Perception of Patients on the Waiting List for Total Hip Arthroplasty on the Resumption of Elective Surgeries during the COVID-19 Pandemic / Percepção dos pacientes em lista de espera para artroplastia total do quadril sobre a retomada das cirurgias eletivas durante a pandemia COVID-19

Abstract Objective To analyze the profile and perception ofpatients on the waiting list for total hip arthroplasty (THA) about performing elective surgeries during the COVID-19 pandemic. Methods From July to November 2021, patients on the THA waiting list were interviewed during outpatient consultations. To compare the groups regarding categorical variables, the Chi-square test or Fisher's exact test was applied, and for quantitative variables the Mann-Whitney test was applied. The results were calculated using the Statistica program version 7. Results 39 patients answered the questionnaire. The mean age was 58.95 years, with 53.85% male. Approximately 60% expressed concern about contracting or transmitting COVID-19 to their family members after hospitalization for THA. 58.9% of patients felt hampered by the delay in scheduling elective surgeries during the pandemic. 23% lost or had a family member who lost their job during the pandemic, with a statistical difference for the group under 60 years old (p = 0.04). Conclusion Most patients were concerned about becoming infected and exposing family members to COVID-19 after surgery and noted damage due to suspensions and delay in scheduling elective surgeries. The economic impact of the pandemic was revealed by the rate of 23% of respondents who lost or had a family member who lost their job during the pandemic, being higher in patients under 60 years of age (p = 0.04).

Resumo Objetivo Analisar o perfil e a percepção dos pacientes em lista de espera para artroplastia total do quadril (ATQ) sobre a realização das cirurgias eletivas durante a pandemia pela COVID-19. Métodos De julho a novembro de 2021, foram entrevistados pacientes em lista de espera para ATQ durante consultas ambulatoriais. Para comparar os grupos com relação às variáveis categóricas foi aplicado o Teste Qui-quadrado ou Teste exato de Fisher e para as variáveis quantitativas foi aplicado o teste de Mann-Whitney. Os resultados foram calculados utilizando o programa Statistica versão 7. Resultados 39 pacientes responderam ao questionário. A média de idade foi de 58,95 anos, sendo 53,85% do sexo masculino. Aproximadamente, 60% manifestaram preocupação em contrair ou transmitir COVID-19 aos seus familiares após internação hospitalar para ATQ. 58,9% dos pacientes sentiram-se prejudicados pelo atraso no agendamento das cirurgias eletivas durante a pandemia. 23% perderam ou tiveram algum familiar que perdeu o emprego durante a pandemia, havendo diferença estatística para o grupo com menos de 60 anos (p = 0,04). Conclusão A maioria dos pacientes sentiram preocupação em infectar-se e expor familiares à COVID-19 após a cirurgia e notaram prejuízo pelas suspensões e atraso no agendamento de cirurgias eletivas. O impacto econômico da pandemia revelou-se pela taxa de 23% de entrevistados que perderam ou tiveram algum familiar que perdeu seu emprego durante a pandemia, sendo maior nos pacientes menores de 60 anos (p = 0,04).

Acceptability of teleconsultation in a public service specialized in the prevention and care of HIV infection and other sexually transmitted infections / Aceitabilidade da teleconsulta em um serviço público especializado na prevenção e cuidado da infecção pelo HIV e outras infecções sexualmente transmissíveis

Introduction: Telemedicine was leveraged for its contribution to mitigate the impact of COVID-19 in Brazil and worldwide. Objective: We aim to evaluate the acceptability of incorporating teleconsultation through synchronized videoconference by users and professionals in a service specialized in the prevention and treatment of the human immunodeficiency virus and other sexually transmitted infections, and to identify associated factors. Methods: This is a cross-sectional study with 410 users and 57 professionals who answered a category-standardized questionnaire. Predictors of acceptability were assessed using logistic regression model. Results: A total of 364 (88.8%) users said they would accept the modality. The factors positively associated with the odds of acceptance were the self-assessment of having favorable conditions to participate in a teleconsultation (aOR 54.8; 95%CI 12.4­242.1; p<0.001), the perception of saving money (aOR 5.2; 95%CI 1.9­14.0; p=0.001), and perceived convenience of the modality (aOR 6.7; 95%CI 2.9­15.9; p<0.001). Factors associated with reduced odds of acceptance were the fear of not being evaluated well (aOR 0.2; 95%CI 0.1­0.4; p<0.001), or remaining long without seeing the professional (aOR 0.2; 95%CI 0.1­0.5; p<0.001). The acceptance of the modality among professionals was 75.4% and the perception of its convenience (aOR 16.8; 95%CI 2.6­108.4; p=0.003) and that the institution has appropriated conditions (aOR 7.7; 95%CI 1.5­40.6; p=0.016) were associated with increased odds of accepting its incorporation in their routine. Conclusion: Governance should invest in infrastructure and support, secure protocols, digital literacy, and training of its users and employees for video teleconsultation. (AU)

