Women In Brazil Research Articles

Breast cancer and molecular testing in Brazil.

e13602 Background: Breast cancer is a common malignancy among women worldwide. Regardless of the economic status of a country, breast cancer poses a burden in prevention, diagnosis and treatment.Accurate pathologic and molecular diagnosis of high quality in breast cancer is a challenge in low- and middle-income countries (LMIC). The two most important aspects needed are the hormonal and epidermal growth factor receptor 2 (HER2) status as they are used as prognostic factor and as predictive biomarker for treatment. The most commonly used tests for assessing HER2 status are immunohistochemistry (IHC) assays for HER2 protein expression and fluorescence in situ hybridization (FISH) for HER2 gene amplification.In this study, we evaluated the hormonal and HER2 status of women with breast cancer and the need for FISH in HER2+++. Methods: We retrospectively reviewed the database of the Hospital Evangelico de Cachoeiro de Itapemirim, a regional cancer center from the south of Espirito Santo State – Brazil.The period covered in the study was from 01/08/2019 to 01/08/2020. We analyzed all new cases of invasive breast cancer diagnosed by IHC for the estrogen (ER), progesterone (PR) and HER2 receptors. All the HER 2++ and HER2 +++ were tested by FISH. We had during this period 152 newly diagnosed cases, 11 patients were excluded due to missing data. Results: The 141 cases were separated into four categories by hormonal status: 109 ER+PR+ (77,3%), 9 ER+PR− (6,4%), 2 ER−PR+ (1,4%) and 21 ER−PR− (14,9%). When these results were associated to HER 2 status we found 11 (7,8 %) triple negative breast cancer (TNBC) , 26 (18,43%) HER2 ++ and 23 (16,31%) HER 2+++. The HER2++ were tested by FISH and 8 (30,7%,) were found positive, 10 (38,6%) negative and 8(30,7%)indeterminate. Among the HER 2 +++ tested by FISH we found 15 (65,3 %) positive and 8 (34,7 %) indeterminate. Conclusions: Our study demonstrated a lower incidence of TNBC and higher incidence of hormone-receptor positive cases as compared with other institutions. Different from other countries, all HER 2++ and HER2+++ in Brazil need to go to molecular testing. Altough trastuzumab is available in the public Brazilian Health System (SUS) for HER 2 positive women, diagnosis with IHC alone is not permitted and there is a need for molecular testing confirmation. Therefore, the most troublesome data in this study was that 34,7% of HER 2+++ had indeterminate FISH results, in these cases SUS does not offer traztuzumab. Newer guidelines allow the use of IHC only in HER2 +++ . We consider important for SUS to review the recommendation for need of molecular testing for all HER2 +++ so this will avoid subtreating women in Brazil

Violência obstétrica relacionada a perda de autonomia da mulher na sala de parto

Introdução: A vulnerabilidade, perda da autonomia da mulher em uma sala de parto e as violências obstétricas, como: maus tratos, desrespeito, abusos e negligência realizados pela equipe de profissionais da saúde sofridas por ela. Objetivo geral: Identificar de que forma é reproduzida a violência obstétrica a mulher, o contexto e implicações a sua condição de vulnerabilidade, tendo como objetivo específico: Descrever a importância de elencar estratégias (educação em saúde) e empoderamento a autonomia da mulher, desde o pré-natal até a sala de parto, analisando o cuidado integral durante o pré natal, respeitando os desejos da parturiente, o que atenuariam em situações de violência obstétrica. Metodologia: Trata-se de um estudo com abordagem qualitativa, de cunho descritivo, do tipo revisão integrativa. A coleta de dados foi realizada na Biblioteca Virtual de Saúde (BVS), aonde foram apontadas quatro bases de dados: BDENF; LILACS; MEDLINE; ColecionaSus; os descritores (DeCS) utilizados foram: violência; obstetrícia; educação em saúde; profissionais de saúde. A amostra final foi composta por 9 artigos publicados entre os anos de 2015 a 2019, redigidos no idioma português e após filtrar os critérios de inclusão e exclusão foram utilizados 05 artigos. Na análise de dados foram estabelecidas três categorias: 1: Conceito abrangente de violência; 2: Violência contra a mulher no Brasil e 3: Violência obstétrica. Concluímos que a violência obstétrica praticada contra a mulher pode ocorrer desde o pré-natal até o momento do parto e que a vulnerabilidade as torna suscetíveis as práticas abusivas. Entretanto, o conhecimento adquirido no pré-natal, o vínculo, confiança e segurança criado entre profissional da saúde e paciente as transformam em mulheres capazes de identificar quando não estão sendo tratadas adequadamente o que diminui o índice de violência no parto e aprimorar a gestação.

