Nevin Manimala

Cien Saude Colet. 2025 Nov;30(11):e14002025. doi: 10.1590/1413-812320253011.14002025. Epub 2025 Jul 26.

ABSTRACT

This qualitative research was conducted from 2015 to 2018 and corroborates communication and education initiatives on HIV prevention. With an intersectoral and territorial perspective, the study aims to describe the methodology used in the shared production of an image game, with 36 cards and gameplay rules, built with students from the teacher training course for the initial grades, from a public high school, located in Rio de Janeiro, Brazil. It also aims to discuss how they understand the relationship between sexuality, health and HIV prevention. The Freirean problematization method guided direct observation and interventions in everyday school life. Topics of interest to young people were discussed: strategies for “deconstructing” the biomedical-prescriptive and heteronormative perspective, hegemonic in discourses on sexuality and HIV prevention; female condoms; meanings of the terms HIV-positive, serodifferent, and viral load (CD4 and CD8); testing; PrEP and PEP; drug treatment and side effects. The conclusion is that the methodology adopted enabled peer-to-peer education and the creation of the game “Sexuality and HIV prevention”, in a contextualized and interactive way.

PMID:41337628 | DOI:10.1590/1413-812320253011.14002025

Cien Saude Colet. 2025 Nov;30(11):e12102025. doi: 10.1590/1413-812320253011.12102025. Epub 2025 Jun 29.

ABSTRACT

We analyzed the engagement of young heterosexual men in contraceptive management based on empirical material from a multicenter socio-anthropological study. We started from an understanding of youth as a social construction, the relational dimension of gender, and the dynamics of masculinities in interaction with social markers of difference. This article analyzes the biographies of 14 cisgender male participants from São Paulo (SP) and Conceição do Mato Dentro (MG), Brazil. They are heterosexual, mostly self-declared Black, and they were interviewed from 2021 to 2022 about certain events in their affective-sexual trajectories. The relational context proved to be crucial in shaping contraceptive and reproductive behavior. Discussions about female autonomy and co-responsibility for possible contraceptive failures shape different forms of contraceptive engagement in affective-sexual relationships. The representations of young men can contribute to a broader understanding of youth reproductive dynamics, giving rise to possibilities for public intervention (especially in the fields of Health and Education) and ways of reducing gender inequalities.

PMID:41337625 | DOI:10.1590/1413-812320253011.12102025

Cien Saude Colet. 2025 Nov;30(11):e11572025. doi: 10.1590/1413-812320253011.11572025. Epub 2025 Jun 22.

ABSTRACT

This article sought to understand the structure of young lesbians’ social representations of sexual health, based on their experiences and practices. This is a descriptive, qualitative study based on the Theory of Social Representations. The Free Word Association Test (FWAAT) was used online for 124 self-declared lesbians, aged 18 to 29 years, and of these, seven responded to a semi-structured interview script. The TALP data was processed using IRaMuTeQ software (prototypical analysis), contextualized by excerpts from the interviews that portray experiences and practices, and scientific references on the subject. The results pointed to the terms ‘condom’, “care” and ‘prevention’ as core elements in the structure of social representations. In the interviews, these terms refer to the importance attributed to protection and disease prevention, although the condom models are not adapted to the sexual practices of trafficked sex. The participants’ practices and experiences also emphasize personal hygiene. The development of effective public policies for lesbian health requires valuing the knowledge they share socially.

PMID:41337622 | DOI:10.1590/1413-812320253011.11572025

Cien Saude Colet. 2025 Nov;30(11):e11532025. doi: 10.1590/1413-812320253011.11532025. Epub 2025 Jun 23.

ABSTRACT

Adolescent fertility in Brazil is influenced by sociodemographic and economic factors, making it necessary to stratify and monitor this indicator to assess the inclusion of adolescents in health, education, and social assistance programs. Using data from the Live Birth Information System (SINASC), we calculated Age-Specific Fertility Rates by age group (10 to 14 years and 15 to 19 years), years of education (0 to 7 years, 8 to 11 years, and 12 or more), and Brazilian macroregions (North, Northeast, Midwest, Southeast, and South) for the period between 2010 and 2023, during which the country faced structural changes, including public health crises, economic crises, an increase in female education, and the rise of a conservative political wave. The results reveal an increase in adolescent fertility in the first half of the analyzed period (up to 2014/2015), followed by a decline in the second half, reaching 41.6 births per thousand women (15-19) and 2.1 births per thousand women (10-14) in 2023. There is significant regional diversity, with the North presenting higher rates despite the decline. Differences by educational level stand out, with a greater proportional decline among the less educated group.

PMID:41337621 | DOI:10.1590/1413-812320253011.11532025

Cien Saude Colet. 2025 Nov;30(11):e11522025. doi: 10.1590/1413-812320253011.11522025. Epub 2025 Jun 21.