Introdução: A telemedicina foi alavancada por sua contribuição para mitigar o impacto da COVID-19 no Brasil e no mundo. Objetivo: Pretendemos avaliar a aceitabilidade da incorporação da teleconsulta por videoconferência síncrona por usuários e profissionais de um serviço especializado na prevenção e tratamento da infecção pelo vírus da imunodeficiência humana (HIV) e outras infecções sexualmente transmissíveis, bem como identificar fatores associados. Métodos: Estudo transversal com 410 usuários e 57 profissionais, que responderam a um questionário padronizado por categoria. Os preditores de aceitabilidade foram avaliados utilizando-se um modelo de regressão logística. Resultados: O total de 364 (88,8%) usuários disseram que aceitariam a modalidade. Os fatores positivamente associados à probabilidade de aceitação foram a autoavaliação quanto a ter condições favoráveis para participar de uma teleconsulta (razão de chances ajustada ­ aOR 54,8; intervalo de confiança de 95% ­ IC95% 12,4­242,1; p<0,001), a percepção de poupar dinheiro (aOR 5,2; IC95% 1,9­14,0; p=0,001) e a percepção de conveniência da modalidade (aOR 6,7; IC95% 2,9­15,9; p<0,001). As menores probabilidades de aceitação foram o medo de não ser bem avaliado (aOR 0,2; IC95% 0,1­0,4; p<0,001) e de permanecer muito tempo sem ver o profissional (aOR 0,2; IC95% 0,1­0,5; p<0,001). A aceitação da modalidade pelos profissionais foi de 75,4% e a percepção de sua conveniência (aOR 16,8; IC95% 2,6­108,4; p=0,003) e a de que a instituição possui condições favoráveis (aOR 7,7; IC95% 1,5­40,6; p=0,016) foram associadas com a maior probabilidade de aceitar a incorporação da modalidade em sua rotina. Conclusão: A governança deve investir em infraestrutura e apoio, protocolos seguros, literacia digital e treinamento de seus usuários e funcionários para a videoconsulta. (AU)

Knowledge, acceptability and utilization of epidural analgesia in antenatal clinic attendees at UNIOSUN Teaching Hospital (UTH), Osogbo, Osun State

Labour pain is perceived as the most harrowing and agonizing event of a woman's life. Efforts at reducing the pain and making the event less stressful have predated modern obstetric practice. Epidural analgesia has provided effective pain relief in labour for over three decades. Delivery with epidural analgesia is routine for willing parturients in the developing world, however ignorance, cost as well as lack of qualified personnel has made this to be out of reach of the average Nigerian mother. The aim of this study was to assess level of awareness, acceptability, previous utilization and willingness to utilize epidural analgesia in labour following health education.Subjects/Methods: This cross-sectional study was carried out in the antenatal clinic of UTH, Osogbo. Health education on events of labour and methods of analgesia available was provided to all antenatal clinic attendees between September 2021and March 2022, following which a semi­structured purpose designed, and self- administered questionnaire was administered to 415 of these women who consented to participate in this study. Results: The mean age of the respondents was 32.57± 4.42 years and mean parity of 1.73± 0.96. 70.8% reported that labour pain was severe. 41.7% were aware of epidural analgesia before the health talk. 3.6% of our subjects had utilized epidural in their last confinement. However, only 47.7% expressed a wish to utilize epidural analgesia in labour. Conclusion: Awareness of epidural analgesia in study population was passable at 40% however willingness to utilize it was less than average despite health talk and reassurance by their attending obstetric team.

Saúde e discriminação no processo de envelhecimento LGBTQIA+ / Health and discrimination in the aging process LGBTQIA+ / Salud y discriminación em el processo de envejecimiento LGBTQIA+

Objetivo: Identificar as experiências e discriminações vividas pela população LGBTQIA+ em envelhecimento durante a prestação dos serviços de saúde. Método: Estudo exploratório de abordagem qualitativa, por meio da aplicação de um questionário com informações sociodemográficas e questões sobre experiências anteriores dentro de instituições de saúde e percepção do cuidado recebido. Resultados: Participaram nove pessoas, predominantemente, identificadas como homens cisgêneros; e, apenas um estava com idade entre 65 e 70 anos. Em sua maioria buscam o serviço de saúde duas vezes ao ano motivado principalmente por problemas particulares, do sistema respiratório, hipertensão arterial ou dores persistentes. Indicaram não haver desencorajamento para a procura de serviços e a maioria não relatou experiências de discriminação. Conclusão: A baixa frequência de discriminação pode indicar a dificuldade de caracterizar a exposição e/ou vivências por esta população. Sendo assim, devese buscar entender o que essa população considera discriminação por parte dos serviços de saúde a pessoas LGBTQIA + durante o processo de envelhecimento.

Objective: To identify the experiences and discrimination experienced by the aging LGBTQIA+ population during the provision of health services. Method: Exploratory study with a qualitative approach, through the application of a questionnaire with sociodemographic information and questions about previous experiences within health institutions and perception of care received. Results: Nine people participated, predominantly identified as cisgender men; and, only one was aged between 65 and 70 years. Most seek the health service twice a year motivated mainly by particular problems, the respiratory system, high blood pressure or persistent pain. They indicated that there was no discouragement to seek services and most did not report experiences of discrimination. Conclusion: The low frequency of discrimination may indicate the difficulty of characterizing the exposure and/or experiences of this population. Therefore, one should seek to understand what this population considers discrimination by health services to LGBTQIA+ people during the aging process.

Objetivo: Identificar las experiencias y la discriminación que vive la población LGBTQIA+ envejecida durante la prestación de los servicios de salud. Método: Estudio exploratorio con enfoque cualitativo, mediante la aplicación de un cuestionario con información sociodemográfica y preguntas sobre experiencias previas dentro de las instituciones de salud y percepción de la atención recibida. Resultados: Participaron nueve personas, predominantemente identificadas como hombres cisgénero; y, solo uno tenía entre 65 y 70 años. La mayoría acude al servicio de salud dos veces al año motivada principalmente por problemas particulares, del sistema respiratorio, hipertensión arterial o dolor persistente. Indicaron que no hubo desánimo para buscar servicios y la mayoría no reportó experiencias de discriminación. Conclusión: La baja frecuencia de discriminación puede indicar la dificultad de caracterizar las exposiciones y/o experiencias de esta población. Por lo tanto, se debe buscar comprender lo que esta población considera discriminación por parte de los servicios de salud a las personas LGBTQIA+ durante el proceso de envejecimiento.