FEMINICÍDIO: SOB A BANALIZAÇÃO DAS MORTES VIOLENTAS POR RAZÕES DE GÊNERO E SEUS DESAFIOS DIÁRIOS

The theme of this article is feminicide: under the trivialization of violent deaths for gender reasons and their daily challenges. The following problem was asked: Have women been killed because of their gender status and because of a patriarchal society? The following hypothesis was considered Women have been killed because of patriarchal behavior in culture. The overall objective To investigate the banal deaths of women and their link with patriarchy. The specific objectives are: present historical evolution and concept; enforcement 13.104/15; analyze cases; challenges in obtaining official data. This work is important for a law operator due to the great relevance in the judiciary and media; for science, it's relevant for verifying whether there is effectiveness in coping against violence of women in Brazil; adds to society because it is a gain in criminal law and to clarify possible questions. This is theoretical qualitative research lasting six months.

Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study.

Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW). A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP. Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics. Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

Tertiary education expansion and access for disadvantaged women in Brazil and Mexico

This paper seeks to identify if women from vulnerable, socioeconomic and ethnic/racially, backgrounds have been benefited from this process through the Maximally Maintained Hypothesis developed by Raftery and Hout (1993), in which vulnerable or less advantageous groups can access education only after the demand of the most advantaged group has been met. Using data from the National Household Surveys from Brazil (PNAD) and Mexico (ENIGH) both countries were studied for the 2004 and 2014 periods in order to observe the changes occurring through time, with a focus on the women population. As a result, this study found two different dynamics of inclusion: while in Brazil higher socioeconomic inclusion has been attained, there is a persistent stratification by race in tertiary education with an underrepresentation of non-white participants. On the other hand, Mexico has advanced in terms of including the population that describes itself as indigenous or understands an indigenous language, nonetheless underrepresentation from those that speak an indigenous language persist and socioeconomic stratification remains a factor of exclusion.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil.

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, “passing” concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher “passing” concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and “passing” concerns in transgender populations.

Translation and validation of the Brazilian version of the Physical Appearance Comparison Scale-Revised in college women

Brazilian women are known to present high levels of physical appearance concerns, and data suggest they often compare themselves with others. Nevertheless, there is no validated instrument to systematically assess appearance comparisons in the Brazilian population. Thus, this study aimed to translate the Physical Appearance Comparison Scale-Revised (PACS-R) into Brazilian Portuguese and evaluate its factor structure, internal consistency, and convergent validity in Brazilian college women. The translated version into Brazilian Portuguese of the PACS-R was completed by 832 Brazilian college women and its factor structure was examined through exploratory and confirmatory factor analyses, internal consistency through McDonald’s omega, and convergent validity through its associations with measures of eating disorder symptoms, internalization of appearance ideals, appearance-related sociocultural pressures, body satisfaction, and self-esteem. The results suggested an 11-item single-factor scale. The Brazilian Portuguese PACS-R showed adequate internal consistency and was significantly associated with all measures of convergent validity in the expected direction, indicating its adequate convergent validity. The Brazilian Portuguese PACS-R might be useful in the investigation of the appearance comparison among women in Brazil, as also in the study of body image and eating disorders.

