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PURPOSE: Breast cancer molecular subtypes show significant differences in different ethnic groups in the United States, but no study has evaluated genetic ancestry in breast cancer in Brazilian women. METHODS: Breast cancer patients from distinct parts of Brazil were evaluated. Molecular subtypes were determined by immunohistochemistry. Genetic ancestry was evaluated using a panel of 46 AIMs (ancestry informative markers), which classified genetic ancestry as European, African, Asian, and Amerindian. PCR products were subjected to capillary electrophoresis and analyzed using GeneMapper 4.0 software. Ancestry was evaluated with Structure v.2.3.3 software. Ancestry was tested for correlations with geographic region and molecular subtype. The chi-square test and ANOVA with Bonferroni adjustment were applied. RESULTS: Genetic ancestry and clinical data were evaluated in 1127 patients. Higher rates of self-reported white ethnicity, European ancestry, and HER-2- luminal tumors were identified in the South region, which may influence age at diagnosis and result in a higher rate of early tumors. Conversely, higher rates of African ancestry in the North and Northeast regions, self-reported nonwhite ethnicity, HER-2+ tumors, and triple-negative tumors were noted. Triple-negative and HER-2+ tumors were associated with higher advanced and metastatic disease rates at diagnosis, with triple-negative tumors being more frequent in young women. CONCLUSION: Differences in genetic ancestry, self-reported ethnicity, and molecular subtype were found between Brazilian demographic regions. Knowledge of these features may contribute to a better understanding of age at diagnosis and the molecular distribution of breast cancer in Brazil.
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Neoplasias da Mama , Feminino , Humanos , População Negra , Brasil/epidemiologia , Neoplasias da Mama/etnologia , Neoplasias da Mama/genética , Etnicidade/genética , AutorrelatoRESUMO
Resumo Fundamento Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos. Objetivos Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia. Métodos O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%. Resultados Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos. Conclusões Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.
Abstract Background It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. Objectives This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. Methods The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. Results Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. Conclusions Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.
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Humanos , Adulto , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/farmacologia , Estados Unidos , Pressão Sanguínea , Brasil , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Estudos Transversais , Estudos Longitudinais , Antagonistas de Receptores de Angiotensina/uso terapêutico , Fatores RaciaisRESUMO
ABSTRACT Objectives: to discuss the influence of urban poverty on the context of violence among adolescents from an intersectional perspective. Methods: the original research, of the action research type, analyzed data from 13 workshops. The participants were adolescents from both sexes, from 15 to 17 years old, from a public school in a peripheral neighborhood of São Paulo, SP. The methodological proposition of intersectional analysis guided the interpretation of the empirical material. Results: the intersection of class and gender may increase the (re)production of violence in some men. The intersection of race/color, social class, and territory contributes to the construction of narratives that naturalize inequality and, thus, justify discrimination. Final Considerations: there is necessity of new public policies that consider the social contexts and experiences of the subjects that stem from the articulation of social markers.
RESUMEN Objetivos: discutir la influencia de la pobreza urbana en el contexto de la violencia entre adolescentes bajo la perspectiva de la interseccionalidad. Métodos: la investigación original, de tipo investigación-acción, se analizó en 13 talleres. Participaron adolescentes de ambos los sexos, entre 15 y 17 años, de una escuela pública de un barrio de la periferia de São Paulo, SP. La propuesta metodológica de análisis interseccional dirigió la interpretación del material empírico. Resultados: la intersección de clase con género puede potencializar en algunos hombres la (re)producción de las violencias. La intersección de raza/color, clase social, género y territorio contribuye en la construcción de narrativas que naturalizan las desigualdades y, así, justifican las discriminaciones. Consideraciones Finales: son necesarias y oportunas políticas públicas que consideren los contextos sociales y experiencias de los sujetos resultantes de las articulaciones de los marcadores sociales.
RESUMO Objetivos: discutir a influência da pobreza urbana no contexto da violência entre adolescentes sob a perspectiva da interseccionalidade. Métodos: a pesquisa original, de tipo pesquisa-ação, analisou dados produzidos em 13 oficinas. Participaram adolescentes de ambos os sexos, entre 15 e 17 anos, de uma escola pública de um bairro de periferia de São Paulo, SP. A proposta metodológica de análise interseccional orientou a interpretação do material empírico. Resultados: a intersecção de classe com gênero pode potencializar em alguns homens a (re)produção das violências. A intersecção de raça/cor, classe social, gênero e território contribui na construção de narrativas que naturalizam as desigualdades e, assim, justificam as discriminações. Considerações Finais: são necessárias e oportunas políticas públicas que considerem os contextos sociais e experiências dos sujeitos resultantes das articulações dos marcadores sociais.