Percepciones de aceptabilidad y reticencia a las vacunas contra la COVID-19 en el Perú / Perceptions of acceptance and reluctance to COVID-19 vaccination in Peru

RESUMEN Objetivos. Explorar los factores que predisponen la aceptabilidad o reticencia a la vacunación contra la COVID-19 utilizando métodos cualitativos. Materiales y métodos. Estudio cualitativo descriptivo realizado entre abril y junio del 2021. Se utilizó una guía de entrevista semiestructurada que exploró las percepciones de los participantes de diferentes regiones del Perú con relación a la aplicación de la vacuna para la COVID-19, tomando como marco teórico el modelo de creencias en salud, cuyas dimensiones son: susceptibilidad, severidad, beneficios, barreras y estímulos asociados para ejecutar la acción. Resultados. Se entrevistó a treinta personas, en su mayoría mujeres. Para los participantes la eficacia de las vacunas se relaciona con el país de procedencia, además, consideran que es importante conocer los efectos a largo plazo en la salud luego de la aplicación de la vacuna. La información recibida por las autoridades gubernamentales y sanitarias puede ser un factor decisivo para la aplicación de la vacuna. Las personas con la intención de no vacunarse sienten que las estrategias de promoción de la vacunación vulneran sus derechos humanos. Conclusiones. Existe un grupo de personas indecisas o inseguras de recibir las vacunas contra la COVID-19 en quienes es necesario fomentar estímulos de acuerdo con sus preocupaciones y necesidades. Las autoridades gubernamentales y sanitarias deben trabajar conjuntamente para mejorar la confianza de la población y brindar mensajes que despejen las principales dudas sobre la eficacia y las reacciones adversas de las vacunas.

ABSTRACT Objectives. To explore factors that influence the acceptance or reluctance to COVID-19 vaccination using qualitative methods. Materials and methods. Descriptive qualitative study conducted between April and June 2021. A semi-structured interview guide was used to explore the perceptions of participants from different regions of Peru regarding COVID-19 vaccination. The Health Belief Model was used as theoretical framework and its dimensions are: susceptibility, severity, benefits, barriers, and cues to action. Results. We interviewed 30 people, mostly were women. For the participants, the efficacy of vaccines is related to the country of origin of the vaccines; in addition, they consider that it is important to know the long-term effects on health after vaccination. The information received by governmental and health authorities can be a decisive factor for vaccination. People with the intention of not being vaccinated feel that vaccination promotion strategies violate their human rights. Conclusions. There is a group of people undecided or unsure about receiving COVID-19 vaccines who need to be encouraged according to their concerns and needs. Governmental and health authorities should work together to improve the confidence of the population and provide messages to clarify doubts about the efficacy and adverse reactions of vaccines.

Frecuencia y factores relacionados al no cumplimiento del control prenatal en gestantes de 35 años o más en el Cauca, Colombia, 2016-2018 / Frequency and associated factors of non-adherence to prenatal care in pregnant women 35 years of age or older in Cauca, Colombia, 2016-2018

RESUMEN Objetivos: describir la frecuencia del no cumplimiento del control prenatal en gestantes de 35 años o más del departamento del Cauca, Colombia, y hacer un análisis exploratorio de los factores asociados. Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron gestantes entre 35 y 41 años afiliadas a la Entidad Administradora de Planes de Beneficios Asociación Indígena del Cauca Entidad Promotora de Salud-I (EAPB AIC-I) e inscritas al programa de control prenatal, entre 2016 y 2018. Se excluyeron pacientes con registros sin información completa. Se analizaron variables sociodemográficas, clínicas y la frecuencia de no asistencia adecuado al control prenatal a través de estadística descriptiva, y se calcularon Odd Ratios con sus intervalos de confianza para los factores asociados. Resultados: en 1016 pacientes entre 35 y 41 años evaluadas se encontró una frecuencia de no cumplimiento de mínimo seis controles prenatales de 61,3 %. El antecedente de aborto (OR ajustado: 0,46; IC 95 % 0,33-0,64,) y gravidez de cinco o más (OR ajustado: 3,22; IC 95 % 1,50-6,91) fueron los factores asociados. Conclusiones: el no cumplimiento de controles prenatales por gestantes de 35 o más años inscritos en la EAPB AIC-I del Cauca es alto. Se requieren nuevos estudios cualitativos que evalúen factores culturales y sociales presentes en estas comunidades que afectan la adherencia al control prenatal, así como estudios prospectivos que confirmen el análisis exploratorio de los factores asociados a la no adherencia. Es importante que las empresas aseguradoras del régimen subsidiado realicen actividades de promoción en estas comunidades para incrementar su cumplimento.

ABSTRACT Objectives: To describe the frequency and factors associated with non-adherence to prenatal follow-up in pregnant women 35 years of age or older in the department of Cauca, Colombia, between 2016 and 2018. Material and methods: Cross-sectional, descriptive observational study of records of pregnant women between 35 and 41 years of age affiliated to the Cauca Indigenous Association Health Benefit Plan Management Organization-I (EAPB AIC-I) and registered in the prenatal care program, between 2016 and 2018. Duplicate records and records with incomplete information were excluded. Sociodemographic and clinical variables, as well as program outcomes, were analyzed using descriptive statistics. Odds ratios and their confidence intervals were calculated. Results: In 1016 patients between 35 and 41 years of age, a frequency of 61.3 % of non-adherence to at least six prenatal visits was found. History of abortion (adjusted OR: 0.46; 95 % CI 0.33-0.64) and pregnancy of five or more (adjusted OR: 3,22; IC 95 % 1,50-6,91) were the associated factors. Conclusions: Non-adherence to prenatal care by pregnant women of 35 years or more affiliated to the Cauca EAPB AIC-I is high. Further qualitative studies are needed to examine the cultural and social factors present in these communities that may affect adherence to prenatal monitoring, together with prospective studies to confirm the exploratory analysis of factors associated with non-adherence. Insurance organizations in the subsidized regime should be called upon to conduct promotion activities in these communities in order to improve adherence.

