient data.

ABSTRACT Objective: to report the virtualization experience of the 81st Brazilian Nursing Week of a public university in the state of Rio de Janeiro. Methods: an experience report with descriptive approach on the planning and virtual operationalization of a traditional nursing event, which took place in May 2020. Results: the event had 543 entries and 39 activities were offered, 3 panels with the presence of international guests, 1 national conference, 3 thematic roundtable discussions, 9 roundtable discussions involving projects and extension leagues, 5 cultural activities and 17 activities in social networks (lives and videos). Final considerations: the virtualization of the 81st Brazilian Nursing Week brought the learning and appropriation of new ways of debating nursing in times of physical isolation, which will contribute to an immediate future in social and work relations as well as to the collaborative construction of knowledge. RESUMO Objetivo: relatar a experiência de virtualização da 81º Semana Brasileira de Enfermagem de uma universidade pública do estado do Rio de Janeiro. Métodos: relato de experiência com abordagem descritiva sobre o planejamento e a operacionalização virtual de um evento tradicional da enfermagem, que aconteceu em maio de 2020. Resultados: o evento contabilizou 543 inscrições e foram oferecidas 39 atividades, sendo 3 painéis com a presença de convidados internacionais, 1 conferência nacional, 3 rodas de conversa temáticas, 9 rodas de conversa envolvendo projetos e ligas de extensão, 5 atividades culturais e 17 atividades em redes sociais (lives e vídeos). Considerações finais: a virtualização da 81ª Semana Brasileira de Enfermagem trouxe o aprendizado e a apropriação de novas formas de debater enfermagem em tempos de isolamento físico, que contribuirão em um futuro imediato nas relações sociais e de trabalho, assim como para a construção colaborativa de conhecimentos. RESUMEN Objetivo: reportar la experiencia de virtualización de la 81ª Semana Brasileña de Enfermería en una universidad pública del estado de Río de Janeiro. Métodos: relato de experiencia con enfoque descriptivo sobre la planificación y operación virtual de un evento de enfermería tradicional, que se llevó a cabo en mayo de 2020. Resultados: el evento contó con 543 inscripciones y se ofrecieron 39 actividades, incluyendo 3 paneles con presencia de invitados internacionales, 1 conferencia nacional, 3 círculos de conversación temáticos, 9 círculos de conversación que involucran proyectos de extensión y ligas, 5 actividades culturales, 17 actividades en redes sociales (lives y videos). Consideraciones finales: la virtualización de la 81a Semana Brasileña de Enfermería trajo el aprendizaje y la apropiación de nuevas formas de debatir la enfermería en tiempos de aislamiento físico, que contribuirá en un futuro inmediato en las relaciones sociales y laborales, así como a la construcción colaborativa del conocimiento.