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RESUMO O número de mulheres pesquisadoras tem crescido mundialmente. No entanto, as desigualdades de gênero persistem em quatro aspectos: as mulheres ainda representam parcela minoritária na ciência mundial; concentram-se em determinadas áreas de conhecimento; predominam nos níveis iniciais da carreira e são sub-representadas em posições deliberativas da política científica e tecnológica. No Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), apesar do aumento de mulheres bolsistas de Produtividade em Pesquisa (PQ) nas últimas décadas, as assimetrias permanecem. Este estudo visou discutir as assimetrias de gênero e raça nas diferentes áreas do conhecimento, em particular na psicologia, tomando como analisador a distribuição de bolsas (PQ) do CNPq. Utilizaram-se dados disponibilizados pelo CNPq e coletados por meio de SurveyMonkey. As desigualdades de gênero na ciência persistem no sistema científico brasileiro: as mulheres são minoria entre os bolsistas PQ/CNPq, concentram-se em guetos disciplinares e enfrentam dificuldades tanto para acessar o sistema PQ quanto para alcançar as modalidades de bolsa de maior prestígio científico. Na psicologia, apesar da presença em todas as modalidades de bolsa, ocupam proporcionalmente menos posições no topo da carreira. Ademais, há invisibilidade de mulheres negras e indígenas, a qual tem suas raízes no projeto moderno colonial.
ABSTRACT The number of women researchers has grown worldwide. However, gender inequalities persist in four aspects: women still represent a minority share in world science; they are concentrated in certain fields of knowledge; they predominate in early career levels; and they are underrepresented in deliberative positions of science and technology policies. At the National Council for Scientific and Technological Development (CNPq), despite the increase in women Research Productivity Scholars (PQ) in recent decades, the asymmetries remain. This study aims to discuss the asymmetries of gender and race in different fields of knowledge, particularly in Psychology, taking as an analyzer the distribution of grants (PQ) by the CNPq. Data made available by the CNPq and collected through SurveyMonkey were used. Gender inequalities in science persist in the Brazilian scientific system: women are a minority among the PQ/CNPq fellows, they are concentrated in disciplinary ghettos and face difficulties both to access the PQ system, and to reach the most prestigious scientific fellowships. In Psychology, despite their presence in all the scholarship modalities, they occupy proportionally fewer positions at the top of the career. In addition, there is the invisibility of black and indigenous women, which has its roots in the modern colonial project.
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Negro ou Afro-Americano , Equidade em Saúde , Adulto , Hispânico ou Latino , Humanos , População BrancaRESUMO
OBJECTIVE: Menopause may augment age-dependent increases in arterial stiffness, with black women having greater progression in midlife compared with white women. We sought to determine whether and when women experience changes in arterial stiffness relative to the final menstrual period (FMP) and whether these changes differ between black and white midlife women. Approach and Results: We evaluated 339 participants from the SWAN (Study of Women's Health Across the Nation) Heart Ancillary study (Study of Women's Health Across the Nation). Women had ≤2 carotid-femoral pulse-wave velocity (cfPWV) exams over a mean±SD of 2.3±0.5 years of follow-up. Annual percentage changes in cfPWV were estimated in 3 time segments relative to FMP and compared using piecewise linear mixed-effects models. At baseline, women were 51.1±2.8 years of age and 36% black. Annual percentage change (95% CI) in cfPWV varied by time segments: 0.9% (-0.6% to 2.3%) for >1 year before FMP, 7.5% (4.1% to 11.1%) within 1 year of FMP, and -1.0% (-2.8% to 0.8%) for >1 year after FMP. Annual percentage change in cfPWV within 1 year of FMP was significantly greater than the other 2 time segments; P<0.05 for both comparisons. Adjusting for concurrent cardiovascular disease risk factors explained part of the change estimates but did not eliminate the difference. Black women had greater increase in cfPWV compared with white women in the first segment; P for interaction, 0.04. CONCLUSIONS: The interval within 1 year of FMP is a critical period for women when vascular functional alterations occur. These findings underscore the importance of more intensive lifestyle modifications in women transitioning through menopause.