Expectativas en salud de las personas mayores que acuden a la atención primaria / Health expectations of older people attending primary care

INTRODUCCIÓN: Desde la última década se ha evidenciado el aumento de la población de personas mayores en Chile. Muchos de ellos son usuarios regulares del sistema público de salud el cual se caracteriza por entregar una atención de tipo integral. En este sentido, resulta relevante conocer los requerimientos en salud desde la perspectiva de las experiencias de las personas mayores con respecto al uso de este servicio. OBJETIDO: El objetivo de este estudio fue identificar las expectativas de las personas mayores que asisten a los centros de APS. MATERIAL Y MÉTODOS: Este es un estudio cualitativo, descriptivo, donde la muestra fue de 13 personas mayores de 65 años y más, autovalentes, de tres centros APS, los cuales fueron entrevistados mediante instrumento semiestructurado, con análisis cualitativo de datos método que incluyó codificación abierta y focalizada. RESULTADOS: Las expectativas de las personas mayores fueron categorizadas como requerimiento de una atención profesional integral, oportunidad de atención, accesibilidad de la atención, promoción de salud sobre el autocuidado, explicación de cambios en el envejecimiento con enfoque biológico y alfabetización en salud. CONCLUSIONES: Las expectativas de las personas mayores en este estudio dan cuenta de una atención profesional integral poco efectiva, además de la necesidad de un trato especializado al grupo poblacional específico, no sólo de los profesionales, sino también del personal administrativo de los centros de APS, considerándolos una barrera en la calidad de la atención.

INTRODUCTION: Since the last decade there has been evidence of an increase in the population of older people in Chile. Many of them are regular users of the public health system (PHS) which is characterized by providing comprehensive care. In this sense, it is relevant to know the health requirements from the perspective of the experiences of the older people regarding the use of this health service. OBJECTIVE: The objective of this study was to identify the needs and expectations of older people attending PHS centers. MATERIAL AND METHODS: It were a qualitative and descriptive study. The sample was compounded by 13 people over 65 years and over, self-sufficient, from three PHS centers. It was used a semi-structured instrument. RESULTS: The main needs of the elderly were categorized as a requirement for comprehensive professional care, the opportunity for care, accessibility of care, health promotion on self-care, explanation of changes in aging with a biological focus and health literacy. CONCLUSIONS: The needs and expectations of the older people in this study account for an ineffective comprehensive professional care, in addition to the need for specialized treatment of the specific population group, not only of professionals but also of the administrative staff of the centers of PHS, considering them a barrier in the quality of care.

Aceitabilidade social de tecnologias da atenção primária à saúde: uma revisão de escopo / Social acceptance of primary health care technologies: a scoping review

Alma-Ata definiu a Atenção Primária à Saúde (APS) como "cuidados essenciais de saúde baseados em métodos e tecnologias práticas, cientificamente bem fundamentadas e socialmente aceitáveis"1, mas parece faltar "aceitabilidade social" paradiversas tecnologias usadas na APS, além de pouca investigação de tal conceito. Esta pesquisa buscou compreendera aceitabilidade social das tecnologias praticadas na APS,no Brasil e no mundo, por meio de uma revisão de escopo, visando mapear conceitos-chave, tipos de evidências e lacunas no campo através de sistemática busca, seleção e síntese do conhecimento existente. Buscaram-se artigos de 1978 a 2019 no Medline -PubMed, BVS/Lilacs, Academic Search Premier, Web of Science, Science Direct, SciELO e CINAHL complete. Pesquisou-se, também, nas referências desses artigos e por meio de busca complementar efetuada no Google e no Google Scholar. Identificados13.874 artigos, foram selecionados 201 para tabulação e análise. Encontrou-se grande variedade de tecnologias usadas na APS em 41 países, que foram organizadas em forma temática. Identificaram-se sete acepções para"aceitabilidade social": percepções sobre uma tecnologia, intenções de aceitar uma tecnologia, aceitar uma tecnologia ou não, confiança, participação, acesso e qualidade do cuidado.

Alma-Ata defined Primary Health Care (PHC) as "essential health care based on practical, scientifically and socially acceptable methods and technology," 1 but it seems that several technologies used in PHC lack social acceptability ­a concept seldom investigated. This research was pursued to acknowledge the social acceptability of PHC technologies, in Brazil and in the world, through a Scoping Review, in order to map concepts, evidence, and gaps in the research field through a systematic search, selection, and synthesis of existing knowledge. The articles, published between the years of 1978 and 2019, were searched in the following databases: Medline-PubMed, BVS/Lilacs, Academic Search Premier, Web of Science, Science Direct, SciELO, and CINAHL Complete. Further references cited in these articles were explored along with complementary searches on Google and Google Scholar. Out of 13,874 articles identified, 201 wereselected for data extraction and analysis. As a result, thematic maps of the large scope of technologies used in PHC were created. Seven different groups were created to assess "social acceptability": perceptions about a specific technology; the intentionto accept it; simply accepting it; trust; participation; access; and quality of care.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in "Crackland", Brazil / Perfil sociodemográfico e clínico de indivíduos em busca de tratamento para o uso de crack que vivem na "Cracolândia"

OBJECTIVE: São Paulo's Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. METHODS: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. RESULTS: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. CONCLUSION: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

OBJETIVO: Localizada em São Paulo, a Cracolândia é o maior e mais antigo cenário aberto de uso de drogas do Brasil. Ainda assim, pouco se sabe sobre o perfil dos indivíduos que vivem nessa região e buscam tratamento para crack. O objetivo deste estudo transversal foi descrever características demográficas e clínicas de usuários de crack vivendo na região da Cracolândia que estão em busca de tratamento. MÉTODOS: Noventa e oito indivíduos foram avaliados para transtornos por uso de substâncias do DSM-V, padrão de uso de substâncias, impulsividade e sintomatologia psiquiátrica. O uso recente de crack também foi determinado por meio de coleta de amostras toxicológicas. RESULTADOS: Os resultados indicaram grave vulnerabilidade social, com significativas prevalências de falta de moradia (46,9%), moradia instável (50%), desemprego (60,4%) e abandono escolar precoce (27,5%). A idade média de início do uso de crack foi de 20 anos (DP = 6,9) e a duração média do uso contínuo do crack foi de 15 anos (DP = 9,7). A maioria dos participantes apresentou alguma comorbidade psiquiátrica, particularmente transtorno por uso de álcool (87,8%), bem como altas taxas de sintomatologia psiquiátrica e impulsividade. Mais da metade da amostra relatou pelo menos uma tentativa anterior de tratamento por internação (73,5%) e ambulatorial (65,3%). CONCLUSÃO: Os achados desse estudo permitem um maior entendimento do perfil e das necessidades de usuários de crack vivendo na região da Cracolândia e podem ajudar serviços de saúde especializados em dependência química a promoverem uma assistência mais direcionada às demandas específicas dessa população.

