Addressing childhood cancer: actions taken in the Dominican Republic / Abordaje del cáncer infantil: medidas adoptadas en República Dominicana / Enfrentamento do câncer infantil: medidas tomadas na República Dominicana

ABSTRACT This report provides a summary of childhood cancer and the efforts made in the Dominican Republic to address child and adolescent cancer in line with the World Health Organization's Global Initiative for Childhood Cancer. Information was obtained by review of recent local and international literature on pediatric oncology. As a result of the Global Initiative, a meeting was held by the Council of Ministers of Health of Central America to support the development of national pediatric cancer plans for each country. The objectives of these plans are to improve overall survival and quality of care for children with cancer through early detection, diagnosis, and treatment. In the Dominican Republic, several steps have been taken in the past 5 years to enhance diagnosis and care of children with cancer. For example, the National Committee of Childhood Cancer, headed by the Ministry of Public Health and including relevant stakeholders, was established to develop the national childhood cancer plan. In addition, a campaign was launched to raise awareness of childhood cancer, and the first early detection manual and public policy on child and adolescent cancer were published. A government initiative has been working to improve the hospital infrastructure and expand the pediatric cancer center, and a national course on early detection of pediatric cancers has been held. In 2023, the National Strategic Childhood Cancer Plan 2023-2030 was launched in the Dominican Republic. The plan will help policy-makers, implementers, researchers, and advocates enhance diagnosis and care of children with cancer.

RESUMEN En este informe se presenta un resumen del cáncer infantil y las medidas adoptadas por República Dominicana para abordar el cáncer en la población infantil y adolescente en consonancia con la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. La información se obtuvo mediante el análisis de las publicaciones nacionales e internacionales recientes sobre oncología pediátrica. Como resultado de la Iniciativa Mundial, el Consejo de Ministros de Salud de Centroamérica celebró una reunión para brindar apoyo a la elaboración de planes nacionales sobre el cáncer infantil para cada país. Los objetivos de estos planes son mejorar la supervivencia general y la calidad de la atención que se presta a la población infantil con cáncer mediante la detección temprana, el diagnóstico y el tratamiento. En los últimos cinco años, República Dominicana ha adoptado varias medidas para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer. Así, por ejemplo, se creó el Comité Nacional de Cáncer Infantil, encabezado por el Ministerio de Salud e integrado por las partes interesadas pertinentes, para elaborar el plan nacional sobre el cáncer infantil. Además, se puso en marcha una campaña de sensibilización sobre el cáncer infantil y se publicaron el primer manual de detección precoz y la primera política pública sobre el cáncer en la población infantil y adolescente. Mediante una iniciativa gubernamental se ha buscado mejorar la infraestructura hospitalaria y ampliar el centro de atención a pacientes oncológicos pediátricos, al tiempo que se ha impartido un curso nacional sobre detección precoz del cáncer infantil. En el 2023, República Dominicana puso en marcha el Plan Estratégico Nacional sobre Cáncer Infantil 2023-2030. Este plan será útil a los responsables de la formulación de políticas, las personas encargadas de su ejecución, los investigadores y los promotores para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer.

RESUMO Este relatório fornece um resumo sobre o câncer infantil e os esforços da República Dominicana para enfrentar a doença em crianças e adolescentes, em consonância com a Iniciativa Global para o Câncer Infantil da Organização Mundial da Saúde. As informações foram obtidas por meio de uma revisão da literatura local e internacional recente sobre oncologia pediátrica. Em consequência da Iniciativa Global, o Conselho de Ministros da Saúde da América Central se reuniu para apoiar a elaboração de planos nacionais de câncer pediátrico para cada país. Os objetivos desses planos são melhorar a sobrevida global e a qualidade da atenção a crianças com câncer por meio de detecção, diagnóstico e tratamento precoces. Na República Dominicana, várias medidas foram tomadas nos últimos cinco anos para melhorar o diagnóstico e a atenção a crianças com câncer. Por exemplo, o Comitê Nacional de Câncer Infantil, que é chefiado pelo Ministério da Saúde e inclui as partes interessadas pertinentes, foi criado para elaborar o plano nacional de câncer infantil. Foi lançada uma campanha de conscientização sobre o câncer infantil no país. Além disso, foram publicados o primeiro manual de detecção precoce e a política pública de câncer infantojuvenil. Uma iniciativa do governo vem trabalhando para melhorar a infraestrutura hospitalar e ampliar o centro de câncer pediátrico e ministrou um curso nacional sobre a detecção precoce de cânceres pediátricos. Em 2023, foi lançado o Plano Estratégico Nacional de Câncer Infantil 2023-2030 na República Dominicana. O plano ajudará formuladores de políticas, implementadores, pesquisadores e defensores da causa a aprimorar o diagnóstico e a atenção a crianças com câncer.

Constructed "ashi point" / 中国针灸

Ashi point is one of the three major categories of acupoint in acupuncture-moxibustion theory nowadays. It is originally recorded in Beiji Qianjin Yaofang (Important Formulas Worth a Thousand Gold Pieces for Emergency) as one of the effective folk methods. The theoretic development of ashi point goes through the innovation period of contemporary and modern acupuncture-moxibustion theory, specifically in three aspects, definition, property and status. Through the analysis of historical data, it is found that the bias of ashi point theory results from the misunderstanding of connotation, the distortion of application techniques, the misinterpretation of semantics and the gradual promotion of status. All of these are generally caused by the reform of acupuncture-moxibustion theory in Japan, which covers the essence of ashi point, limits its connotation and clouds the concept of acupoint. It is necessary to re-understand the literal sense and theoretic construction of ashi point and timely update the knowledge system of acupuncture-moxibustion in association with the results of theoretical researches.

