Introduction: In March 2014, Brazil began its national HPV immunization campaign targeting girls ages 9-13. Objective: Describe determinants of parental decisions to vaccinate their daughters against HPV.Method: In this qualitative study, thirty semi-structured interviews were conducted at five health posts in São Paulo, Brazil. Interview questions explored parental opinions of disease prevention methods, vaccines in general, and the HPV vaccine. Interviews were analyzed using grounded theory. Results: Overall, parental knowledge about HPV and the vaccine was low, yet most eligible daughters had been vaccinated. Parents perceived the HPV vaccine to be normal, preventative, and protective. Parents viewed themselves as accountable for their children’s health, and saw the vaccine as a parenting tool for indirect control. Trust in healthcare professionals and an awareness of the dangers of “nowadays” (uncertainties regarding disease and sexual behavior) were also important in vaccine decision-making. These factors held more explanatory power for decisions to vaccinate than parental knowledge levels. This was the first study to qualitatively examine the perception of publically provided HPV vaccination among parents with eligible daughters in Brazil. The findings help interpret the greater than 90% coverage for the first HPV vaccine dose in Brazil. The results indicate that attempts to understand, maintain, or modify vaccination rates require the consideration of context specific factors, which influence both parent perspectives and vaccination decisions. Conclusion: HPV knowledge levels are not predictive of parental decisions to vaccinate daughters. Context specific factors from the sociocultural dimensions of parenting, sexuality, gender, and the healthcare system are more influential in vaccine decision-making.

Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil.

Little is known about how perceptions of government affects women’s views of violence against women. This qualitative study examines women’s perceptions of violence against women laws and trust in the health and legal sector response in São Paulo State, Brazil. Thirty interviews with female residents of Santo André, 18 years and older, were audio recorded, transcribed, coded, and analyzed for themes using MAXQDA12 software. All women were familiar with at least one federal violence against women law. They expressed widespread lack of trust in the government. They viewed the legal sector as ineffective and felt violence against women laws have little impact, or exacerbate violence. Disdain for the health sector was less prominent than for the legal sector. A generalized lack of trust in government manifests as a lack of confidence in these laws for women seeking support through legal and health sectors. Adoption of legal protections for women is a significant accomplishment. However, health and legal sector violence against women response needs to consider perceptions of government, how violence against women laws are operationalized, and the role of each sector in ensuring women’s safety. Violence against women response efforts should include standardized intersectoral procedures including referral to accessible resources and means of screening women who may be at high risk for femicide.

This article uses a case study design to explore attempted intimate femicide in metropolitan São Paulo, Brazil. We conducted 30 in-depth interviews with adult women on community and personal relationship experiences, health-care services, and national legislation about violence against women. Through a thorough transcript review, we identified two participants, Maria* and Raquel*, whose intimate partners attempted to kill them. We used a modified grounded theory approach to code the entire sample, and further analysed these transcripts to identify missed opportunities for intervention in both the prevention of- and responses to intimate partner violence (IPV), and the antecedents of attempted intimate femicide. Both women had normalized experiences of violence, and experienced psychological abuse prior to the attempted intimate femicide. Social and familial networks were sources of shame for Raquel and support for Maria. Neither woman expressed confidence in law enforcement’s ability to protect women and girls from IPV. These cases illustrate the need for multi-tiered interventions to prevent femicide in Brazil, which boasts one of the highest global female homicide rates. Although anti-femicide laws exist, better mechanisms are needed to integrate health, legal and social services for IPV and femicide prevention. In addition, community- and interpersonal- level interventions that counteract the Brazilian ‘culture of violence’ and machismo may provide support for at-risk women and girls. *pseudonyms have been used to protect the identity of the participants

ObjectiveVitamin D has been shown to influence indexes of immunity, including antimicrobial peptides (AMPs). Vitamin D deficiency is common in critical illness, but the impact of vitamin D status or the response to treatment with high‐dose vitamin D on AMPs in this population is unknown. Thus, we evaluated the impact of two doses of vitamin D3 (D3) versus placebo on AMPs in ventilated, critically ill subjects.MethodsThirty critically ill, ventilated subjects were enrolled in a randomized, double‐blind controlled trial of enteral high‐dose D3 (total dose = 250,000 IU or 500,000 IU) given in divided doses over 5 consecutive days. Plasma 25‐hydroxyvitamin D [25(OH)D] was measured by chemiluminescence. Plasma levels of AMPs, cathelicidin (LL‐37) and human beta‐defensin‐2 (hBD‐2), were measured by ELISA, and PBMC LL‐37 mRNA by quantitative PCR at baseline, days 7 and 14 after study entry. Descriptive statistics (mean ± SD), Spearman correlations, and repeated measures ANOVA were used for analysis.ResultsThe study population was 60% male, mean age was 63.5 ± 17.3 yrs, and 43% were vitamin D deficient at baseline. D3 administration significantly increased plasma 25(OH)D levels from baseline to day 14 vs placebo (500,000 IU: 20.0 ± 7.3 to 62.4 ± 16.7 ng/mL; 250,000 IU: 23.2 ± 7.8 to 50.4 ± 29.4 ng/mL; placebo: 21.5 ± 12.2 to 21.5 ± 11.3 ng/mL, respectively; p < 0.01). Baseline 25(OH)D levels were unrelated to baseline AMP indexes. Plasma LL‐37, hBD‐2, and PBMC LL‐37 mRNA did not change over time in any group.ConclusionsBaseline vitamin D status did not influence plasma LL‐37 and hBD‐2 levels or PBMC LL‐37 mRNA in critically ill, ventilated adults. High‐dose D3 administration markedly increased 25(OH)D levels, but did not alter production of AMPs.

ObjectiveAnemia and vitamin D deficiency are highly prevalent in critically ill patients, and vitamin D may be involved in the regulation of iron recycling. The purpose of this study was to examine the impact of vitamin D therapy on hemoglobin concentrations in critically ill patients.MethodsWe conducted a secondary analysis of a randomized, double‐blinded, placebo‐controlled trial of high‐dose vitamin D3 (D3) therapy in critically ill adults requiring mechanical ventilation (N=30). Participants were randomized to receive a total enteral dose of 500,000 IU D3, 250,000 IU D3, or placebo administered over 5 days. Blood was drawn weekly throughout hospitalization for up to 4 weeks. Linear mixed effects models were used to assess change in hemoglobin concentration by treatment group over time.ResultsThe prevalence of anemia at baseline was 93.3%. Baseline mean hemoglobin and plasma 25‐hydroxyvitamin D concentrations were 9.7 g/dL (SD=1.9) and 21.4 ng/mL (SD=9.1), respectively, and did not differ significantly across treatment groups. In the 250,000 IU D3 group, change in hemoglobin over time did not differ from placebo (P=0.5). However, in the group who received 500,000 IU D3, hemoglobin concentrations increased by 0.8 g/dL (SE=0.3) per week (P=0.005).ConclusionIn this population of critically ill patients, treatment with 500,000 IU D3 over 5 days increased hemoglobin concentrations during hospitalization, while no significant change in hemoglobin was observed in the 250,000 IU D3 or placebo groups. These findings support a role for vitamin D in improving hemoglobin concentrations in critical illness, which should be confirmed in larger studies.Funding: T32 DK7734‐17, R21 HL110044