COVID in women in Brazil: length of stay and outcomes of first hospitalizations

Objective: to analyze the length of hospital stay and outcomes of the first hospitalizations due to COVID-19 of women at the beginning of the pandemic. Methods: ecological study with data on COVID-19 hospitalizations of women. Data classification was done by states, regions, age, length of hospital stay, main and secondary diagnosis (underlying diseases), and outcome. Kruskal-Wallis, Mann-Whitney, and chi-square tests were used for the analysis. Results: the Southeast region had the highest number of hospitalizations (0.6%). Of the total number of hospitalizations, 14.6% required an intensive care unit. The length of hospital stay of women over 50 years was significant for Brazil (p<0.001). There was an association between length of hospital stay and levels 2 and 3 of comorbidity. Deaths in women over 50 years old were significant in Brazil, Northeast, and Southeast (p<0.001). Conclusion: women over 50 years old with comorbidities are associated with longer hospital stays and deaths.

Factors Associated with HIV and Vulnerability Contexts for Women in Brazil.

The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.

Afro-descendant women Bolsa Familia and Supplemental Nutrition Assistance Program in Brazil and the United States

We examine the impact of class and racial discrimination on Afro-descendant women social welfare beneficiaries in Brazil and the USA. We focus on the cities Salvador, São Paulo, Charlotte, and Milwaukee. We find that in all these cities, more than a majority of social welfare beneficiaries ate dark skinned thus showing that both countries are pigmentocracies where disadvantage is based on skin color, class, and gender. We find that of those admitting they experienced skin color discrimination more than a majority ate dark skinned. Women in the USA are generally more likely to acknowledge skin color discrimination while women in Brazil are more likely to acknowledge class based discrimination.

DOS LAÇOS E NÓS DA DIÁSPORA

Kim Butler narrates her life trajectory in New York, at university and experience in Brazil in the 1980s. She remembers her first ideas about Brazil and black culture in the diaspora. It analyzes the theoretical, methodological and political changes that have been guiding new generations of academic black men and black women in Brazil.

DESENGAVETANDO GÊNERO À LUZ DOS FEMINISMOS NO BRASIL

O artigo trata de questões emanadas pela diversidade de resistências de movimentos de diferentes mulheres no Brasil, as quais se norteiam por vivências concretas distintas e com projetos societários variados. De caráter teórico - porém fundado em trajetória pessoal e profissional da autora junto aos movimentos feministas e de mulheres - visa refletir sobre as diferentes visibilidades e mesmo invisibilizações de movimentos de mulheres e feministas, a partir da dinâmica particular de nossa formação social brasileira. Ao final, visando desdobramentos futuros do debate, sinalizamos elementos importantes para os estudos de feminismos, movimentos de mulheres e de gênero na academia. Palavras-chave: Gênero. Relações sociais de sexo. Raça. Classe social. Formação social brasileira.

Knowledge of Zika Virus Transmission and Its Prevention among High-Risk Pregnant Women in Brazil.

Recent outbreaks of Zika virus (ZIKV) infection highlight the urgent need to evaluate the efficacy of current public health measures to educate susceptible groups about how to prevent infection, modes of viral transmission, and consequences of infection. We performed a cross-sectional study in the city of Jundiaí, São-Paulo, from March 2016 to August 2017. In 315 high-risk pregnant women we evaluated the rate of ZIKV infection, knowledge of pathways of ZIKV transmission, and the use of protective measures. Data were analyzed and correlated with sociodemographic variables. The rate of ZIKV infection was 10.8%. ZIKV transmission by mosquitoes was the best-known means of virus acquisition, while transmission of ZIKV by sexual intercourse as well as mother–fetus transmission was known by less than half of the women. The use of insect repellent, reported by 53% of participants, was correlated with higher education and personal directives from health professionals. Condom use was reported by 19.5% of subjects. Improved strategies to increase awareness of ZIKV infection and its consequences, designed to appeal to specific, targeted populations, are clearly necessary to more accurately prevent the spread of this infection and diminish adverse consequences in the pregnant population.

Mulheres negras que narram a luta pela liberdade individual e/ou coletiva:

This article intends to analyze the account of two black women who appropriated writing to narrate their stories, while narrating the history of the nation of each one of them. The authors, Maria Carolina de Jesus and Deolinda Rodrigues, the first Brazilian and the second Angolan, write their stories in diaries. We investigate, literarily, how, in Quarto de despejo: diario de uma favelada, first edition in 1960, Carolina Maria de Jesus presents a writing of herself that is also an account of the daily struggle of the poor, blacks and women in Brazil for existence and subsistence . In the book of Deolinda Rodrigues, Diario de um exilio sem regresso, we follow the story of the struggle for independence for the Angolan nation by a black woman. In this comparative article, we intend to show the distances and approximations of the narrative strategies of these two black women.