Herbal medicine use in Republic of Korea to alleviate side effects of COVID-19 vaccines: A cross-sectional study / 中西医结合学报

OBJECTIVE@#Coronavirus disease 2019 (COVID-19) has spread worldwide, and several virus variants have emerged. Vaccines are administered to help prevent the infection. In Republic of Korea, most people take herbal medicine. This study investigated the use of herbal medicine to counter the side effects of COVID-19 vaccines.@*METHODS@#This cross-sectional study was conducted using an online survey. Chi-square tests were used to determine differences in the use of herbal medication according to sociodemographic characteristics. Independent two-sample and paired t-tests were performed to examine the effect and satisfaction of herbal medicine use for countering the side effects of COVID-19 vaccines. One-way analysis of variance was used to determine vaccine-related differences.@*RESULTS@#A total of 233 and 181 participants received the first and second doses of COVID-19 vaccines, respectively. The majority of herbal medicine users were in their thirties, had a bachelor's degree, suffered from side effects of vaccination, and received Vaxzevria for their first COVID-19 vaccine dose and Comirnaty for their second dose. The herbal medicine group had a higher satisfaction level of post-vaccination side effects than the non-herbal medicine group (P < 0.0001). The numeric rating scale scores for vaccination side effects were lower among participants who took herbal medication to alleviate those symptoms (P < 0.0001). The most commonly used herbal formula was Shuanghetang.@*CONCLUSION@#A third of participants receiving COVID-19 vaccines used herbal medication to counter the side effects of vaccination. The use of herbal medicine was associated with age, education level, vaccine brand, and whether side effects of vaccination occurred. Herbal medication use was associated with greater satisfaction compared to vaccine recipients not using herbal medication. Please cite this article as: Yoon HC. Herbal medicine use in Republic of Korea to alleviate side effects of COVID-19 vaccines: A cross-sectional study. J Integr Med. 2023; 21(4):361-368.

Midwives are crucial human resources for health to achieve universal health care

@#Midwives are primarily considered as professionals with expertise in assisting women before, during, and after childbirth. Thus, the competencies for midwifery as defined by the International Confederation of Midwives revolve principally around assessment and provision of care to women and the fetus/newborn/infant during the pre-pregnancy and antenatal periods, labor and birth, postnatal/postpartum periods.1 The availability of skilled midwives in communities has allowed women, especially those who belong to lower income groups, to access professional services around childbirth, as reflected in responses from the National Demographic and Household Survey.2 For instance, while 50% of all women surveyed received antenatal care from a midwife, it is notable that 70% of those who belonged to the lowest wealth quintile were seen by a midwife during the antenatal period. Furthermore, midwives assisted 30% of deliveries reported by respondents, while roughly a little over a third of deliveries for each of the three lowest quintiles were attended by a midwife. Furthermore, in the Philippine setting, midwives are recognized as the first professional point of contact for most members of a community, especially in rural and remote places, as midwives are the ones deployed to manage Barangay Health Stations. Elaborating the scope of the practice of midwifery in relation to the provision of “primary health care services in the community” as stipulated in Republic Act No. 73923, the Board of Midwifery of the Professional Regulation Commission, in a primer for the profession, stated that midwives are expected to, among others, (a) implement government health programs in accordance with policies and guidelines of the Department of Health; (b) supervise barangay health workers; and (c) manage a Barangay Health Station.4 Stated differently, midwives, given the scope of work that they do and the areas where they are deployed, serve as the face and touchpoint of the health sector in our communities. They are the embodiment of the different health policies and programs enacted at the national and local levels through which Filipinos experience, individually and collectively, the drive for better health (or lack thereof ) advanced by different agencies, personalities, and stakeholders. However, as pointed out by Felipe-Dimog et al.5 in this issue of Acta Medica Philippina, midwives, especially those working in the public health sector, may take on roles beyond that contemplated by law. For instance, in the course of my professional practice during which I was deployed briefly in a rural health unit, and worked with an urban health department, I have encountered midwives who were tasked to work as program coordinators (or assistant coordinators), sanitation inspectors, field epidemiologists, and supply managers, among others, because of scarcity in the overall staff complement of health departments. Given their close ties with their areas of assignments, midwives are also expected to be community coordinators, if not organizers. The extent to which midwives are assigned these additional tasks depend on their professional relationship with their immediate supervisor; the level of trust and confidence reposed on them by their superiors; in some instances, their attendance to specific training workshops; as well as the availability of more qualified personnel (or lack thereof ) in the locality. Yet despite all these – placement in remote, if not hardship posts; additional assignments beyond their job description – midwives receive salaries that may not be commensurate after consideration of the job context. Staff midwife positions (i.e., Midwife I to III) in government institutions are remunerated at Salary Grades 9 to 13 (i.e., approximate gross pay of PHP 21,000 to PHP 31,000, based on the fourth tranche of the Salary Standardization Law, but may be lower depending on the income classification of the local government unit6). Additional compensation and benefits under special laws may not always be provided as this will depend on the paying capacity of the employing agency. Furthermore, midwives – especially those who completed the two-year program under the previous policy – also must contend with issues concerning their professional status. I have personally encountered community members who do not consider midwives as professionals in the same league as nurses or physicians, or who view midwives as “assistants” or “subordinates” of nurses and physicians, forgetting that a certain degree of independent practice is allowed each professional licensed by the Republic of the Philippines. Midwives play a crucial role in caring for Filipinos not only around childbirth – this is their primary professional duty – but throughout the lifespan – especially for midwives working in local health departments. Stakeholders must not forget to give due recognition to the value and worth contributed by midwives in shaping the health and well-being of each generation of Filipinos.

Voluntary blood donation among the youth: Time to consider service-improving strategies?

