Impacts of pregnancy among quilombola adolescents

OBJECTIVE

understand the impacts of pregnancy on the lives of quilombola adolescents.

METHOD

this is a qualitative study using an exploratory descriptive design. Ten quilombola mothers who experienced pregnancy during adolescence participated in this study. Data were collected through semi-structured interviews and then submitted to content analysis.

RESULTS

three categories were identified, showing the knowledge of the participants about being a quilombola and about the impacts on their lives after discovering they were pregnant and how they handled the fact of being a mother-adolescent according to the adaptations and expectations of their new phase.

CONCLUSION

pregnancy in adolescence had impacts on several aspects of the lives of adolescents, with psychological, educational, socioeconomic, and family implications, as well as new responsibilities. Also, this study highlights the role of pregnant adolescent reception of nursing professionals to meet the individual needs of adolescents and develop prevention strategies to help reduce pregnancy among quilombola adolescents.

HIGHLIGHTS

(1) Impacts of pregnancy on the daily routine of quilombola adolescents.(2) Psychological, educational, socioeconomic, and family implications.(3) Discovering motherhood and assuming new responsibilities.(4) Developing strategies to prevent pregnancy in quilombola adolescents.(5) Nursing assumes the role of reception of these pregnant quilombola adolescents.

Dentofacial and skeletal pattern in African descendants from southeastern Brazil: clinical prospective study

OBJECTIVE

The aim of this study was to evaluate characteristics of African-Brazilians young adults with excellent dental occlusion, including bimaxillary protrusion; compare them to European-American Caucasian standards, and determine whether there is sexual dimorphism in the display of this phenotype.

METHODS

Lateral cephalometric radiographs were obtained from 43 African-Brazilians within military personnel (28 males and 15 females, average age 22.4 ± 3.4 years) with normal occlusion, selected from a group of 394 volunteers. Thirty-one angular and linear measurements were evaluated. Student's t-test for independent samples was used to compare results with those established by European-American standards, previously described in the literature.

RESULTS

Considering the dentoalveolar pattern, seven angular and six linear measurements showed statistically significant differences (p< 0.001) when compared to Caucasian cephalometric standards. African-Brazilians' subjects showed lower cranial base angle (SNAr = 119.87 ± 5.66º) and anterior cranial base length (SN-distance = 68.63 ± 4.50 mm) (p< 0.001). The maxilla (SNA = 88.51 ± 3.23º) and the mandible (SNB = 85.06 ± 3.24º) were protruded in relation to the SN line (p< 0.001). Sexual dimorphism was significant for L1.NB (degrees) (p< 0.01), and interincisal angle (U1.L1) (p< 0.05).

CONCLUSION

African-Brazilian young adults presented differences regarding dental and craniofacial characteristics, when compared to European-American norms. It can be stated that Caucasian cephalometric norms should not be applied to African-Brazilian faces.

Social Determinants of Appropriate Treatment for Muscle-Invasive Bladder Cancer

BACKGROUND

Racial disparities in guideline-based, appropriate treatment (ApT) may be a significant driving force for differences in survival for people with nonmetastatic muscle-invasive bladder cancer (MIBC). We hypothesize that receipt of ApT is influenced by factors such as race and socioeconomic status, irrespective of neighborhood-level differences in healthcare, variations in practice patterns, and clinical characteristics of patients with nonmetastatic MIBC.

METHODS

Within the National Cancer Database, we identified individuals diagnosed with MIBC between 2004 and 2013. Multivariable logistic regression and mixed effects modelling was used to examine predictors of ApT, clustered within institutions.

RESULTS

A total of 51,350 individuals had clinically staged nonmetastatic, lymph node-negative MIBC. Black individuals comprised 6.4% of the cohort. Mean age was 72.6 years (SD 11.6) with a male predominance (71.4%). Less than half received ApT (42.6%). Fewer black individuals received ApT compared with white individuals (37% vs. 43%, P < 0.001). When clustered by institution, the odds of ApT were 21% lower for black individuals [odds ratio (OR), 0.79; 95% confidence interval (CI), 0.73-0.87] compared with white individuals with nonmetastatic MIBC. When restricted to higher volume centers with more diverse populations, black individuals had 25% lower odds of ApT (OR, 0.75; 95% CI, 0.61-0.91; P < 0.01), compared with white counterparts.

CONCLUSIONS

Racial disparities in treatment persisted after accounting for various clinical factors and social determinants of health. Future efforts should focus on addressing racial bias to improve disparities in bladder cancer treatment.

IMPACT

If we are not delivering evidence-based care due to these biases (after accounting for access and biology), then it is expected that patients will experience inferior outcomes.