Itinerários terapêuticos de pessoas com diabetes mellitus no Brasil: revisão integrativa / Therapeutic itineraries of people with diabetes mellitus in Brazil: an integrative review / Itinerarios terapéuticos de personas con diabetes mellitus en Brasil: revisión integrativa

Objetivo: Analisar a produção científica sobre itinerários terapêuticos de pessoas com diabetes mellitus no Brasil. Métodos: Trata-se de uma revisão integrativa da literatura com publicações recuperadas a partir do acesso a Medical Literature Analysis and Retrievel System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Base de Dados em Enfermagem (BDENF), incluindo nestes dois últimos casos a literatura cinzenta (dissertações e teses). Os critérios de inclusão deram-se por: artigo de pesquisa de campo, teórico e de revisão; relato de experiência ou trabalho de conclusão de curso que abordasse os itinerários terapêuticos de pacientes com diabetes mellitus no Brasil, no idioma inglês, português ou espanhol, publicado até a data das buscas (março e abril de 2020), sem restrição quanto à data inicial. Resultados: Dez publicações compuseram a amostra final. Os resultados apresentaram-se agrupados em quatro categorias temáticas: a) experiência em relação aos serviços de atenção à saúde; b) recursos de apoio no cuidado à saúde; c) práticas de autocuidado utilizadas; e d) dificuldades para o autocuidado e enfrentamento do diabetes mellitus. Conclusão: A organização e a articulação dos serviços, a atuação das equipes, o apoio familiar ou social, além de aspectos pessoais, socioeconômicos e laborais são fatores que influenciam os itinerários terapêuticos e o enfrentamento do diabetes mellitus.

Objective: To analyze the scientific production on therapeutic itineraries of people with Diabetes Mellitus in Brazil. Methods: This is an integrative literature review of publications retrieved from the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and the Nursing Database (Base de Dados Enfermagem ­ BDENF), including in these last two cases the gray literature (theses and dissertations). Inclusion criteria were: field, theoretical and review research article, experience report or course completion work that addressed the therapeutic itineraries of patients with Diabetes Mellitus in Brazil, in English, Portuguese or Spanish, published until the date of the searches (March and April 2020), without restrictions as to the starting date. Results: Ten publications made up the final sample. The results were grouped into four thematic categories: a) experience in relation to health care services, b) health care support resources, c) self-care practices used and d) difficulties in self-careand coping with Diabetes Mellitus. Conclusion: The organization and articulation of services, the performance of the teams, the family or social support and personal, socioeconomic, and work aspects are factors that influence therapeutic itineraries and coping with Diabetes Mellitus.

Objetivo: Analizar la producción científica sobre los itinerarios terapéuticos de personas con diabetes mellitus en Brasil. Métodos: Se trata de una revisión integrativa de la literatura con publicaciones recuperadas a partir del acceso al Medical Literature Analysis and Retrievel System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) y la Base de Datos en Enfermería (BDENF), incluyendo en los dos últimos casos la literatura gris (trabajos de maestría y tesis). Los criterios de inclusión se dieron por artículo de investigación de campo, teórico y de revisión; relato de experiencia o trabajo de fin de grado que tratara de itinerarios terapéuticos de pacientes con diabetes mellitus en Brasil, en los idiomas inglés, portugués o español, que hubiera sido publicado hasta la fecha de las búsqueda (marzo y abril de 2020), sin restricción de la fecha inicial. Resultados: Diez publicaciones han compuesto la muestra final. Los resultados se presentaron de manera agrupada en cuatro categorías temáticas: a) experiencia con los servicios de atención a la salud; b) recursos de apoyo con el cuidado de salud; c) prácticas de autocuidado utilizadas; y d) dificultades para el autocuidado y el afrontamiento de la diabetes mellitus. Conclusión: La organización y la articulación de los servicios, la actuación de los equipos, el apoyo familiar o social, además de los aspectos personales, socioeconómicos y laborales son factores que influyen en los itinerarios terapéuticos y el afrontamiento de la diabetes mellitus

Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda

introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross-sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives. Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

BACKGROUND: Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district. METHODS: A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02­30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization. RESULTS: Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization. CONCLUSION: Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it

Preferences, Utilization and Factors affecting Use of Contraceptives amongWomen attending Primary Health Care Facilities in Delta State,Southern Nigeria

Contraceptive use has numerous benefits for thefamily and the nation that can be maximized with its consistent use.However, many women have preferences for certain contraceptiveswith implications for continued use.OBJECTIVE: To determine the contraceptive preferences of women,their utilization pattern and factors affecting utilization of the preferredcontraceptive choices.METHODS: This cross-sectional study was conducted among 426women of reproductive age selected from 32 primary health facilitiesusing multistage sampling technique. Data was collected using a semi-structured interviewer-administered questionnaire. Descriptive andinferential analysis of data collected was carried out using IBM SPSSversion 22 software. P-value was set at 0.05.RESULTS: Close to half of the respondents 211 (49.5%) preferredinjectable contraceptives, 79 (18.6%) selected implants and 27 (6.3%)chose condoms. The majority 212 (49.8%) of respondents usedinjectable contraceptives, followed by implants 66 (15.5%), condoms33 (7.7%), IUCD 54 (12.7%) and OCP 61 (14.3%). Age (p<0.001),number of children (p<0.001), clients' employment status (p<0.001),husband support (p<0.021) and desire for more children (p<0.001)were all statistically associated with the utilization of preferredcontraceptives.CONCLUSION: Even though respondents preferred the injectablecontraceptives, implants and IUCD in that order, their utilizationpattern followed the order of Injectable, implants and OCP. Severalfactors were identified to be statistically associated with the utilizationof preferred contraceptives. Health education on contraceptive useamong women, spousal support and health workers training tohighlight those factors influencing women's contraceptive preferencesand utilization are recommended