@#Voluntary blood donation is a key strategy in improving availability of, and access to, a life-saving product for populations requiring blood transfusion for a variety of medical conditions.1 In the Philippines, the value of voluntary blood donation is recognized by the state through Republic Act No. 7719, enacted nearly three decades ago.2 Among others, this piece of legislation aims to encourage citizens to donate blood through educational and advocacy activities that will “instill public consciousness of the principle that blood donation is a humanitarian act.” But is this appeal to altruism sufficient? The repeated calls for action by the Department of Health (DOH), through its National Voluntary Blood Services Program, may indicate otherwise. For instance, it was noted that in 2009, about one in four blood units collected were from replacement donation (i.e., blood donation from family and friends in exchange for stored blood used by a patient).3 The low voluntary blood donation rates were further exacerbated by the pandemic situation amidst a constant demand for blood transfusion, hence the DOH taps its regular donors such as uniformed personnel.4 Stakeholders particularly appealed to the youth to donate blood to boost supply.5,6 But how do the youth fare? In the paper by Mappala et al.7 in this issue of the Acta Medica Philippina, the authors reported that among a sample of relatively young, educated, internet-savvy, and urban-dwelling respondents, only about one in three ever donated blood, and of this number, about two-thirds either donated blood only when needed, or just did the practice once. Most of the respondents have a relatively high knowledge and awareness of blood donation, and were motivated to donate blood for altruistic and pro-social purposes. From this data alone, appealing to humanitarian and civic duty, the very heart of the current national policy and program, appears to be not enough to encourage the practice of blood donation, at least in so far as this population segment is concerned. Other results from the same survey, however, point to one other area that stakeholders in the voluntary blood donation program can focus on to increase uptake by the population, and this is with respect to the availability and accessibility of the service to the target population. Participants rated highly the statements pertaining to the geographic proximity of the facility, attitude of staff towards blood donors, and availability of communication lines for addressing queries, as motivators for blood donation. From a management perspective, these align with the value chain strategic service delivery model, which can be considered by stakeholders in designing the voluntary blood donation service and facility.8 More specifically, blood donation services can look into incorporating value-adding service delivery strategies in their design of their offering, considering the experience of the service user before, during, and after the service has been rendered. These strategies are described in detail elsewhere, and I will just attempt to list down some considerations specific to the blood donation service. Pre-service strategies include market analysis (including market segmentation and differentiation, in this case possibly developing different approaches and messages for target donors such as the youth, older adults, etc.), pricing (while voluntary blood donation is free, some facilities are authorized to charge a fee for the processing of the donated blood), location (of the blood donation facilities, and deciding whether these should be fixed post or mobile units), and promotion (among others, how to inform the target donors about the service). Point-of-service considerations, meanwhile, pertain to the totality of the donor experience from the time they arrive, and eventually leave, the blood donation facility, and encompasses all aspects of clinical operations, quality assurance, process innovation, and patient satisfaction. Lastly, after-service strategies will have to include aspects on how to encourage a person who donated blood once to become a regular donor, as well as an advocate and ambassador for blood donation who can encourage and influence family and friends to likewise donate blood in a voluntary manner (i.e., as part of follow-up and follow-on activities). I write this Editorial on the eve of the 29th year since Republic Act No. 7719 was promulgated. Given the evolving characteristics of the target blood donor pool, this may be the opportune time to shift from focusing purely on promotion of the pro-social value of blood donation, and incorporate service-improving strategies in the blood donation system, to bring us closer to the policy vision of mobilizing “all sectors of the community to participate in mechanisms for voluntary and nonprofit collection of blood.”

Stigma kills

@#Stigma due to an HIV diagnosis is a well-known phenomenon and is a major barrier to accessing care.1 Over the last forty years, HIV has been transformed from a fatal disease to a manageable one, thanks to the remarkable success of antiretroviral (ARV) medication.2 When people living with HIV (PLHIV) start ARV treatment early, their life expectancy is almost completely restored. Moreover, a suppressed viral load means that PLHIV are no longer able to infect other people.3 They can have children naturally without risk to their seronegative partner or their child. PLHIV nowadays are more likely to die with HIV, not of HIV. While a cure remains elusive, the successful global rollout of ARVs means that there is no good reason for a PLHIV to die of AIDS and its complications due to lack of access to proper treatment. The Philippine AIDS Law Republic Act 8504 and its successor, Republic Act 11116 explicitly states that the State should “ensure access to HIV and AIDS-related services by eliminating the climate of stigma and discrimination that surrounds the country’s HIV and AIDS situation, and the people directly and indirectly affected by it.” Unfortunately, despite this admonition, stigma remains a significant cause of delayed HIV testing and of not seeking treatment in our country. In this issue of the journal, Dr. De Los Santos and her colleagues examine the effect of healthcare facility stigma on PLHIV accessing care in the Philippines.4 They report that 81% of their Filipino PLHIV respondents experienced stigma, which is an unacceptably high number. They identify which facilities are more likely to be correlated with stigma and make suggestions on how to address this problem. This study is very timely and comes at a time when the Department of Health is shifting first line antiretrovirals to dolutegravir-based regimens.5 Dolutegravir-based treatment is associated with fewer side effects than efavirenz-based regimens and is much more durable against resistance.6 With an HIV transmitted-drug resistance rate of 11.7%, it is imperative that PLHIV are started on more durable regimens which they are less likely to discontinue.7 Properly addressing stigma means that more people will access care. Better regimens will ensure that people stay in care. This will go a long way towards minimizing the impact of HIV and AIDS on Filipino PLHIV. Stigma among PLHIV is a complicated subject matter. Aside from the stigma associated with diagnosis, there is also stigma associated with the mode of acquisition of the disease. The most-at-risk populations are highly stigmatized. Men who have sex with men, people who inject drugs, and female sex workers experience additional stigma on top of the stigma from an HIV diagnosis.8 Aside from societal stigma, PLHIV are also prone to self-stigma.9 This phenomenon occurs when PLHIV believe they no longer deserve to live since they contracted the disease from deviant or sinful behavior. High rates of depression are found among these self-stigma sufferers. This significantly impacts the entire HIV healthcare cascade, starting from early diagnosis, to accessing treatment, and staying in care. The finding that Public Rural Health Units are the most stigmatizing healthcare facilities is very concerning since these are usually the only facilities available to PLHIV in far-flung areas. This needs to be addressed with better sensitivity training as well as concrete guidelines on avoiding stigma. It is very troubling that facilities that are supposed to cater to vulnerable populations inadvertently make it difficult for them to access care.10 Unfortunately, even facilities in urban areas are not immune to discrimination and stigmatizing behavior. I recall the experience of one of my early PLHIV patients who developed and eventually succumbed to a disseminated fungal infection.11 He told me that he had tried getting tested several years earlier but he had a traumatic experience in the government health facility that he accessed. He made a wrong turn and entered a different clinic in that hospital and when he asked for an HIV test, people recoiled from him in horror. Because of that terrible experience, he put off getting his HIV test for years until he started developing the fungal infection that eventually killed him. Had he been started on proper treatment earlier, he could have been saved. For me, it wasn’t just the fungus that killed him but it was the delay in diagnosis and care as a direct result of stigma. Addressing HIV-related stigma in our country entails a whole-of-society and a whole-of-nation approach. Mental health services to address self-stigma and depression should be standard of care not just among confirmed PLHIV but among the most-at-risk populations. Proactive education of all members of society, especially healthcare workers in facilities that diagnose and care for PLHIV is essential for ensuring sustained linkage to care. Ensuring that the majority of the PLHIV population are properly diagnosed, enrolled in treatment hubs, and have suppressed viral loads will ultimately lead to fewer transmissions and less AIDS-related deaths.

