BackgroundThe relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services.MethodA systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population’s access to health services and original articles with full text available online.ResultsThe electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services.ConclusionsThe non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

ObjectiveTo analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database.ResultsThe highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9–60.5%) followed by that in men (52.9%; 95% CI 52.6–53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5–62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.

IntroductionThe objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012.MethodsSecondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0.ResultsThere were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group.ConclusionWe observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults.

BackgroundBreast cancer affects millions of women worldwide, particularly in Brazil, where public healthcare system is an important model in health organization and the cost of chronic disease has affected the economy in the first decade of the twenty-first century. The aim was to evaluate the role of health policy in the burden of breast cancer in Brazil between 2004 and 2014.MethodsSecondary analysis was performed in 2017 with Brazilian Health Ministry official data, extracted from the Department of Informatics of the National Health System. Age-standardized mortality and the age-standardized incidence of hospital admission by breast cancer were calculated per 100,000 people. Public healthcare costs were converted to US dollars. Regression analysis was performed to estimate the trend of breast cancer rates and healthcare costs, and principal component analysis was performed to estimate a cost factor. Stata® 11.0 was utilized.ResultsBetween 2004 to 2014, the age-standardized rates of breast cancer mortality and the incidence of hospital admission and public healthcare costs increased. There was a positive correlation between breast cancer and healthcare public costs, mainly influenced by governmental strategies.ConclusionsGovernmental strategies are effective against the burden of breast cancer in Brazil.

Background Hypertension (AH) is an emerging disease that has rapidly increased in the last decades throughout the world. The increase in blood pressure (BP) is observed with growth and development and, although the manifestation of the disease is rare in childhood and adolescence, its occurrence is increasing and the causes are likely to be from different combinations of factors. Afrodescendants have been consistently observed in many populations, including Brazil, which has the largest population of Afrodescendants outside Africa; nevertheless, data is scarce on the disease in children and adolescents. In this study, we investigated BP disorders in children and adolescents of “Quilombola” populations of the state of Tocantins, northern Brazil, and determined the disease occurrence with some factors, namely food consumption, body composition, anthropometric measures, and biochemical data. Methods We carried out a cross-sectional study with 67 children aged 10–17 years, comparing the variables studied between the normotensive and non-normotensive groups, using the Chi-square test for qualitative variables and the appropriate tests, according to data adherence to the Gaussian distribution for the quantitative variables. High blood pressure was defined as mean systolic or diastolic blood pressure ≥ 90 percentile for age, height, gender. Results The rate of adolescents with BP disorders was 19.4% (prehypertension 14.9% and hypertension 4.5%). There were no significant differences between the sexes for high blood pressure. In the Poisson regression analysis, the high fat percentage was associated with elevated blood pressure ( p = 0.021) for adolescents. Similar associations were observed for non-HDL-c ( p < 0.001) and low calcium intake ( p = 0.015). Conclusion Most children and adolescents in “Quilombola” communities had normal blood pressure. However, higher levels of dyslipidemia and low calcium intake are factors associated with prehypertension in the population studied with high BP.

Background: About 7% of rape cases in Brazil result in pregnancy.Overall, Brazilian women are unaware of the right to legal interruption of pregnancy after rape, so they delay in applying the procedure to get a legal abortion or at the end they try to abort in a condition that may be unsafe. Objective:To analyse factors associated with the leadtime to have a legal abortion after rape.Methods: This is a cross-sectional study. The data were collected from electronical medical records of 1,270 women who requested legal abortion in a public hospital in São Paulo during the period of 1994 to 2013. The variables age, education, race, marital status, religion, form of intimidation, vulnerable condition, perpetrator of sexual violence, number of perpetrators, and police report were analysed in relation to gestational age, according to multiple multinomial logistic regression models. Results BackgroundSexual crimes particularly affect vulnerable young females and may be associated with physical trauma, mortality, sexual disorders, unwanted pregnancy, and psychological consequences. Damages to reproductive health include increased risk of infertility, anogenital cancer, and sexually transmitted diseases (STDs) [1]. In addition to representing a public health problem in developing countries, the subject of discussing the conflict of interrupting an unwanted pregnancy, as a consequence of a rape or not, requires a well informed decision making proccess, covering the scope of legal, moral, religious, social, and cultural aspects that are linked to it [2].Emerging data on violence against females around the world suggest that in some countries, one in five female suffer rape or attempted rape in their lifetime. Recent research on the behaviour, attitudes, and sexual experiences of young people in areas of Africa, Asia, and Latin America revealed that between 5 and 20% of females' first sexual experience was forced. Regardless of whether they have access to contraception, a forced sexual act is usually unprotected, exposing females not only to unwanted pregnancy but also to STDs, including HIV [3].In Brazil, about 7% of rape cases resulted in pregnancy. Under Brazilian law, the victim of this type of violence has the right to abort. However, 67.4% of females who were pregnant after being raped didn't get the access to legal abortion in a The delay verified in the decision to search for legal termination of pregnancy cannot be attributed to or explained by the cost of abortion in Brazil. The Brazilian Unified Health System (SUS) ensures full and free coverage for abortion in these cases, regardless of the woman has any sort of health insurance. Therefore, the females who have participated in this study did not face any financial barriers to make legal abortion.According to the Allan Guttmacher Institute, the highest rates of abortions were observed between 1995 and 2008 mainly in those regions where laws against abortion are more rigid. In 2008, an average of 28 women per thousand carried out an abortion, indicating a...

Introduction: University students are exposed to many factors related to Night Eating Syndrome (NES), an eating disorder that may be associated with obesity.Objective: To determine the prevalence of NES among students from a Brazilian university and evaluate the association of the syndrome behaviours with emotional, biological and environmental factors. Methods:Cross-sectional study with 200 students from a private higher education institution located in the city of Juazeiro do Norte, Ceará, Brazil. NES was evaluated using the Night Eating Questionnaire (NEQ), considering the NEQ score ≥ 25 as the cutoff value for indication of the syndrome. Depression, anxiety, and stress symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21) questionnaire. Additional information was collected about the participants (gender, age, weight and height), the academic status (enrolled course, study period and year) and the employment status (whether the participant worked at least 4h daily in addition to studying).Results: 30 participants (15%) presented NEQ score ≥ 25, indicative of NES. There was no association between the NEQ score and the variables: gender, nutritional status, work, enrolled course, study period and academic year. There was an association between NEQ score and severity of depression (p=0.0001), anxiety (p=0.0001) and stress (p=0.0218). Conclusion:Evidence of a high prevalence of NES was found among Brazilian university students and an association between the behaviours of the syndrome with depressive, anxiety and stress symptoms was found.

Breast cancer early detection is the major strategy for mortality rates reduction. In Brazil, Primary Health Care is an important strategy for public health promotion. To analyse the association between breast cancer mortality and primary health care indicators in Brazilian municipalities, data on breast cancer mortality and primary healthcare coverage of the 5,700 Brazilian municipalities were collected from the Department of Informatics of the Brazilian Unified Health System. We collected data on the deaths of women living in Brazil in 2010 with breast cancer. Breast cancer mortality was calculated by 100,000 women and age-standardised from the World Health Organisation population. We studied the coverage of primary health care, family health team and community health agents. We found that increase of both primary care indexes was related to increasing of the breast cancer mortality. Additionally, improving the scholarly and reducing the income inequality was related to reducing the breast cancer mortality. Strategies to improve the quality of primary care, reduce the income inequality and improve elementary scholarly should be taken into account in the development of public policies in the Brazilian municipalities to reduce breast cancer in Brazilian municipalities.