provides community-based primary health care to more than 70% of the population. Yet, primary health care has been overlooked by the federal government as a key element in this public health crisis response. Financial emergency aid to the most vulnerable populations was gravely delayed, insufficient, and cumbersome to obtain. Moreover, the federal administration denies international recommendations for non-pharmacological interventions, refusing to establish a national mandate for social isolation and mask use.It is necessary to analyse the Brazilian Government's response to the COVID-19 pandemic based on trustworthy knowledge built upon scientific facts. The negative effects of governmental decisions represent important risks to the health of Brazilians and for the pandemic's global situation. A coordinated politi cal response guided by social justice and evidence-based knowledge is essential to managing any public health emergency, especially one with as broad economic and health impacts as COVID-19. Regretfully, this is not what is happening in Brazil.We declare no competing interests.
Background: In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika's association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services. Methods: Individual semi-structured interviews were conducted with 22 young women, aged 14-24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis. Results: Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika's sexual transmission. Conclusions: The young women's knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.
Receptor guanylyl cyclases respond to ligand stimulation by increasing intracellular cGMP, thereby initiating a variety of cell-signaling pathways. Furthermore, these proteins are differentially localized at the apical and basolateral membranes of epithelial cells. We have identified a region of 11 amino acids in the cytosolic COOH terminus of guanylyl cyclase C (GCC) required for normal apical localization in Madin-Darby canine kidney (MDCK) cells. These amino acids share no significant sequence homology with previously identified cytosolic apical sorting determinants. However, these amino acids are highly conserved and are sufficient to confer apical polarity to the interleukin-2 receptor a-chain (Tac). Additionally, we find two molecular weight species of GCC in lysates prepared from MDCK cells over-expressing GCC but observe only the fully mature species on the cell surface. Using pulse-chase analysis in polarized MDCK cells, we followed the generation of this mature species over time finding it to be detectable only at the apical cell surface. These data support the hypothesis that selective apical sorting can be determined using short, cytosolic amino acid motifs and argue for the existence of apical sorting machinery comparable with the machinery identified for basolateral protein traffic.
Until 2015, Zika was mostly unknown in Brazil and in the world. Since then, the Zika virus has been found to be vertically transmitted and to cause congenital Zika syndrome (CZS). This study aims to describe and analyze the vulnerabilities of the women and children most affected by the Zika epidemic in Brazil. Alagoas has the lowest Human Development Index in Brazil and one of the highest rates of adolescent pregnancy. Between December 2016 and March 2017, interviews were conducted with 54 women with children affected by Zika. The interviews had two components: a narrative-oriented conversation and a semi-structured questionnaire. This comprehensive mixed methods case study represented 45% of the confirmed CZS cases and 20% of the cases under investigation in the state at that time. The women are predominantly Afro-Brazilian; most experienced their first pregnancy during adolescence, and had little education. Many were not covered by social protection programs and were not receiving adequate health care. The rights and needs of these women and children are impacted by a systemic lack of access to services and medications. There is inadequate transportation to services that many families depend on. Discrimination against their children with disabilities is a new and complex concept in their lives. The Zika epidemic has compounded rights violations in their lives and worsened their social and economic layers of vulnerability. There is an urgent need for a robust public response to guarantee the rights of these women and children and to implement mechanisms to prevent and eliminate their vulnerabilities.
K E Y W O R D S : Brazil; Public Health; Sexual and Reproductive health; Unmet needs; Young women; Zika virus Zika virus (ZIKV) is a flavivirus that is mainly transmitted by the Aedes aegypti; it is also transmitted sexually, perinatally, via blood transfusion, and probably by breastfeeding. Unlike other flaviviruses, ZIKV has adverse effects on the pregnancy, embryo, fetus, and postnatal development. The effects of Zika virus congenital infection have been referred to as Congenital Zika Syndrome (CZS), as there is a wide range of presentations and severity of manifestations, not limited to microcephaly. 1 In addition, Zika virus infection during pregnancy can lead to damage to the placenta, fetal loss, and spontaneous abortion. 1 The Zika virus epidemic emerged in northeast Brazil in 2015; although the outbreak has subsided, Brazil continues to be the epicenter of the Zika virus. Studies estimate over 8 million symptomatic Zika cases between January 2015 and May 2017, with an overwhelming concentration of Zika case burden (93%) in northeast Brazil. 2 Since the monitoring of Zika infection cases began, the Brazilian epidemiological surveillance system has registered over 17 000 suspected cases of CZS; there is no official data at present for 2019. 3 Among the most affected populations are underserved women, most of them young Afro-Brazilians with little education, living in one of the poorest regions of the country. 4 From January 2015 to November 2016, most of the infection-related microcephaly cases were concentrated in the northeast region of Brazil and 83% of women who had a child with CZS were Afro-Brazilian and/or Native Brazilian, whereas only 49% of the female Brazilian population falls within these groups. 5,6 Moreover, northeast Brazil was disproportionately affected by the Zika epidemic: this geographical region ranks lowest among the country's macro-regions on the Human Development Index. 7 We conducted a social research study supported by WHO Human Reproduction Programme to investigate the sexual and reproductive health needs and challenges in accessing services of women living in the most affected areas. Focus groups and individual semi-structured interviews were conducted with women who sought sexual and reproductive care in public health facilities of three Zika-affected municipalities in northeast Brazil. The age range was 14-48 years. Each focus group was comprised of between 5 and 15 women. There were nine focus group with 81 participants in total. Individual interviews were conducted with 41 women from the different focus groups and municipalities. The national protocol for health professionals about clinical manifestations, prevention measures, prenatal and newborn care in the context of Zika has not been updated since early 2017. 8 Brazilian women continue to be at risk for Zika infection, as the national epidemiological surveillance reports new cases of Zika in the region. 9The link between the discovery and public announcement of the consequences of ZIKV epidemic with the decline of live b...
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