Health care access and migration experiences among Venezuelan female sex workers living in the Dominican Republic / Experiencias en materia de migración y acceso a la atención de salud en trabajadoras sexuales venezolanas residentes en República Dominicana / Acesso à atenção à saúde e experiências de migração entre trabalhadoras do sexo venezuelanas que vivem na República Dominicana

ABSTRACT Objective. To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic. Methods. This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Information collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022. Results. In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years participated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Dominican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services. Conclusions. This mixed-methods study found that nationality and social exclusion have a multilayered influence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers.

resumen está disponible en el texto completo

RESUMO Objetivo. Identificar comportamentos sexuais de risco e barreiras aos cuidados de saúde sexual e reprodutiva (SSR) entre trabalhadoras do sexo venezuelanas que vivem na República Dominicana. Métodos. Estudo de métodos mistos. Foram realizadas quatro discussões com grupos focais e uma pesquisa quantitativa transversal com trabalhadoras do sexo migrantes venezuelanas. O estudo foi realizado de setembro a outubro de 2021 em dois áreas urbanas (Santo Domingo e Puerto Plata) da República Dominicana. As informações coletadas dos grupos focais foram analisadas por meio de análise temática de conteúdo, e os dados quantitativos foram analisados por meio de estatísticas descritivas univariadas. A análise dos dados foi realizada de 30 de novembro de 2021 a 20 de fevereiro de 2022. Resultados. No total, 40 trabalhadoras do sexo migrantes venezuelanas, com mediana de idade de 33 anos (mínimo, 19; máximo, 49), participaram dos grupos focais e da pesquisa. Os grupos focais identificaram barreiras aos serviços de SSR, incluindo status de imigração e suas repercussões para o emprego formal e o acesso à saúde, bem-estar mental, qualidade de vida na República Dominicana, navegação do trabalho sexual, percepções do trabalho sexual, conhecimento de SSR e apoio social limitado. Conforme a análise quantitativa, a maioria das participantes relatou sentir-se deprimida (78%), solitária/isolada (75%) e com dificuldade para dormir (88%). As participantes relataram uma média de 10 parceiros sexuais nos últimos 30 dias; 55% praticaram sexo sob efeito de álcool; e apenas 39% usaram preservativo na prática de sexo oral nos últimos 30 dias. Em relação ao HIV/aids, 79% fizeram teste de HIV nos últimos 6 meses e 74% sabiam onde procurar serviços de HIV. Conclusões. Este estudo de métodos mistos constatou que a nacionalidade e a exclusão social têm uma influência multifacetada nas trabalhadoras do sexo migrantes, nos comportamentos sexuais de risco e no acesso à atenção à saúde. É preciso implementar recomendações para intervenções eficazes e baseadas em evidências para abordar o conhecimento da saúde sexual, visando a abordar comportamentos sexuais de risco, melhorar o acesso aos serviços de SSR e reduzir as barreiras de acessibilidade.

Creencias, Actitudes Y Prácticas Del Médico En Rol De Paciente: Perspectivas En República Dominicana / Beliefs, Attitudes and Practices of the Medical in the Patient Role: Perspectives in the Dominican Republic

El mito existente sobre la ausencia de vulnerabilidad en los médicos hace que estos sean más difíciles de manejar en su rol de paciente. Así mismo, en ocasiones sus conocimientos previos los hacen tener creencias, actitudes y prácticas no favorables. En este artículo se presentan los resultados de un estudio descriptivo, de corte transversal, cuyo objetivo fue determinar las creencias, actitudes y prácticas del médico dominicano en el rol de paciente. En el mismo se aplicó una encuesta virtual que generó un total de 238 respuestas. Como resultado, se observó que, en su mayoría, los médicos consideran que es más difícil tratar como paciente a un colega. Sobre sus creencias y actitudes, las mismas suelen ser favorables en sus labores como médico, sin embargo, actitudes como la automedicación y los cambios de receta fueron notorios. En conclusión, se entiende que es necesario realizar estudios similares a este y concientizar a quienes se desempeñan como médicos en cuanto a esta temática.

The existing myth about the absence of vulnerability in doctors makes them more challenging to manage in their role as patients. Likewise, sometimes their previous knowledge makes them have opposing beliefs, attitudes, and practices. Therefore, a descriptive, cross-sectional study was carried out to determine the Dominican doctor's beliefs, attitudes, and practices in the role of the patient. A survey was created and disseminated online, and 238 responses were obtained. As a result, most doctors find it more challenging to treat a patient if they are colleagues. Concerning their beliefs and attitudes, they are usually favorable in their work as a doctor; however, in practice, acts such as self-medication and change of prescription are present in large proportion.

Factores Asociados A Severidad Y Mortalidad En Pacientes Con Covid-19: Estudio Multicéntrico En República Dominicana / Factors associated with severity and mortality in patients with COVID-19: a multicentered study in Dominican Republic

Objetivo: identificar factores asociados a severidad y mortalidad por COVID-19. Material y métodos: estudio observacional multicéntrico retrospectivo de pacientes ingresados por COVID-19 en centros de una ciudad de la República Dominicana. Se reportaron datos demográficos, clínicos, terapéuticos y de laboratorio para su comparación entre pacientes con enfermedad severa y no severa, fallecidos y dados de alta. Resultados: los factores asociados a mayor riesgo de severidad y mortalidad fueron el sexo masculino, la hipertensión arterial, la cantidad de comorbilidades, el uso de fármacos previos, niveles elevados de marcadores inflamatorios, linfopenia, neutrofilia, entre otros. Mientras que el uso de inhibidores de la enzima convertidora de angiotensina se asoció a menor mortalidad. Conclusiones: la identificación de los factores asociados a progresión severa y mortal por COVID-19 contribuye a la toma temprana de decisiones relacionadas a la hospitalización y a pautas de manejo médico diferencial en quienes conllevan mayor riesgo de desenlaces adversos.