Breast Cancer Mortality in Young Women in Brazil.

ObjectiveMalignant breast cancer is the leading cause of death by cancer in young women. The study aimed to determine if breast cancer mortality among young women has increased between the period from 1996 to 2017 in Brazil.MethodsA time-series analysis of breast cancer mortality rate in young women (20–39 years old) was carried out. Mortality data, from 1996 to 2017, were collected from the Mortality Information System of the Health Ministry, and demographic data, from the Brazilian Institute of Geography and Statistics. Trends in mortality were performed by Joinpoint Regression, the spatial distribution of the mortality rate was done with the QGIZ Software version 2.18, and Spearman’s correlation coefficient was used to correlate the mortality rates with the Human Development Index.ResultsThere was an increase in breast cancer mortality rates in young women in the majority of Brazilian states, with an upward trend in all regions. The correlation with the Municipal Human Development Index, income, and education had a significant impact on the mortality rate for women from 30–39 years old in both time frames evaluated and for women from 20–29 years old, only from 1996 to 2000.ConclusionThe data obtained in the study, showed that even though the breast cancer mortality rate of young women is lower than women over 40 years old, it has been increasing in all regions of Brazil, mostly for women from 30–39 years old, suggesting that this group should be included in screening programs.

The role of women in artisanal fishing on the Oléria River, Marajó archipelago, Brazil

Fishing women in Brazil are still “invisible” in the eyes of contemporary society. It is with this perspective, that this work analyzed the role of riverside women in artisanal fishing in the Marajó archipelago (state of Pará, Brazil). The research was carried out in the Santo Antônio community in the municipality of Breves, located on the Oléria river. The methodological procedure used was bibliographic research and questionnaires with twenty women who practice fishing along this river. Data collection took place in January 2020. The information was analyzed using a simple description. The research revealed that even though women engaged in various fishing-related activities, they are usually represented by their husbands or children and their activity is seen as an aid. Therefore, there is a need for these women to have greater visibility so that Marajoara society can value them once their work in artisanal fishing is fundamental for their subsistence and that of their social group.

Epidemiological Analyses Reveal a High Incidence of Breast Cancer in Young Women in Brazil.

PURPOSEBreast cancer screening is not recommended for young women (< 40 years old); therefore, those diagnosed are more likely to have advanced and metastatic disease, reducing treatment outcomes. This study aimed to investigate breast cancer epidemiology among young women in Brazil.METHODSData from three publicly available databases and a cohort from a university hospital in Brazil were analyzed in a retrospective study. Descriptive statistics was performed on disease prevalence and stage distribution across age groups. Incidence was estimated using age-standardized incidence ratio. The impact of age in disease-specific survival was also analyzed.RESULTSInvasive breast cancer prevalence data by age group revealed that 4.4% and 20.6% of patients were < 35 and < 45 years old, respectively. In the United States, this prevalence was 1.85% and 11.5%, respectively (odds ratio [OR], 2.2; P < .0001). The percentage of regional and metastatic diseases were higher in São Paulo State (Fundação Oncocentro de São Paulo [FOSP]) compared with the United States (45% and 9.8% v 29% and 5.7%, respectively; P < .0001). In FOSP, regional and metastatic disease prevalence were higher among young patients (53.5% and 11.3%, respectively). The median tumor size in patients < 40 years old was higher (25.0 mm × 20.9 mm; P < .0001), and young patients have higher risk to be diagnosed with positive lymph nodes (OR, 1.5; P = .004) and higher proportion of luminal-B and triple-negative (TNBC) tumors. Young patients have a poor disease-specific survival because of late-stage diagnosis and more aggressive breast cancer subtypes (human epidermal growth factor receptor 2–enriched and TNBC) (P < .0001).CONCLUSIONIn Brazil, breast cancer prevalence among young patients and late-stage incidence during this age span is higher. Advanced disease and more aggressive subtypes lead to a significant impact on breast cancer-specific survival in young patients.