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População Negra , Menopausa/etnologia , Menopausa/fisiologia , Rigidez Vascular/fisiologia , População Branca , Doenças Cardiovasculares/fisiopatologia , Artérias Carótidas/fisiologia , Feminino , Artéria Femoral/fisiologia , Humanos , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND AND OBJECTIVES: In the United States mortality rates for patients treated with dialysis differ by racial and/or ethnic (racial/ethnic) group. Mortality outcomes for patients undergoing maintenance dialysis in the United States territories may differ from patients in the United States 50 states. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective cohort study of using US Renal Data System data included 1,547,438 adults with no prior transplantation and first dialysis treatment between April 1, 1995 and September 28, 2012. Cox proportional hazards regression was used to calculate hazard ratios (HRs) of death for the territories versus 50 states for each racial/ethnic group using the whole cohort and covariate-matched samples. Covariates included demographics, year of dialysis initiation, cause of kidney failure, comorbid conditions, dialysis modality, and many others. RESULTS: Of 22,828 patients treated in the territories (American Samoa, Guam, Puerto Rico, Virgin Islands), 321 were white, 666 were black, 20,299 were Hispanic, and 1542 were Asian. Of 1,524,610 patients in the 50 states, 838,736 were white, 444,066 were black, 182,994 were Hispanic, and 58,814 were Asian. The crude mortality rate (deaths per 100 patient-years) was lower for whites in the territories than the 50 states (14 and 29, respectively), similar for blacks (18 and 17, respectively), higher for Hispanics (27 and 16, respectively), and higher for Asians (22 and 15). In matched analyses, greater risks of death remained for Hispanics (HR, 1.65; 95% confidence interval, 1.60 to 1.70; P<0.001) and Asians (HR, 2.01; 95% confidence interval, 1.78 to 2.27; P<0.001) living in the territories versus their matched 50 states counterparts. There were no significant differences in mortality among white or black patients in the territories versus the 50 states. CONCLUSIONS: Mortality rates for patients undergoing dialysis in the United States territories differ substantially by race/ethnicity compared with the 50 states. After matched analyses for comparable age and risk factors, mortality risk no longer differed for whites or blacks, but remained much greater for territory-dwelling Hispanics and Asians.
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Asiático , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino , Nefropatias , Diálise Renal/mortalidade , Adulto , Negro ou Afro-Americano , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/etnologia , Nefropatias/mortalidade , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Ilhas do Pacífico/epidemiologia , Porto Rico/epidemiologia , Fatores Raciais , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , População BrancaRESUMO
Objetivo: Este estudo teve como objetivo descrever as carac-terísticas antropométricas do palato ósseo de uma amostra brasileira de esqueletos identificados Metodologia: Foi desen-volvido um estudo de corte transversal, por meio da análise de 178 crânios secos humanos, oriundos do Arquivo de Ossadas do Departamento de Odontologia Social da Faculdade de Odon-tologia de Piracicaba (FOP/UNICAMP), São Paulo. Utilizando paquímetro digital, foram realizadas medições lineares que incluíam forame incisivo à espinha nasal posterior (FI-ENP), forame palatino maior direito ao forame palatino maior esquer-do (FPMD-FPME), forame incisivo ao forame palatino maior direito (FI-FPMD) e forame incisivo ao forame palatino maior esquerdo (FI-FPME). Os testes t-Student, F(ANOVA), Tukey, LSD, Kruskal Wallis e Pearson, com nível de significância de 5,0%. Resultados: Do total de crânios analisados, 54,5% eram do sexo masculino, com mediana de idade de 56 anos. Todas as medidas analisadas apresentaram dimorfismo sexual, onde homens possuíram maiores dimensões do que o sexo oposto (p<0,001). Do total de palatos estudados, 104 eram pertencen-tes a indivíduos brancos, 49 a miscigenados e 25 a negros. As medidas FI-ENP, FPMD-FPME e FI-FPME apresentaram-se maiores em negros, seguidos dos miscigenados e brancos. Conclusão: Conclui-se que as características do palato ósseo podem ser aplicadas como maior confiabilidade para a estima-tiva do sexo na amostra brasileira estudada. (AU)