Objective: To identify factors associated with severity and mortality by COVID-19. Material and methods: Retrospective multicenter observational study of patients admitted with COVID-19 in health centers in a city of the Dominican Republic. Demographic, clinical, therapeutic and laboratory data were reported for comparison between patients with severe and non-severe disease, deceased and discharged. Results: Factors significantly associated with higher risk of severity and mortality were male sex, hypertension, number of comorbidities, drugs' used previously, high levels of inflammatory markers, lymphopenia, neutrophilia, among others. While the use of angiotensin converting enzyme inhibitors was associated with lower mortality. Conclusions: Identification of factors associated with severe and fatal progression of COVID-19 contributes to early clinical decision-making related to hospitalization and differential medical management in those at increased risk of adverse outcomes.

Epistemologia e crítica à regressão: contribuições da Educação Física/Ciências do Esporte / Epistemology and criticism of regression:contributions from Physical Education/Sports Science / Epistemología y crítica a la regresión: aportes de la Educación Física/Ciencias del Deporte

RESUMO O artigo trata dos limites e potencialidades das instituições republicanas e democráticas no que diz respeito às relações da Epistemologia, da Política e da Educação/Educação Física. Enfatiza a necessidade de reafirmar, ante as novas gerações, os valores fundantes e a necessidade de manter uma relação crítica com seus modos de objetivação. Conclui com a aposta em uma Educação/Educação Física que promova o desenvolvimento de uma cultura democrática capaz de resistir às tentações autoritárias, à direita e à esquerda, de "cortar caminho", e em uma cultura científica que sirva de anteparo crítico ao charlatanismo, sem mistificar a ciência.

ABSTRACT This article deals with the limits and potentialities of republican and democratic institutions with regard to the relations between Epistemology, Politics, and Education/Physical Education. It emphasizes the need to reaffirm, before the new generations, the founding values and the necessity of maintaining a critical relationship with its modes of objectification. It concludes with a commitment to an Education/Physical Education that promotes the development of a democratic culture capable of resisting authoritarian temptations, on the right and the left, to "cut corners", and a scientific culture that serves as a critical shield against charlatanism, without mystifying science.

RESUMEN El artículo tematiza acerca de los límites y las potencialidades de las instituciones republicanas y democráticas en lo que respecta a las relaciones de la Epistemología, la Política y la Educación Física. Pone énfasis en la necesidad de reafirmar, frente a las nuevas generaciones, los valores fundantes de este modo específico de sociabilidad como así también de mantener una relación crítica con sus modos de objetivación. Concluye con la apuesta en una Educación/Educación Física que promueva el desenvolvimiento de una cultura democrática, que resista a las tentaciones autoritarias, a la derecha y a la izquierda, de "cortar camino", y en una cultura científica que sirva de amparo crítico al charlatanismo, sin que ello genere una mistificación de la ciencia.

Emergency centre patients in the Democratic Republic of Congo: Some epidemiological and clinical aspects at Beni General Referral Hospital

Introduction: Little information is available regarding the characteristics of patients attending the emergency centre (EC) in the Democratic Republic of Congo. This study aims to provide some epidemiological and clinical aspects of patients admitted to the emergency centre at Beni General Referral Hospital. Methodology: For a year, from January to December 2021, a cross-sectional study was conducted. Data regarding patients' characteristics, admission modality, stay duration, reason for admission, and discharge modality was anonymously collected from patients' registers. A descriptive analysis was done with Epi-Info 7. Result: A total of 1404 patients were admitted to the EC, with a male-to-female ratio of 1.2 to 1. The age group below 18 years accounted for 35.4%. Most of the patients (75.7%) originated from urban areas. In 83% of cases, there was no recommendation from another medical facility for EC admission. The most common reasons for admission are non-traumatic gathering on top of neuropsychiatric and non-specific symptoms. Road traffic accidents are the most frequent causes of trauma symptoms. Few patients (14.7%) spent less than 12 hours in the EC. Globally, 7.3% of patients admitted to the EC were discharged after being managed, and 89% were transferred to different wards. The intra-emergency centre mortality rate was 11.8% among admitted patients in the ER at Beni General Referral Hospital. Conclusion: This epidemiology database underlines the need for developing globalizing and multi-sectoral interventions (diagnosis, therapeutic strategy, organization, health program, or health policies) in the perspective of bringing change and/or taking action in the Democratic Republic of Congo's emergency medical system.

Secondary Metabolites and Mineral Elements of Manotes expansa and Aframomum alboviolaceum Leaves Collected in the Democratic Republic of Congo

Background and Aims: Manotes expansa Sol. ex Planch. and Aframomum alboviolaceum (Ridl.) Schum. are two plants belonging respectively to the family Connaraceae R.Br. and Zingiberaceae Martino widely used in traditional medicine for the treatment of eye diseases, fever, headaches, gastritis as well as asthma. The aim of the present study is the valorization of these two plants collected in the Democratic Republic of Congo by a quantitative and qualitative analysis of secondary metabolites and mineral elements in their leaves. Materials and Methods: The determination of secondary metabolites in the leaves of Manotes expansa and Aframomum alboviolaceum was carried out by UV-Visible spectrophotometry and X-ray fluorescence spectrophotometry for the identification and quantitative analysis of mineral elements. Results: The results showed that the leaves of these two plants are rich in phenolic compounds, i.e. 442.2 mgEqAG/g for the leaves of A. alboviolaceum, 370.64 mgEqAG/g for the red leaves and 282.64 mgEqAG/g green leaves of M. expansa. Although being part of the same plant, the red and green leaves of M. expansa presented a totally different phytochemical profile. The contents of condensed tannins, anthocyanins and flavonoids are respectively 0.3%, 0.68% and 3.29% for the leaves of A. alboviolaceum; 0.58%, 0.36% and 6.89% for the red leaves, and 0.65%, 0.26% and 7.55% for the green leaves of M. expansa. The mineral content in the leaves of both plants remains dominated by the high concentration of potassium (K), calcium (Ca), Magnesium (Mg), Manganese (Mn) and Iron (Fe). Conclusion: The high content of phenolic compounds and essential trace elements makes the leaves of M. expansa and A. alboviolaceum potential candidates to alleviate several health problems in Africa in general and particularly in the Democratic Republic of Congo.