Prevalence and factors associated with intimate partner violence against adult women in Brazil: National Survey of Health, 2019.

To estimate the prevalence and factors associated with intimate partner violence against adult women in Brazil. Quantitative cross-sectional epidemiological study using the database of the National Survey of Health 2019. The prevalence in the last 12 months and crude and adjusted prevalence ratios of intimate partner violence were calculated, stratified by sociodemographic characteristics. Intimate partner violence was reported by 7.60% of Brazilian women aged from 18 to 59 years, with higher prevalence among younger women (8.96%), black women (9.05%), those with lower education level (8.55%) and low income (8.68%). After adjusted analysis, the age groups of 18-24 years old (PRadj: 1.41) and 25-39 years old (PRadj: 1.42) and income lower than one minimum wage (PRadj: 1.55) remained associated with intimate partner violence. Intimate partner violence was associated with younger and poorest women. This result points to the need to develop intersectoral policies, especially those aimed at reducing social inequalities and at the coping with intimate partner violence among adult women.

Effectiveness of the CoronaVac Vaccine in Prevention of Symptomatic and Progression to Severe COVID-19 in Pregnant Women in Brazil

Background: The effectiveness of Covid-19 inactivated vaccines in pregnant women is unknown. We estimated vaccine effectiveness (VE) of CoronaVac against symptomatic and severe Covid-19 and in preventing progression from symptomatic to severe Covid-19 in pregnant women in Brazil. Methods: We conducted a test-negative design study in all pregnant women aged 18 to 49 years in Brazil, linking records of negative and positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) tests to national vaccination records. We also linked records of test positive cases with notification of severe, hospitalized or fatal Covid-19. Using logistic regression, we estimated adjusted odds and VE against symptomatic Covid-19 by comparing vaccine status in test positive (confirmed cases) to that in subjects with a negative test result. We also calculated the odds/VE against progression by comparing vaccine status in symptomatic cases to that in severe Covid-19 cases. Results: Of 19838 tested pregnant women, 7424 (37.4%) tested positive for Covid-19 and 588 (7.9%) had severe disease. Only 83% of pregnant women who received a first dose of CoronaVac completed the vaccination scheme. A single dose of the CoronaVac vaccine was not effective at preventing symptomatic Covid-19. Effectiveness of two doses of CoronaVac was 41% (95% CI 27.1- 52.2) against symptomatic Covid-19, 85% (95% CI 59.5-94.8) against severe Covid-19 and (75%; 95% CI 27.9- 91.2) in preventing progression to severe Covid-19 among those infected. Conclusion: A complete regimen of CoronaVac in pregnant women was effective in preventing symptomatic Covid-19, and highly effective against severe illness in a setting that combines high disease burden and elevated Covid-19 related maternal deaths.Funding Information: This study is part of the VigiVac Fiocruz program, partially supported by a donation from the "Fazer o bem faz bem" program. EPS is funded by the Wellcome Trust [Grant number 213589/Z/18/Z]. Declaration of Interests: We declare no competing interests. VO, VB, MB, and MB-N are employees from Fiocruz, a federal public institution, which manufactures Vaxzevria in Brazil, through a full technology transfer agreement with AstraZenecaEthics Approval Statement: This study analysed de-identified data and was approved by the National Ethics committee (CONEP) (CAAE registration no. 50199321.9.0000.0040).

Spatial distribution of agricultural farms led by women in Brazil

Abstract: This work aims to analyze the spatial distribution of agricultural establishments managed by women in the Brazilian municipalities, based on data from the Agricultural and Livestock Censuses of 2006 and 2017, applying spatial econometrics. The results showed that the Northeast and North regions had the highest concentration of High-High clusters in 2006, and increased in 2017. These regions with greater and poorer rural areas expanded the participation agricultural establishments managed by women, and they were responsible for 72.42% the variation that occurred between both Censuses. The education variable was positively related to the increase of the establishments managed by women in 2017. In the municipalities where there was a process of disappearance of agricultural establishments, there was an increase in the presence of female managers. We concluded that the promotion of public policies for women in rural areas improves of potential to promote the development of these establishments as well as rural areas.