Objective: This study aimed to describe the anthropometric characteristics of the bony palate in a Brazilian sample of identified skeletons. Methodology: This was a cross-sectional study of 178 human skulls from the Laboratory of Forensic Physical Anthropology at Piracicaba Dental School, University of Campinas, São Paulo. A digital pachymeter was used to perform linear measurements from the incisive foramen to the posterior nasal spine (IF-PNS); right greater palatine foramen to left greater palatine foramen (RGPF-LGPF); incisive foramen to the right greater palatine foramen (IF-RGPF); and incisive foramen to the left greater palatine foramen (IF-LMPF). The data were submitted to Student's t, F (ANOVA), Tukey, LSD, Kruskal Wallis and Pearson tests, with a significance level of 5.0%. Results: Of the total skulls analyzed, 54.5% were from males, with a median age of 56 years. All the study measures presented sexual dimorphism, in which males had larger dimen-sions than females (p<0.001). Of the total palates studied, 104 were from white individuals, 49 were from mixed-race and 25 from black individuals. The IF-PNS, RGPF-LGPF and IF-LGPF measurements were greater in black individuals, followed by mixed-race and white individuals. Conclusion: In conclusion, the characteristics of the bony palate can be applied with higher reliability to estimate sex in Brazilian sample studied.(AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Palato , Antropologia Forense , Medicina LegalRESUMO
OBJECTIVE: Black individuals are at an increased risk of myocardial infarction and stroke, 2 vascular diseases with strong thrombotic components. Platelet activation is a key step in platelet clot formation leading to myocardial infarction and stroke, and recent work supports a racial difference in platelet aggregation through the thrombin protease-activated receptors (PARs). The underlying mechanism for this racial difference, however, has not been established. Determining where in the signaling cascade these racial differences emerge will aid in understanding why individuals of differing racial ancestry may possess an inherent difference in their responsiveness to antiplatelet therapies. APPROACH AND RESULTS: Washed human platelets from black volunteers were hyperaggregable in response to PAR4-mediated platelet stimulation compared with whites. Interestingly, the racial difference in PAR4-mediated platelet aggregation persisted in platelets treated ex vivo with aspirin and 2MeSAMP (2-methylthioadenosine 5'-monophosphate triethylammonium salt hydrate), suggesting that the racial difference is independent of secondary feedback. Furthermore, stimulation of platelets from black donors with PAR4-activating peptide showed a potentiated level of activation through the Gq pathway compared with platelets from white donors. Differences in signaling included increased Ca(2+) mobilization, Rap1 (Ras-related protein 1) activation, and integrin αIIbß3 activation with no observed difference in platelet protein expression between the groups tested. CONCLUSIONS: Our study is the first to demonstrate that the Gq pathway is differentially regulated by race after PAR4 stimulation in human platelets. Furthermore, the racial difference in PAR4-mediated platelet aggregation persisted in the presence of cyclooxygenase and P2Y12 receptor dual inhibition, suggesting that current antiplatelet therapy may provide less protection to blacks than whites.
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População Negra , Subunidades alfa Gq-G11 de Proteínas de Ligação ao GTP/sangue , Ativação Plaquetária/fisiologia , Receptores de Trombina/sangue , População Branca , Adulto , Sinalização do Cálcio , Inibidores de Ciclo-Oxigenase/farmacologia , Feminino , Humanos , Masculino , Ativação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/fisiologia , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/metabolismo , Prostaglandina-Endoperóxido Sintases/sangue , Proteína Quinase C/sangue , Antagonistas do Receptor Purinérgico P2Y/farmacologia , Receptores Purinérgicos P2Y12/sangue , Complexo Shelterina , Transdução de Sinais , Proteínas de Ligação a Telômeros/sangueRESUMO
The aim of this study was to compare the retention in medical care and antiretroviral (ARV) treatment of individuals living with HIV and AIDS to antiretroviral therapy in southern Brazil according to their "race" or skin color. This study is part of a 225-day prospective trial, comprising 7 interviews, in which an intervention designed to improve adherence to treatment was tested. A convenience sample of 73 individuals living with HIV and/or AIDS enrolled in this follow-up procedure. The mean length of continuance in treatment was 161.5 (standard deviation [SD] = 18.6; 95% confidence interval [CI] = 125-198) and 138.4 (SD = 14.1; 95% C.I. = 111-166) days in the "nonwhite" and "white" categories, respectively. There was no significant difference between the 2 categories, χ(2)(1, n = 72) = 0.76, P = .38, which include similar levels of retention in medical care and treatment with ARV medications between groups of individuals categorized as white and nonwhite in this sample.