COVID 19: determinants and barriers to infection prevention and control practice among residents in Bonny Island, Rivers State

Background: Coronavirus disease 2019 (COVID-19) which was declared a pandemic and described as a disease of public health emergency caused worldwide disruption of business activities, education, tourism and health challenges including death. Prevention is a viable strategy to contain the pandemic, including the use of vaccines. However, evidence abound which reveals that majority of people do not comply with proposed health and safety measures recommended by World Health Organization (WHO) and their respective country health authorities. This study identified socio-demographic and other variables which may influence compliance to practice of infection prevention and control (IPC) measures. Method: This is a descriptive cross-sectional study conducted at zonal hospital Bonny. All eligible respondents who visited the hospital for Medicare were included into the study until sample size was achieved. Pretested interviewer administered questionnaire was used to elicit information from respondents. Multinomial regression analysis was used to analyze data with statistical significance set at 0.05. Ethical clearance, permission for the study and informed consent were derived from relevant authorities and respondents respectively. Result: Compliance to good IPC measures was 73.9%. There was statistically significant compliance to good practice among public servants, respondents aged 31-40 years and females. Conclusion: Good IPC measures was high among respondents, COVID 19 vaccine acceptance was poor, while factors such as inability to procure personal protective equipment and non-availability of water were responsible for poor compliance

"It is just a lot to deal with": A qualitative study exploring the sexual and reproductive health needs of a sample of female sex workers in six locations in Southern Africa

The sexual and reproductive health of female sex workers in Southern Africa is particularly important, given the high prevalence of HIV among this population. This paper presents the results of a rapid assessment study conducted prior to the implementation of the "SRHR-HIV Knows No Borders" project in six Southern African countries. Trained interviewers interviewed 20 sex workers across 10 high migration communities. Data were analysed thematically. Participants were well informed about and were able toaccess preventive methods for STIs and pregnancy, although reports of condom failures were common. While sex workers found SRH services easily accessible, many reported experiences of stigma and discrimination when accessing them. Physical and sexual violence were common occurrences among participants, both from their clients and the police. In addition to addressing stigma within the healthcare and broader community, interventions could provide opportunities for those looking to exit the industry by providing skills training and microfinance support. (Afr J Reprod Health 2022; 26[5]: 72-80).

Determinants of COVID-19 vaccine acceptance and hesitancy among healthcare professionals in the Kintampo North Municipality, Bono East Region, Ghana

tives: To assess the determinants of COVID-19 vaccine acceptance and hesitation among Health Care Professionals (HCPs) in the Kintampo North Municipality of Ghana. Design: An analytical cross-sectional study. Setting: The study was carried out in the Kintampo North Municipality. Participants: All health care professionals within the Kintampo North Municipality of Ghana. Main outcome measure: Acceptance of COVID-19 vaccine. Results: In all, 215 HCPs were included in this study. The overall vaccine acceptance was 78.6% among HCPs, while 21.4% were hesitant to receive the COVID-19 vaccine. Majority (57.7%) of HCPs believed that COVID-19 vaccines were safe. The following factors were found to influence vaccine acceptance significantly; those who knew someone who has taken the vaccine (adjusted Odds Ratio [aOR]; 14.9, 95% Confidence Interval [95% CI];5.0-45.0, p<0.001), those who think COVID -19 vaccine in Ghana was safe (AOR;9.2, 95%CI;3.3-25.8, P<0.001), those who said vaccines are effective in controlling COVID-19 transmission (aOR=5.0, 95%CI;2.1-12.4, p<0.001), and those who have never refused vaccines in the past (aOR=7.8, 95CI;1.6-37.8, p=0.01). Conclusion: The study indicated high COVID-19 vaccination acceptability among HCPs. However, some HCPs are hesitant to take COVID-19 vaccinations immediately. Increased adoption of COVID-19 vaccinations among HCPs and the broader Ghanaian population requires concerted efforts, including strengthening public health education on the perceived risks and safety of COVID-19 vaccines

Couverture vaccinale et raisons de l'acceptation et de l'hésitation à la vaccination contre la COVID-19 chez les patients porteurs de pathologie cardiovasculaire à Ouahigouya / Vaccination coverage and reasons for accept ance orhesitation in vaccination against COVI D-19 in patients with cardiovascular disease in Ouahigouya

Objectif. La pandémie de COVID-19 a été cause d'une mortalité élevée chez les patients porteurs de comorbidités comme les pathologies cardiovasculaires. L'accélération de la mise sur marché des vaccins contre la pandémie a suscité une réticence envers ces derniers. L'étudié porte sur l'attitude des patients porteurs de pathologie cardiovasculaires vus en consultation cardiologique à Ouahigouya vis-à-vis de la vaccination contre la COVID-19. Population et méthodes. Une étude transversale a été menée du 1er au 25 avril 2022 dans trois cliniques privées de la ville de Ouahigouya. Nous avons inclus les patients consentants et porteurs de pathologie cardiovasculaire vus en consultation cardiologique. Le questionnaire était centré sur les connaissances, attitudes et pratiques de groupe vis-à-vis de la vaccination, notamment les raisons de 'l'acceptation ou du refus de se faire vacciner. Résultats. Cent-un patients ont été interviewés. Le sex-ratio était 1,46 avec un âge moyen de 48,26 ± 11,93 ans. Les plus représentés étaient les travailleurs indépendants, les urbains, les musulmans, les non-scolarisés et les mariés. L'HTA et ses complications étaient les atteintes cardiovasculaires les plus fréquentes (93,07%). La proportion de vaccinés était de 55,45%. Les raisons les plus évoquées par les vaccinés pour se vacciner étaient pour se protéger (100%) et le suivi des Recommandations gouvernementales et des agents respectivement 78,52% et 72,21%. Les raisons de l'hésitation vaccinale les plus citées étaient : la COVID-19 est une maladie banale (62,22%) et la peur des effets secondaires (44,44%). Conclusion. La vaccination contre la COVID-19 devrait se poursuivre, accompagnée d'une sensibilisation efficace afin d'améliorer le taux de couverture vaccinale parmi les patients porteurs de pathologies cardiovasculaires