Da Independência ao Império: saúde e doença no Brasil do século XIX / From Independence to Empire: health and disease in Brazil in the nineteenth century

Resumo Como apresentação do dossiê "Da Independência ao Império: saúde e doença no Brasil no século XIX", o artigo contrasta o "Brasil moderno" imaginado pelas elites médicas e políticas por ocasião do I Centenário da Independência, em 1922, com os inúmeros problemas e desafios no campo da saúde que a República, em sua terceira década, herdou dos períodos colonial e imperial. Além disso, destaca questões da história da saúde no século XIX que permitem aos leitores do dossiê refletir sobre as promessas civilizacionais não cumpridas de 1822-1922, à luz dos imensos desafios do ano de 2022, quando o Brasil completa duzentos anos de soberania política.

Abstract As a presentation of the dossier "From Independence to Empire: health and disease in Brazil in the nineteenth century," the article contrast "modern Brazil" imagined by the medical and political elites on the occasion of the First Centenary of Independence in 1922 with the numerous problems and challenges in the field of health that the republic, in its third decade, had inherited from the colonial and Imperial periods. In addition, it highlights issues in the history of health in the 19th century that allow the readers of the dossier to reflect on the unfulfilled civilizational promises of 1822-1922 in light of the immense challenges of the year 2022 when Brazil completes two hundred years of political sovereignty.

Quality of Life and Associated Risk Factors in Hemodialysis: Perspective from a Center in the Dominican Republic

Background: Chronic kidney disease has an overall prevalence of 10 %. It can progress to a condition called end-stage renal disease. Therapies such as hemodialysis are necessary at this stage. Our study aims to measure the quality of life of patients on hemodialysis. Methods: We conducted an observational, cross-sectional study with 81 patients. Data was collected using a survey that included sociodemographic variables, the Center for Epidemiological Studies Depression Screening Index (CES-D), and the Kidney Disease Quality of Life (KDQOL-SF36). Data were analyzed using the software Epi Info™ 7.2, t-test, ANOVA, and correlation coefficient. Results: The severity of symptoms is more significant in the female sex than in males (65.7117 vs. 74.2874). All of the components of the KDQOL-SF36 showed a negative correlation with the CES-D. Household income had a mild positive correlation with the scale (r = 0.2608, p = 0.0229). Physical activity was shown to be associated with the physical component of the scale (41.6346 vs. 35.7365, p = 0.0412). Patients with partners were associated with higher quality of life scores than single patients (53.6585 vs. 42.6783, p = 0.0348). Conclusion: This is the first study conducted in the Dominican Republic to analyze the variables affecting the quality of life in patients in hemodialysis units. The severity of the symptoms increased in female patients, and patients without a partner are associated with worse quality of life scores.

Introducción: la enfermedad renal crónica presenta una prevalencia global del 10 % y puede progresar a una condición llamada enfermedad renal en etapa terminal. Terapias como la hemodiálisis son necesarias en esta etapa. Nuestro estudio tiene como objetivo medir la calidad de vida de pacientes en hemodiálisis. Método: se realizó un estudio observacional transversal, en el cual se recolectaron los datos de 81 pacientes. Para esto, se aplicó un cuestionario con las variables sociodemográficas, así como la escala CES-D y la escala KDQOL-SF36. Los datos se analizaron con el software Epi Info ™ 7.2. mediante la prueba t, ANOVA y el coeficiente de correlación. Resultados: la gravedad de los síntomas fue mayor en el sexo femenino que en el masculino (65,7117 vs. 74,2874). Los componentes de KDQOL-SF36 mostraron una correlación negativa con la puntuación de la escala CES-D. El ingreso del hogar tuvo una correlación positiva leve (r = 0,2608, p = 0,0229). La actividad física mostró estar asociada con la escala (41,6346 vs. 35,7365, p = 0,0412). Los pacientes con parejas tuvieron mejor calidad de vida que los pacientes solteros (53.6585 vs 42.6783, p = 0.0348). Conclusiones: este es el primer estudio realizado en la República Dominicana con el fin de evaluar las variables que afectan la calidad de vida de los pacientes en hemodiálisis. La gravedad de los síntomas aumentó en pacientes del sexo femenino y vivir sin pareja estuvo asociado a un menor puntaje en las escalas de calidad de vida.

Localization and Distribution of Two Invasive Alien Species Eichhornia crassipes and Echinocloa pyramidalis in the Pool Malebo Eco-region, Democratic Republic of the Congo

Aim: To study the distribution of two invasive alien plants and associated plants as well as their distribution in the Malebo Pool eco-region. Methodology: The study was carried out by direct observation by circulating on a motorized canoe. Plant samples were randomly harvested (n=6) in August 2020 depends on the sites. Plant species identification was performed on the field, and those species of which the identification was difficult, were brought to the laboratory for proper identification according to APG III. Results: 19 species, including two Pteridophytes and 17 Angiosperms, belonging to 19 families and 12 orders were identified. The site of Molondo was the most diversified with 15 plant species, followed respectively by the sites of Mipongo (13 species), Japon (12 species) and Kingabwa (07 species). The plant species Ludwigia abyssinica A. Rich., Ipomoea aquatica Forsk, Eichhornia crassipes (Mart), Pistia stratiotes L, Echinochloa pyramidalis (Lam) and Salvinia molesta D.S. Mitchell were present in all four prospected sites. E. pyramidalis and E. crassipes constitute a serious threat for the environment and are source of erosion/loss of aquatic biodiversity. Physiologically, these species form a mono-specific carpet and eliminate native or autochthonous species of aquatic flora.Conclusions and Suggestions: The invasion of alien species is a consequence of human activities and a concern, as it affects all sectors of society. These plants can alter, disrupt, and degrade many ecosystem services like the disturbing of habitats and the alteration of the environmental and biological conditions around them. They can also reduce light and diversity of native aquatic plant species. Controlling invasive alien species is thus a challenge for the Congolese society. Political decision-makers are therefore invited to take appropriate measures for managing and protecting the local aquatic flora and valorize the invasive plants as potential medicinal remedy.