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Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/métodos , Adesão à Medicação/etnologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Pigmentação da Pele , Adulto , População Negra , Brasil , Estudos de Coortes , Escolaridade , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/etnologia , Estudos Prospectivos , Classe Social , População BrancaRESUMO
PURPOSE: To observe hypogonadal men undergoing testosterone replacement therapy (TRT) and assess racial differences in hypogonadal improvement and prostate-specific antigen (PSA) levels. MATERIALS AND METHODS: In a retrospective analysis, 75 hypogonadal men were followed for an average 34 months after initiating TRT. Total testosterone and PSA levels were assessed every 6 months, and patients diagnosed with prostatitis or prostate cancer during treatment were excluded. RESULTS: For 16 African American men, the average age at diagnosis of hypogonadism was 53.5 years, compared with 57.8 years in 59 Caucasian men (p = NS). Pre- and post-treatment testosterone was 219 ng/dL and 310 ng/dL in African American men, and 247 ng/dL and 497 ng/dL in Caucasian men (p = NS). Symptomatic response was 81 percent in African American men and 93 percent in Caucasian men (p = NS). Baseline PSA level was 1.32 ng/mL in African American men and 1.27 ng/mL in Caucasian men, and there was no significant difference in PSA between racial groups at 6-month intervals, although there was a small decreasing trend in the PSA of African Americans compared with Caucasians. CONCLUSIONS: Hypogonadal African American men have a similar normalization of testosterone and symptomatic response as hypogonadal Caucasian men, and PSA levels remain stable over time in both groups. In this hypogonadal cohort, in contrast to studies of eugonadal men, higher PSA levels in African Americans were not observed.
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Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Terapia de Reposição Hormonal , Hipogonadismo/terapia , Antígeno Prostático Específico/análise , Testosterona/deficiência , Testosterona/uso terapêutico , Negro ou Afro-Americano , População Branca , Seguimentos , Hipogonadismo/etnologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
CONTEXT AND Objective: Many factors influence occurrences of vulvovaginitis. The aims here were to assess skin color and age-related differences in the vaginal flora and occurrences of vulvovaginitis. DESIGN AND SETTING: Cross-sectional study; tertiary referral hospital (Universidade Federal do Triângulo Mineiro, Uberaba). METHODS: Healthy women who underwent routine outpatient gynecological assessments were assessed for vulvovaginitis and vaginal flora and then divided into whites (n = 13,881) and nonwhites (n = 5,295). Statistical analysis was performed using the X² test, logistic regression and odds ratios. RESULTS: The vaginal microflora was skin-color dependent, with greater occurrence of clue cells, Trichomonas vaginalis and coccobacilli in nonwhite women (p < 0.0001). Döderlein bacilli and cytolytic flora were more prevalent in white women (p < 0.0001 and p < 0.05, respectively). The vaginal microflora was age-dependent within the skin color groups. Among the nonwhite women, clue cells were more prevalent in women aged 21 to 50 years; Trichomonas in women up to 40 years and coccobacili in women between 21 and 40 years (P < 0.05). During the proliferative and secretory phases, the nonwhite women were more likely to present clue cells, Trichomonas, Candida and coccobacilli (OR, proliferative phase: 1.31, 1.79, 1.6 and 1.25 respectively; secretory phase: 1.31, 2.88, 1.74 and 1.21 respectively), while less likely to present Döderlein flora (OR, proliferative phase: 0.76; secretory phase: 0.66), compared with white women, irrespective of age. CONCLUSIONS: There are differences in vulvovaginitis occurrence relating to skin color, which may be associated with variations in vaginal flora.