Objective. COVID-19 pandemic has caused high mortality in patients with comorbidities such as cardiovascular pathologies. The acceleration of the marketing of vaccines against the pandemic has caused reluctance towards them. The study focuses on the attitude of patients with cardiovascular disease seen in cardiology consultation in Ouahigouya vis-à-vis COVID-19 vaccination. Population and methods. A cross-sectional study was conducted from April 1 to 25, 2022 in three private clinics of the city of Ouahigouya. We included consenting patients and carriers of cardiovascular pathology seen in cardiology consultation. Our main data of interest were the knowledge, attitude and practice of this population towards vaccination, especially thereasons for accepting or refusing vaccination. Results One hundred and one patients were interviewed. The sex ratio was 1.46 with an average age of 48.26 ± 11.93 years. The most represented were the self-employed, urban dwellers, Muslims, the uneducated and the married. Hypertension and its complications were the most common cardiovascular disorders (93.07%). The proportion of vaccinated was 55.45%. The reasons most mentioned by the vaccinated for getting vaccinated were to protect themselves (100%) and to follow government recommendations and agents, respectively 78.52% and 72.21%. The most cited reasons for vaccine hesitation were: COVID-19 is a common disease (62.22%) and fear of side effects (44.44%). Conclusion. Vaccination against COVID-19 must continue, accompanied by effective awareness-raising in order to improve the vaccination coverage rate among patients with cardiovascular pathologies

Conhecimento e atitudes de pais de crianças/adolescentes sobre papillomavirus humano: estudo transversal / Conocimiento y actitudes de padres de niños/adolescentes sobre el virus del papiloma humano: estudio transversal / Knowledge and attitudes of parents of children/adolescents about human papillomavirus: cross-sectional study

Resumo Objetivo Analisar as características associadas aos pais de crianças e adolescentes que ouviram falar sobre o Papillomavirus humano, bem como o conhecimento sobre a infecção e a intenção de vacinar seus filhos. Métodos Estudo transversal com abordagem quantitativa, realizado por meio de entrevista utilizando instrumento estruturado. Entrevistaram-se 376 pais de crianças e adolescentes que aguardavam atendimento pediátrico em unidades de saúde de Três Lagoas/MS. Os dados coletados (características sociodemográficas; características reprodutivas e sexuais; conhecimento sobre o Papillomavirus humano e intenção de vacinar o/a filho/a) foram analisados por meio de técnica de estatística descritiva, teste de associação Qui-quadrado ou exato de Fisher e Teste T Student. Resultados Dentre os entrevistados, 327 (87,0%) afirmaram ter ouvido falar sobre o Papillomavirus humano. Identificou-se associação entre os pais que nunca ouviram falar sobre a infecção e sexo masculino, idade entre 18 e 25 anos e ensino fundamental incompleto. Dentre os pais que ouviram falar sobre o Papilomavírus Humano, 152 (46,5%) afirmaram que é uma infecção sexualmente transmissível, 245 (74,9%) garantiram que a transmissão ocorre através da relação sexual desprotegida, 275 (75,5%) desconhecem seus sinais e sintomas, 218 (66,7%) afirmaram erroneamente que tal infecção tem cura e 283 (86,5%) sabem da existência da vacina. Dentre todos os entrevistados, 98,1% levariam seu(ua) filho(a) para vacinar contra o vírus. Conclusão Observaram-se lacunas no conhecimento dos pais de crianças e adolescentes sobre o Papillomavirus humano, mostrando a necessidade de educação em saúde e divulgação de ações de enfrentamento à infecção em meios de comunicação e redes sociais.

Resumen Objetivo Analizar las características asociadas a padres de niños y adolescentes que escucharon hablar sobre el virus del papiloma humano, así como el conocimiento sobre la infección y la intención de vacunar a sus hijos. Métodos Estudio transversal, con enfoque cuantitativo, realizado por medio de encuesta con instrumento estructurado. Se encuestaron 376 padres de niños y adolescentes que esperaban atención pediátrica en unidades de salud de Três Lagoas, estado de Mato Grosso do Sul. Los datos recopilados (características sociodemográficas, características reproductivas y sexuales, conocimiento sobre el virus del papiloma humano e intención de vacunar al hijo/a) se analizaron por medio de técnica de estadística descriptiva, prueba de asociación ji cuadrado o prueba exacta de Fisher y test-T Student. Resultados Entre los encuestados, 327 (87,0 %) afirmaron haber escuchado hablar sobre el virus del papiloma humano. Se identificó relación entre los padres que nunca escucharon hablar sobre la infección y el sexo masculino, edad entre 18 y 25 años y educación primaria incompleta. De los padres que escucharon hablar sobre el virus del papiloma humano, 152 (46,5 %) afirmaron que es una infección de transmisión sexual, 245 (74,9 %) aseguraron que la transmisión ocurre a través de las relaciones sexuales sin protección, 275 (75,5 %) desconocen sus signos y síntomas, 218 (66,7 %) afirmaron erróneamente que tal infección tiene cura, y 283 (86,5 %) saben de la existencia de la vacuna. Entre los encuestados, el 98,1 % llevaría a su hijo/a vacunarse contra el virus. Conclusión Se observaron vacíos de conocimiento en los padres de niños y adolescentes sobre el virus del papiloma humano, lo que muestra la necesidad de educación para la salud y difusión de acciones para enfrentar la infección en medios de comunicación y redes sociales.