ABSTRACT

Comprehensive sexuality education is an effective strategy to promote adolescents’ sexual and reproductive health and exercise citizenship. This paper presents the social validity of the effects of intervention research, through multiple case studies, with students and teachers, in two public schools in the Federal District. Participatory workshops were used to address self-esteem, gender identity, sexual orientation, support networks, contraceptive methods, youth participation, and violence. We generated data through reports and evaluations of each workshop, field diaries, photographic records, and final evaluation questionnaires with teachers and students. The results indicate that the study could: i) expose the context of structural vulnerability in the cases studied; ii) promote new behaviors and ways of thinking; iii) facilitate learning and the development of skills for health and well-being. The findings endorse the intervention’s high social validity of the effects, showing its ability to effect change for teachers and students, including improving their relationship. The observed tensions confirm the importance of teacher training and the urgency of support initiatives that can overcome the political and ideological challenges of the issue.

PMID:41337620 | DOI:10.1590/1413-812320253011.11522025

Cien Saude Colet. 2025 Nov;30(11):e11452025. doi: 10.1590/1413-812320253011.11452025. Epub 2025 Jun 20.

ABSTRACT

The increase in HIV incidence rates among young people contrasts with the discontinuity of educational actions and the invisibility of AIDS in public spaces. Based on socio-anthropological research, this article analyzes conceptions and practices regarding HIV prevention of 139 men and women, aged 15 to 24 years, mostly heterosexual and cisgender, from low-income Brazilian communities in Porto Alegre, São Paulo, Rio de Janeiro, Manaus, and Salvador. The study involved ethnographic observation, interviews, and focus groups. According to the findings, the knowledge about diagnosis and new technologies for prevention and treatment of HIV is limited. HIV transmission is still associated with gays, trans people, and individuals with many partners; the fear of the stigma of AIDS still persists; and there is rare contact with people with HIV. There is a prevailing self-perception that HIV infection is a very distant possibility, especially if condoms are used with strangers; the concern regarding an unintended pregnancy is far greater. The results point to the need for policies that address AIDS stigma and social, racial, and gender inequalities, as well as the need to create spaces for learning and dialogue in schools, health services, and social movements, updating successful experiences and exploring the potential of social networks.

PMID:41337619 | DOI:10.1590/1413-812320253011.11452025

Hum Vaccin Immunother. 2025 Dec;21(1):2592425. doi: 10.1080/21645515.2025.2592425. Epub 2025 Dec 3.

ABSTRACT

Co-administration of multiple vaccines during a single clinical visit is common in pediatric immunization programs, but administering three or more injections simultaneously has raised safety concerns. This systematic review, conducted in 2023, assessed the safety of administering three or more vaccines at the same time compared with giving fewer or the same vaccines across separate sessions. Data from 26 studies were analyzed using random-effects meta-analyses. The risk of any adverse event (AE) was modestly increased (OR ≈ 1.54), mainly due to expected and transient reactions such as fever, irritability and injection-site pain. Importantly, there was no significant increase in serious adverse events (SAEs) (OR 1.07, 95% CI 0.92-1.25). Differences in systemic (OR 1.19, 95% CI 0.95-1.50) or local AEs (OR 1.37, 95% CI 0.85-2.22) were not statistically significant. These findings support the continued co-administration of multiple vaccines in pediatric programs, providing a nuanced safety profile for policymakers and clinicians.

PMID:41335471 | DOI:10.1080/21645515.2025.2592425

Eur J Public Health. 2025 Dec 3:ckaf232. doi: 10.1093/eurpub/ckaf232. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse retention is a critical challenge across Europe, directly affecting workforce sustainability, quality of care, and health systems resilience. Despite persistent shortages and increasing emigration, evidence on nurse retention determinants within the Portuguese National Health Service (NHS) remains limited. This study aims to identify factors influencing nurses’ intention to stay in the NHS, contributing to national and European debates on sustainable workforce strategies.

METHODS: A quantitative, observational, cross-sectional survey was conducted among a representative sample of 1 494 nurses working in NHS. A validated questionnaire was developed using a Nominal Group Technique and Delphi Panel with stakeholders, to measure job satisfaction with Likert scales. Inferential statistical analyses, including t-tests and multiple linear regression, examined associations between intention to stay and factors such as job satisfaction, work-life balance, career development opportunities, remuneration, and sociodemographic characteristics.

RESULTS: Fixed work schedules, overall job satisfaction, age, satisfaction with work-life balance, and career development emerged as significant predictors of intention to stay. Satisfaction with salary and financial incentives, while low, was not statistically significant. Findings highlight the importance of integrated workforce retention strategies combining organisational improvements, career progression pathways, and work-life balance policies. These findings differ from those observed among physicians in parallel research, confirming the need for profession-specific retention approaches.