CONTEXTO E OBJETIVO: Muitos fatores influenciam a ocorrência de vulvovaginites. Os objetivos foram avaliar diferenças relacionadas à cor da pele e idade na flora vaginal e vulvovaginites. TIPO DE ESTUDO E LOCAL: Estudo transversal; hospital de referência terciário (Universidade Federal do Triângulo Mineiro, Uberaba). MÉTODOS: Mulheres saudáveis em atendimento de rotina para exames ginecológicos foram divididas em brancas (n = 13.881) e não brancas (n = 5.295) e avaliadas quanto a vulvovaginites e flora vaginal. Para análise estatística, foram utilizados teste X², regressão logística e odds ratio. RESULTADOS: Microflora vaginal foi dependente da cor da pele, com maior ocorrência de "clue cells", Trichomonas vaginalis e bacilos cocoides em não brancas (p < 0,0001); bacilos de Döderlein e flora citolítica foram mais prevalentes em brancas (p < 0,0001 e p < 0,05, respectivamente). Flora vaginal foi dependente da idade nos grupos de cor da pele. Entre não brancas, "clue cells", Trichomonas e bacilos cocoides foram mais prevalentes nas idades: 21 a 50 anos, até 40 anos, e 21 a 40 anos respectivamente (p < 0,05). Durante as fases proliferativa e secretória, mulheres não brancas tiveram maior probabilidade de apresentar "clue cells", Trichomonas, Candida e cocoides (odds ratio, OR - fase proliferativa: 1,31; 1,79; 1,6 e 1,25 respectivamente; fase secretória: 1,31; 2,88; 1,74 e 1,21 respectivamente), e menor chance de apresentarem flora Döderlein (OR - fase proliferativa: 0,76; fase secretória: 0,66) comparadas com brancas, independentemente da idade. CONCLUSÕES: Há diferenças na ocorrência de vulvovaginites relacionadas com a cor da pele, podendo haver associação com variações na flora vaginal.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Candida/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Pigmentação da Pele , Trichomonas vaginalis/isolamento & purificação , Vagina/microbiologia , Vulvovaginite/microbiologia , Distribuição por Idade , Métodos Epidemiológicos , Ciclo Menstrual/fisiologia , Vulvovaginite/epidemiologiaRESUMO
CONTEXT AND OBJECTIVE: The lack of a clear definition for human "race" and the importance of this topic in medical practice continue to create doubt among scholars. Here, we evaluate the use of the variable "race" by medical students in Salvador, Brazil. DESIGN AND SETTING: Cross-sectional study at a Brazilian federal public university. METHODS: 221 randomly selected subjects were included. A semi-structured questionnaire was used for data collection. The results were expressed as means and standard deviations of the mean, proportions and frequencies. The χ2 (chi-square) test was used for the statistical calculations. RESULTS: Approximately half of the students (45.4 percent) used the racial group variable in their studies on clinical practice. Of these, 86.8 percent considered it to be relevant information in the medical records and 92.7 percent, important for diagnostic reasoning; 95.9 percent believed that it influenced the cause, expression and prevalence of diseases; 94.9 percent affirmed that it contributed towards estimating the risk of diseases; 80.5 percent thought that the therapeutic response to medications might be influenced by racial characteristics; 41.9 percent considered that its inclusion in research was always recommendable; and 20.3 percent thought it was indispensable. The main phenotypic characteristics used for racial classification were: skin color (93.2 percent), hair type (45.7 percent), nose shape (33.9 percent) and lip thickness (30.3 percent). CONCLUSIONS: Despite the importance of different racial groups in medical practice, the majority of the professionals do not use or know how to classify them. It is necessary to add to and/or expand the discussion of racial and ethnic categories in medical practice and research.