Ethno-botanical Survey and Chemical Study of Medicinal Plants Traditionally used to Treat Anemia in Yakoma Territory (Nord Ubangi), Democratic Republic of the Congo

Aims of the Study: To identify plant species traditionally used to treat anemia in Yakoma territory and to evaluate their chemical composition. Place and Duration: Yakoma Territory (survey) and University of Kinshasa (Phytochemical study), from August and October 2019. Methods: Ethnobotanical survey according to the "snowball" sampling technique among traditional healers (based on the free consent of the respondents), chemical analyses of plant materials (chemical screening, TLC, phytomarkers content, minerals composition) according to standard methods. ED-XRF was used for mineral analysis. Microsoft Excel version 2010, Origin version 8.5 Pro and IBM SPSS statistics version 20 software packages were used for data processing and analysis. Results and Discussion: The survey showed that 18 plant species are traditionally used by Ngbandi traditional healers to treat anemia in Yakoma territory. They belong to 16 families and 17 genera. The most used organs are the leaves (68.4%) and the roots (10.5%). Decoction and infusion are the most used mode of preparation (33.3% each), followed by cooking (22.2%) and maceration (11.1%). The oral route (77.8%) is the most used mode of administration followed by the enema (16.7%) and the anal route (5.6%). Morphological types consist of herbs and trees (33.3% each) and shrubs and lianas (16.7% each). The biotope types consist of forest plants (44.4%), cultivated plants/Crops (38.9%), marshy ground plants (11.1%) and ruderal plants (5.6%). These plants belonging to five biological types: erected therophytes (44.4%), mesophanerophytes (27.8%), microphanerophytes and climbing phanerophytes (11.1% each) and lianescent phanerophytes (5.56%). These anti-anemic plant species are mostly Pantropical and Afro-tropical (39% of species each) followed by Guineo-Congolese (17% of species) and American (5%). Chemical analysis revealed the presence of alkaloids, anthocyanins, flavonoids, anthraquinones and terpenoids and various minerals including iron, zinc, copper, calcium, magnesium and manganese. Conclusion: In the current state of knowledge, the survey of anemic plants from this part of the Democratic Republic of the Congo is reported for the first time.

Controle externo e drift institucional na Primeira República / Control externo y drift institucional en la Primera República brasileña / External control and institutional drift in the First Brazilian Republic

Resumo Esta pesquisa trata do desenvolvimento das instituições federais de controle externo durante a Primeira República brasileira. É um tema pouco visitado pela bibliografia, em geral abordado em retrospectivas que compõem estudos cujos focos estão na história recente do Tribunal de Contas da União (TCU), marcada pelo advento da Nova República (1985-). Tais estudos sugerem um padrão histórico no desenvolvimento das instituições federais de controle externo, caracterizado pela alternância entre períodos de expansão e de retração de suas atribuições. O conhecimento acerca desse padrão histórico de desenvolvimento institucional, para avançar, carece do aprofundamento das pesquisas sobre o período no qual se estabeleceram as bases de sua construção: a Primeira República. Este estudo pretende ser uma contribuição à superação dessa lacuna. Ele sustenta que o desenvolvimento das instituições federais de controle externo no período em questão foi caracterizado pela expansão legal de atribuições, de 1890 a 1892, seguida pela abdicação prática dali até 1930, por drift institucional, da responsabilidade de julgar as contas anuais de governo. O estudo é institucionalista histórico e foi construído com base na análise de fontes primárias.

Resumen Esta investigación aborda el desarrollo de las instituciones federales de control externo durante la Primera República brasileña. Es un tema es poco visitado por la bibliografía, que, en general, lo aborda en retrospectivas presentes en estudios centrados en la historia reciente del Tribunal de Cuentas de la Unión, a menudo demarcada por el advenimiento de la Nueva República (1985-actualidad). Los estudios sugieren la existencia de un patrón histórico de desarrollo de las instituciones federales de control externo, caracterizado por la alternancia entre períodos de expansión y de retracción de sus atribuciones. Para avanzar en el conocimiento acerca de este patrón histórico es necesario profundizar las investigaciones sobre el momento en el cual se establecieron las bases de su construcción, la Primera República. Este estudio pretende ser una contribución a la superación de esa laguna. Sostiene que el desarrollo de las instituciones federales de control externo en el período en cuestión se caracterizó por la expansión legal de atribuciones de 1890 a 1892, seguida de la abdicación práctica desde entonces hasta 1930, por drift institucional, de la responsabilidad de juzgar las cuentas anuales del gobierno. El estudio es institucionalista histórico y se compuso a partir del análisis de fuentes primarias.

Abstract This research deals with the development of the federal institutions of external control during the First Brazilian Republic. This subject is scarcely explored in the literature. In general, it is addressed as a background in studies focusing on the recent history of the Federal Court of Accounts, characterized by the emergence of the New Republic (started in 1985). Such studies suggest a historical pattern in the development of federal institutions of external control, characterized by the alternation between periods of expansion and retraction of their attributions. To advance the knowledge of this historical pattern and contribute to expanding the literature on these institutions, we need a more in-depth look at the period of they were established, i.e., the First Brazilian Republic. This study suggests that the development of federal external control institutions in the First Brazilian Republic was characterized by the legal expansion of attributions from 1890 to 1892, followed by the practical abdication until 1930 by the institutional drift of the responsibility of judging the annual accounts of the government. This is a historical institutionalist study based on the analysis of primary sources.

Characteristics and artemisinin based treatment effect of 362 malaria cases in the peacekeeping mission area of the Democratic Republic of the Congo / 中华地方病学杂志

Objective:To analyze the epidemiological characteristics, diagnosis and treatment of malaria in the peacekeeping mission area of the Democratic Republic of the Congo (DRC), and to evaluate the efficacy of artemisinin based combination therapy (ACT), to provide clinical basis for the diagnosis and treatment of malaria.Methods:The clinical data of malaria-infected peacekeepers admitted to the Chinese Secondary Hospital of the United Nations Stabilization Mission in DRC (MONUSCO) from January 2014 to September 2020 were collected, and the general information, incidence characteristics, treatment and clinical outcomes of the patients were retrospectively analyzed.Results:From January 2014 to September 2020, 362 peacekeepers were hospitalized with malaria, the average annual incidence case was 54 cases per year, and the annual incidence was 9.5/1 000, with a median of 2.5 days (1 - 9 days) from onset to diagnosis. Severe malaria accounted for 7.73% (28/362) and uncomplicated malaria accounted for 92.27% (334/362). The incidence rate was 37.57% (136/362) in the dry season (April to September) and 62.43% (226/362) in the rainy season (October to March of the following year). After ACT antimalarial treatment, all patients were cured clinically. Eight cases recurred and were cured clinically after drug conversion ACT retreatment.Conclusions:In the peacekeeping mission area of DRC, peacekeepers are generally susceptible to malaria. ACT has a high cure rate, safety and efficiency in clinical treatment.