Abstract Objective Analyze the characteristics associated with the parents of children and adolescents who have heard about the human papillomavirus, as well as the knowledge about the infection and the intention to vaccinate their children. Methods Cross-sectional study with quantitative approach, conducted through a structured interview. We interviewed 376 parents of children and adolescents who were awaiting pediatric care at health services in Três Lagoas/MS. The collected data (sociodemographic characteristics; reproductive and sexual characteristics; knowledge about human papillomavirus and intention to vaccinate the child) were analyzed using descriptive statistics, Fisher's exact test or the chi-square association test and Student's t-test. Results Among the respondents, 327 (87.0%) said they had heard about the human papillomavirus. An association was identified between parents who had never heard of the infection and male sex, age between 18 and 25 years and unfinished primary education. Among the parents who had heard about the human papillomavirus, 152 (46.5%) stated that it is a sexually transmitted infection, 245 (74.9%) assured that the transmission occurs through unprotected sexual intercourse, 275 (75.5%) are unaware of its signs and symptoms, 218 (66.7%) mistakenly stated that this infection is curable and 283 (86.5%) know of the existence of the vaccine. Among all respondents, 98.1% would take their child to get vaccinated against the virus. Conclusion Gaps were observed in the knowledge of the parents of children and adolescents about the human papillomavirus, showing the need for health education and dissemination of actions to cope with the infection in the media and social networks.

Knowledge, attitudes, and practices of adolescents regarding human papillomavirus / Conhecimentos, atitudes e práticas de adolescentes sobre o papilomavírus humano

ABSTRACT OBJECTIVE To analyze knowledge, attitudes, and practices of adolescent students from public schools in the municipality of Teresina, state of Piauí, regarding human papillomavirus (HPV). METHODS Cross-sectional, analytical study carried out in 12 public schools in the municipality of Teresina, with a random sample of 472 15-year-old adolescents. All participants answered a validated questionnaire, which evaluated sociodemographic characteristics, level of knowledge about HPV, attitudes regarding vaccination and vaccination status. The levels of knowledge and attitude were classified by standardized scores and practice by the vaccination situation. The analyses were carried out using the SPSS software. In the bivariate analysis, simple logistic regression was used generating odds ratios to identify the associations of sociodemographic characteristics, knowledge, and attitude with HPV prevention practice. Variables that presented p-value ≤ 0.20 in the bivariate analysis were inserted in a multivariate logistic regression model. Statistical significance was set at p < 0.05. RESULTS Among the participants, 27.3% had sufficient knowledge, 34.1% had positive attitudes, and 74.6% had adequate practice. In the multivariate analysis, we observed a statistically significant association among females (ORa = 15.62; 95%CI: 9.08-26.9), satisfactory knowledge (ORa = 2.09; 95%CI: 1.15-3.81), and positive attitudes (ORa = 1.89; 95%CI: 1.10-3.23) with proper practice. CONCLUSIONS Being female, having a satisfactory level of knowledge about HPV and the vaccine, and having positive attitudes towards HPV vaccination reinforce the appropriate practice of vaccination. These findings demonstrate the need to expand the knowledge of adolescents, generating positive attitudes towards vaccination within an appropriate perspective.

RESUMO OBJETIVO Analisar conhecimentos, atitudes e práticas de adolescentes estudantes de escolas públicas do município de Teresina-PI sobre o papilomavírus humano (HPV). MÉTODOS Estudo transversal, analítico, realizado em 12 escolas da rede pública do município de Teresina, com uma amostra aleatória de 472 adolescentes de 15 anos. Todos os participantes responderam a um questionário validado, que avaliou as características sociodemográficas, o nível de conhecimento sobre o HPV, atitudes relacionadas à vacinação e ao status vacinal. Os níveis de conhecimento e atitude foram classificados por meio de escores padronizados e a prática mediante a situação vacinal. As análises foram realizadas com o uso do SPSS. Na análise bivariada, utilizou-se a regressão logística simples, por meio de odds ratio para identificar as associações entre as características sociodemográficas e o conhecimento, e a atitude com a prática de prevenção contra o HPV. As variáveis que na análise bivariada apresentaram valor de p ≤ 0,20 foram submetidas ao modelo multivariado de regressão logística. A significância estatística foi fixada em p < 0,05. RESULTADOS Dentre os participantes, 27,3% apresentaram conhecimento suficiente, 34,1% atitudes positivas e 74,6% prática adequada. Na análise multivariada observou-se associação estatisticamente significativa entre o sexo feminino (ORa = 15,62; IC95%: 9,08-26,9), conhecimento satisfatório (ORa = 2,09; IC95%: 1,15-3,81), e atitudes positivas (ORa = 1,89; IC95%: 1,10-3,23) com a prática adequada. CONCLUSÕES Ser do sexo feminino, ter nível de conhecimento sobre o HPV e a vacina classificados como satisfatório, bem como ter atitudes positivas frente à vacinação contra o HPV reforçam a prática adequada de vacinação. Estes achados demonstram a necessidade de ampliar o conhecimento dos adolescentes, gerando atitudes positivas com vistas à vacinação dentro de uma perspectiva adequada.

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals - sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06-1.12), health insurance (PR = 1.13; 95%CI 1.09-1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84-0.90) and informal workers (PR = 0.89; 95%CI 0.84-0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05-1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33-2.12) but lower in men (PR = 0.55; 95%CI 0.44-0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51-0.89), and unemployed (PR = 0.72; 95%CI 0.53-0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01-1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65-0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.