CONTEXTO E OBJETIVO: A falta de uma definição clara da raça humana e a importância desse tema na prática médica continua a ser fonte de dúvidas para estudiosos. No presente artigo nós avaliamos o uso da variável raça por estudantes de medicina em Salvador, Brasil. TIPO DE ESTUDO E LOCAL: corte transversal, realizado numa universidade pública federal. MÉTODO: 221 estudantes, , foram incluídos. Um questionário semi-estruturado foi utilizado para a coleta dos dados. Os resultados são expressos como média e desvio-padrão da média, proporções e frequências. O teste do χ2 (qui-quadrado) foi utilizado para o cálculo estatístico. RESULTADOS: Aproximadamente metade dos estudantes (45,4 por cento) usava a variável grupo racial na sua prática clínica em estudos. Desses, 86,8 por cento a consideravam uma informação relevante no prontuário médico; 92,7 por cento no raciocínio diagnóstico; 95,9 por cento acreditavam que ela influenciava a causa, expressão e prevalência das doenças; 94,9 por cento afirmaram que ela contribuía para estimar o risco de doenças; 80,5 por cento informaram que a resposta terapêutica a medicamentos pode ser influenciada pelas características raciais; 41,9 por cento consideravam que sua inclusão nas pesquisas era sempre recomendável; e 20,3 por cento a avaliavam como indispensável. As principais características fenotípicas usadas para a classificação racial foram: cor da pele (93,2 por cento), tipo de cabelo (45,7 por cento), formato do nariz (33,9 por cento) e espessura dos lábios (30,3 por cento). CONCLUSÃO: Apesar de sua importância na prática médica, a maioria dos profissionais não usa e não sabe classificar os diversos grupos raciais. É necessário adicionar e/ou ampliar a discussão sobre as categorias raciais e étnicas no exercício da medicina e nas pesquisas médicas.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Grupos Raciais/classificação , Etnicidade/classificação , Identificação Social , Estudantes de Medicina , Brasil/etnologia , Distribuição de Qui-Quadrado , Estudos Transversais , Inquéritos e Questionários , Autoimagem , Percepção Social , EstereotipagemRESUMO
Epidemiology analyzes differences in states of health and disease of populations. Public Policies are established considering inequities associated with ethnicity and race. In this context, the identification of vulnerable groups for concentration of resources is relevant. Nevertheless, the lack of a clear definition of these variables might lead to biased results and interpretations. Two problems about the use of these variables are discussed. First, lack of a measurable and objective characteristic, even considering self reference (gold standard), considering that the opinion of a person can change in time. The second problem is a consequence of the former, basing research on a poorly defined variable. Uses of ethnicity and race variables between 1920-1999 in the American Journal of Epidemiology, Health Services Research and American Journal of Public Health were reviewed. In 919 articles, 27 different names identified to describe these variables and more than half did not describe the reason to use these variables. Almost half did not describe analytical methods. Although some articles found statistically significant relationships, ¡ess than half discussed those results. It has been suggested that there is enough evidence to exclude these variables in biomedical investigations. However, others propose that they cannot be excluded, given their multidimensional condition that includes social, cultural and genetic features. Therefore, provided the lack of clear definition, the assessment of ethnicity and race effects must be done as rigorously as possible
Assuntos
Humanos , Grupos Raciais , Estudos Epidemiológicos , Etnicidade , Disparidades em Assistência à Saúde , Projetos de Pesquisa/normas , Classe Social , Saúde Pública , Fatores SocioeconômicosRESUMO
Este estudo aborda a dermatologia na pele negra. Inicialmente, discute os conceitos de raça e etnia, assim como os critérios de classificação da população brasileira, indicando as regiões em que a população negra se concentra. A seguir, faz breve explanação sobre os sistemas de classificação da cor da pele e descreve particularidades estruturais, biológicas e funcionais da epiderme, derme e anexos cutâneos que diferenciam as peles clara e escura. Posteriormente, mostra algumas alterações fisiológicas comumente observadas na pele, nas unhas e nas mucosas dos indivíduos negros. Aponta, também, alguns padrões de reações e modificações da cor das lesões, decorrentes da hiperpigmentação cutânea, que determinam aspectos inusitados às dermatoses, dificultando seu reconhecimento. Finalmente, destaca algumas doenças em especial, enfatizando particularidades inerentes ao padrão das lesões e à freqüência de algumas dermatoses na pele negra. Nesse contexto, a intenção foi fornecer dados para auxiliar o dermatologista a se familiarizar com as diferentes nuanças que as doenças podem adquirir na pele mais pigmentada.
This study approaches dermatology in dark skinned individuals. First, it discusses the concepts of race and ethnicity, as well as the classification criteria of the Brazilian population, indicating areas where the dark skinned people are concentrated. Next, it makes one brief explanation on skin color classification systems and describes structural, biological and functional characteristics of the epidermis, dermis and cutaneous attachments that differentiate dark from fair skin. It also approaches some physiological alterations that usually are observed in the skin, nails and in the mucosa of dark skinned people. Also discussed are some patterns of reactions and alterations of lesion color, due to cutaneous hyperpigmentation, which lend unexpected aspects to the dermatosis, making its recognition difficult. Finally, the study highlights some diseases in particular, emphasizing inherent characteristics associated to lesion patterns and the frequency of some dermatoses in the black skin. The aim of this study was to bring data to help the dermatologist be familiar with the different nuances that lesions may present in a more pigmented skin.