Sexual behavior and associated factors in rural adolescents

OBJECTIVE

To describe the sexual behavior and to identify associated factors in adolescents from rural communities in Bahia, Brazil.

METHODS

This is a cross-sectional, population-based, and household-based study, carried out in 2015 with adolescents aged 10 to 19 years. We described the variables of sexual intercourse in life and in the last 12 months, age at first intercourse, condom use and number of partners, guidance on pregnancy, AIDS, or other sexually transmitted infections, and guidance on how to get condoms. The analysis was performed for the total sample and for the quilombola and nonquilombola strata. We used Poisson regression, with robust variance, to estimate the prevalence ratios for sexual intercourse in relation to the explanatory variables.

RESULTS

A total of 390 adolescents were interviewed, of them 42.8% were quilombolas, 51.3% females, and the median age was 14.8 years. Of these adolescents, 26.4% reported sexual intercourse (28.1% quilombolas and 25.1% non-quilombolas), and the median age of the first relation was 15 years; 77.7% of them mentioned condom use in the last intercourse and more than half received guidance on pregnancy, AIDS, or other sexually transmitted infections and received no guidance on how to get free condoms. Age (PR = 1.42) and alcohol use experimentation (PR = 2.41) were positively associated with sexual intercourse after adjustment. In the quilombola stratum, age (RP = 1.37), having three or more close friends (PR = 1.37), and experimentation with alcohol (PR = 2.60) were associated. In the non-quilombola stratum, age (PR = 1.43), black persons (PR = 2.06), and alcohol use experimentation (PR = 2.68) were associated.

CONCLUSIONS

Lack of information and exposure to behaviors such as alcohol use experimentation are conditions that need to be addressed in health promotion strategies and in strategies for the prevention of sexual health problems in rural adolescents. Intersectoral partnerships between education and health also need to be strengthened to promote the autonomous and safe exercise of sexuality in this population.

Black women's hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity

Afro-ethnic hair is different from Caucasian and Asian hair and has unique features. Ethnic hair is more prone to certain conditions or diseases. Such diseases are not only related to the fragile inner structure of the hair, but also to the cultural habits of hairstyles that often exert traction forces upon the pilosebaceous follicle. Women with African hair subject their hair to chemical treatments such as hair straightening and relaxing, and thus modify the structure of their hair shaft, making it more susceptible to damage. For this reason, hair complaints are common among black women and represent a diagnostic challenge to the dermatologist, requiring a thorough clinical examination of the hair and scalp, and a detailed medical history of the patient. The purpose of this review is to warn of the potential side effects and sequelae related to hairstyles and hair treatments used by black women, and to highlight the major diseases that affect this ethnicity.

Perforated submitral left ventricular aneurysm resulting in severe mitral annular regurgitation

Annular submitral left ventricular aneurysm, which predominantly occurs in blacks who live in tropical regions of Africa, is a relatively unknown cardiac condition in the United States. We describe a patient with submitral left ventricular aneurysm who underwent resection of the mass and of the native mitral valve, followed by mitral valve replacement.

Levels of lipoprotein(a), apolipoprotein B, and lipoprotein cholesterol distribution in IDDM. Results from follow-up in the Diabetes Control and Complications Trial

Levels of lipoprotein(a) [Lp(a)], apolipoprotein (apo) B, and lipoprotein cholesterol distribution using density-gradient ultracentrifugation were measured as part of a cross-sectional study at the final follow-up examination (mean 6.2 years) in the Diabetes Control and Complications Trial. Compared with the subjects in the conventionally treated group (n = 680), those subjects receiving intensive diabetes therapy (n = 667) had a lower level of Lp(a) (Caucasian subjects only, median 10.7 vs 12.5 mg/dl, respectively; P = 0.03), lower apo B (mean 83 vs. 86 mg/dl, respectively; P = 0.01), and a more favorable distribution of cholesterol in the lipoprotein fractions as measured by density-gradient ultracentrifugation with less cholesterol in the very-low-density lipoprotein and the dense low-density lipoprotein fractions and greater cholesterol content of the more buoyant low-density lipoprotein. Compared with a nondiabetic Caucasian control group (n = 2,158), Lp(a) levels were not different in the intensive treatment group (median 9.6 vs. 10.7 mg/dl, respectively; NS) and higher in the conventional treatment group (9.6 vs. 12.5 mg/dl, respectively; P < 0.01). No effect of renal dysfunction as measured by increasing albuminuria or reduced creatinine clearance on Lp(a) levels could be demonstrated in the diabetic subjects. Prospective follow-up of these subjects will determine whether these favorable lipoprotein differences in the intensive treatment group persist and whether they influence the onset of atherosclerosis in insulin-dependent diabetes.