CONCLUSION: This study provides new evidence on nurse retention in Portugal, reinforcing the need for human resources policies aligned with European Union priorities on workforce sustainability. Cross-country policy learning and evidence-informed, context-sensitive strategies are crucial for supporting nurse retention and health system resilience.

PMID:41335460 | DOI:10.1093/eurpub/ckaf232

JAMA Surg. 2025 Dec 3. doi: 10.1001/jamasurg.2025.5282. Online ahead of print.

ABSTRACT

IMPORTANCE: Unhoused individuals face significant structural barriers to postacute recovery following traumatic injury. However, national estimates of trauma readmission risk in this population remain limited. This study aimed to evaluate the association between unhoused status and 30-day hospital readmission after trauma.

OBJECTIVE: To assess if unhoused status is linked to higher 30-day readmission rates after traumatic injury.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the 2017 through 2019 National Readmission Database. These data included a national, population-based sample of hospitalizations in the US. Participants included adults aged 18 years or older who were admitted for traumatic injury, identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Elective admissions, in-hospital deaths, and discharges in December were excluded, given the 30-day outcome. Unhoused status was defined using ICD-10-CM code Z59.0. A total of 2 663 876 trauma admissions were included, of whom 46 381 were unhoused (1.7%). Patients were stratified by housing status based on the ICD-10 code for homelessness. The primary outcome was 30-day all-cause readmission. Multivariable logistic regression and marginal effects models estimated adjusted odds ratios (aOR) and predicted probabilities, controlling for demographic and clinical factors.

RESULTS: Unhoused patients were substantially younger (65 years, 10.4% vs 59.4%), predominantly male (77.8% vs 48.2% female), and had much higher rates of substance use disorders (alcohol, 41.3% vs 9.9%; drug, 38.4% vs 5.1%) compared with housed patients; all comparisons were statistically significant (P < .001). The 30-day readmission rate was significantly higher among unhoused patients (19.3% vs 12.2%; P < .001), with increased adjusted odds of readmission on multivariable analysis (aOR, 1.63; 95% CI, 1.58-1.67). Against medical advice discharge carried the highest readmission risk among unhoused patients (predicted probability, 30.3%; aOR, 1.81; 95% CI, 1.67-1.96). Unhoused patients were more likely to be readmitted for new traumatic injuries (aOR, 1.48; 95% CI, 1.41-1.56), sequelae of prior trauma (aOR, 1.19; 95% CI, 1.02-1.39), and postprocedural complications (aOR, 1.26; 95% CI, 1.12-1.42).

CONCLUSIONS AND RELEVANCE: In this observational study, unhoused status was independently associated with significantly higher odds of 30-day readmission following trauma, often for new injury or poor healing. Improved discharge planning, continuity of care, and access to housing and postacute services are needed.

PMID:41335455 | DOI:10.1001/jamasurg.2025.5282

J Crohns Colitis. 2025 Dec 3:jjaf209. doi: 10.1093/ecco-jcc/jjaf209. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: This study aims to evaluate the diagnostic accuracy of tools commonly employed in clinical practice for the assessment of malnutrition in patients with inflammatory bowel disease (IBD), including Global Leadership Initiative on Malnutrition (GLIM) criteria, Subjective Global Assessment (SGA), European Society of Parenteral and Enteral Nutrition (ESPEN) criteria, and World Health Organization (WHO) related-Body Mass Index (BMI).

METHODS: Eligible observational studies and randomized controlled trials (RCTs) were identified through searches of databases, including PubMed, Scopus, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Epistemonikos until August 2024. Clinical trial registries, grey literature, and reference lists of included studies were also screened. Study selection, data extraction, and quality assessment were conducted independently by two reviewers. A bivariate mixed-effects model was utilized to evaluate the diagnostic test accuracy, producing pooled estimates for sensitivity and specificity with the corresponding confidence intervals (CI), using SGA as reference method for malnutrition diagnosis.

RESULTS: Nine primary studies (1420 participants) and data from one unpublished work were included in the present review. Based on data deprived from three studies, GLIM criteria demonstrated high sensitivity (0.80, 95% CI: 0.68-0.88) and moderate specificity (0.71, 95% CI: 0.53-0.84) using the SGA as reference standard. The certainty of the evidence supporting these findings was rated as very low.

CONCLUSIONS: The GLIM criteria demonstrate potential as an effective tool for diagnosing malnutrition in patients with IBD. However, further validation is necessary, requiring additional diagnostic accuracy studies to enhance their reliability and establish their clinical applicability.

PMID:41335454 | DOI:10.1093/ecco-jcc/jjaf209