RESUMO
OBJETIVOS: Determinar la frecuencia del síndrome metabólico (SM) en cuatro subpoblaciones de residentes de las Islas Vírgenes estadounidenses y calcular el riesgo de sufrir SM asociado con una circunferencia abdominal superior a determinados puntos de corte en personas con sobrepeso y obesidad. MÉTODOS: En un estudio realizado entre 1995 y 1999 se obtuvieron las características demográficas, medidas antropométricas, presión arterial y muestras de sangre de miembros de una cohorte poblacional de 893 personas que pertenecían a cuatro subgrupos poblacionales en Saint Croix (la mayor de las Islas Vírgenes estadounidenses) y que nunca habían recibido un diagnóstico de diabetes. Las cuatro subpoblaciones fueron: 1) hispanos de raza blanca; 2) hispanos de raza negra; 3) personas no hispanas de raza negra nacidas en las Islas Vírgenes estadounidenses y 4) personas no hispanas de raza negra nacidas en otras partes del Caribe. A las muestras de sangre en ayunas se les midieron las concentraciones de glucosa, insulina, triglicéridos y colesterol transportado por lipoproteínas de alta densidad (HDLc). Para identificar el SM se aplicaron las pautas generadas por el Panel III en torno al Tratamiento de Adultos, del Programa Educativo Nacional sobre el Colesterol [National Cholesterol Education Program Adult Treatment Panel III]. La resistencia a la insulina se calculó mediante la valoración de un modelo homeostásico (HOMA-IR). RESULTADOS: La prevalencia general de síndrome metabólico en la muestra fue de 20,5% (intervalo de confianza de 95% [IC95%]: 15,3% a 25,7%). Las personas que se habían clasificado a sí mismas como hispanas y de raza negra tuvieron la frecuencia más alta (27,8% (IC95% = 16,3% a 39,3%)) de SM y los puntajes más altos en el HOMA-IR. Después de hacer ajustes en función de los factores asociados con el estilo de vida y el HOMA-IR, la etnia hispana mostró una asociación independiente con un mayor riesgo de tener SM (razón de posibilidades [RP] = 1,82 (IC95%: 1,07 a 3,07)), triglicéridos séricos elevados (RP = 3,66 (IC95% = 2,18 a 6,15)) y concentraciones séricas bajas de HDLc (RP = 1,60 (IC 95% = 1,04 a 2,45))...
Objectives. To determine the frequency of the metabolic syndrome (MS) among four subpopulations in the United States Virgin Islands and to estimate the risk for the MS that is associated with waist circumference cutpoints among overweight and obese individuals. Methods. In a study undertaken from 1995 to 1999, data on demographic characteristics, anthropometric measurements, blood pressure measurements, and a blood sample were obtained from a population-based cohort of 893 Caribbean-born persons from four population subgroups who were living on Saint Croix (the largest island of the U.S. Virgin Islands) and who did not have a history of diagnosed diabetes. The four subpopulations were: (1) Hispanic white, (2) Hispanic black, (3) non-Hispanic black born in the U.S. Virgin Islands, and (4) non-Hispanic black born elsewhere in the Caribbean. Fasting blood samples were analyzed for glucose, insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C). National Cholesterol Education Program Adult Treatment Panel III guidelines were used to identify the MS. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) method. Results. The overall prevalence of the MS in the sample was 20.5% (95% confidence interval (CI) = 15.3%25.7%). Persons who had classified themselves as both Hispanic and black had the highest frequency (27.8% (95% CI = 16.3%39.3%)) of the MS and the highest HOMA-IR scores. After controlling for lifestyle factors and HOMA-IR, Hispanic ethnicity was independently associated with an increased risk of having the MS (odds ratio (OR) = 1.82, (95% CI = 1.073.07)), high triglycerides (OR = 3.66 (95% CI = 2.186.15)), and low HDL-C (OR = 1.60 (95% CI = 1.042.45)). A waist circumference of > 88 cm was associated with an increased risk of metabolic abnormalities among overweight and obese women. Conclusions. The frequency of the MS among Caribbean-born persons in the U.S. Virgin Islands is comparable to the frequency of the MS among the general population on the mainland of the United States. Among Caribbean-born persons living in the U.S. Virgin Islands, those who are Hispanic blacks may have a greater risk of cardiovascular disease than do other groups