Caracterización de la lesión renal aguda en un hospital de la República Dominicana

Resumen: Objetivo: Caracterizar la lesión renal aguda (LRA) para describir el patrón etiológico, manifestaciones clínicas y de laboratorio. Material y métodos: Diseño observacional, retrospectivo tipo serie de casos. Se analizaron los registros de 88 pacientes, atendidos en la Unidad de Nefrología de un Hospital en la República Dominicana, sin importar el estadio de la enfermedad. Resultados: Encontramos que la edad media es 64 años con una TFG 17 mL/min/1.73 m2. El principal motivo de ingreso como de interconsulta es la "elevación de azoados" con 7.51% (n= 19 / 253) y 29.90% (n=58 / 194), respectivamente. El diagnóstico final más común fue la anemia con un 17.09% (n=50 / 396), la hipertensión arterial con un 34.16% (n=55 / 151) fue la comorbilidad predominante. La mayoría de pacientes no tuvo ningún antecedente medicamentoso con un 31.17% (n=48 / 154), la intervención más común fue el uso de fluidos en un 40.83% (n=49 / 120). El hallazgo clínico más descrito fueron los campos pulmonares hipoventilados 42,72% (n=44 / 103). Conclusiones: Recomendamos poner en funcionamiento acciones que ayuden con un oportuno diagnóstico y tratamiento temprano de la LRA en el hospital.

Abstract: Objective: To characterize acute kidney injury (AKI) and describe its etiological pattern, clinical and laboratory manifestations. Material and methods: Retrospective, observational design, case series type. We analyzed the records of 88 patients treated in the nephrology unit of a hospital in the Dominican Republic, regardless of the stage of the disease. Results: We found that the average age is 64 years with a GFR 17mL/min/1.73 m2. The main reason for admission and consultation is the "elevation of BUN and creatinine levels" with 7.51% (n= 19 / 253) and 29.90% (n=58 / 194), respectively. The most common final diagnosis was anemia 17.09% (n=50 / 396), hypertension with 34.16% (n=55 / 151) was the predominant comorbidity. The majority of patients had no medication history with 31.17% (n=48 / 154), the most common intervention performed was fluid use with 40.83% (n=49 / 120). The most frequently described clinical finding was hypoventilated lungs with 42, 72% (n=44 / 103). Conclusions: We recommend the implementation of actions to improve the timely diagnosis and management of AKI in the hospital.

Resumo: Objetivo: Caracterizar a lesão renal aguda (LRA) prá descrever o padrão etiológico, manifestações clinicas e do laboratório. Métodos: Modelo observacional, retrospectivo tipo série de casos. Foram analisados os registros de 88 pacientes, antendidos na Unidade de Nefrología dum Hospital na República Dominicana, sem importar o estágio da doença. Resultados: Encontramos que a edade média é 64 anos com uma TFG de 17 mL/min/1.73 m2. A razão principal da admissão e interconsulta é a "elevação de azoados" com 7.51% (n=19/253) e 29.90% (n=58/194), respectivamente. O diagnóstico final mais comum foi a anemia com um 17.09% (n=50/396), a hipertensão arterial com um 34.16% (n=55/151) foi a comorbidade predominante. A maioria dos pacientes não tinha histórico medicinal com um 31.17% (n=48/154), a intervenção mais comum foi o uso de fluidos num 40.83% (n=49/120). O achado clínico mais comum foi campos pulmonares hipoventilados 47.72% (n=44/103). Conclusões: Recomendamos colocar em operação ações que ajudam com um diagnóstico oportuno e um tratamento precoce da LRA no hospital.

Medición de adherencia a antirretrovirales con métodos múltiples en La Romana, República Dominicana / Use of Multiple Methods to Measure Adherence to Antiretroviral Treatment in La Romana, Dominican Republic / Medição da adesão a antirretrovirais com múltiplos métodos em La Romana, República Dominicana

RESUMEN Objetivo. El objetivo fue desarrollar una herramienta para medir los niveles de adherencia al tratamiento antirretroviral (la TARV) en un entorno de escasos recursos, a partir de la combinación de cuatro métodos de medición de adherencia. Métodos. Revisión retrospectiva de 500 expedientes médicos de personas que viven con VIH, elegidos de manera aleatoria desde octubre del 2017 hasta enero del 2020. Se midió la adherencia a la TARV combinando cuatro métodos de medición (porcentaje de cobertura de la TARV recetada, recogida de la TARV en farmacia, nivel de carga viral y autoinforme de adherencia). Se realizaron pruebas de chi al cuadrado con P <0,05 para diferencias estadísticamente significativas y regresión binaria logística para identificar probabilidades de adherencia óptima y subóptima. Realizamos pruebas de Spearman para correlación de categorías y alfa de Cronbach para medir la consistencia interna de la herramienta. Resultados. Obtuvimos 497 calificaciones de adherencia. De estas, 307 (61,8%) usuarios se calificaron como adherentes, 141(28,4%) como semiadherentes y 49 (9,8%) como no adherentes. Se encontró una mayor probabilidad de adherencia óptima en grupos de 60 años o más (odds ratio [OR]: 1,6; IC95%: 0,8-3,5) sin diferencia entre hombres y mujeres (OR: 0,9; IC95%: 0,7-1,4). La prueba de Spearman informó una relación (r = 0,8) entre los niveles de carga viral y la calificación final, y la prueba alfa de Cronbach arrojó una modesta consistencia interna (α = 0,7). Conclusiones. Se desarrolló una herramienta para medir adherencia en un entorno de escasos recursos. La herramienta presenta niveles modestos de consistencia interna y una correlación fuerte en la categoría de carga viral y adherencia.

ABSTRACT Objective. To develop a tool that measures levels of adherence to antiretroviral treatment (ART) in resource-poor settings, based on a combination of four methods for measuring adherence. Methods. Retrospective review of 500 medical records of people living with HIV, randomly selected from October 2017 to January 2020. Adherence to ART was measured by combining four measurement methods (coverage of prescribed ART, ART picked up at pharmacies, viral load, and self-reported adherence). Chi-squared tests were performed with p<0.05 for statistically significant differences and logistic binary regression to identify the probability of optimal and suboptimal adherence. Spearman tests were performed for correlation of categories, and Cronbach's alpha was used to measure the internal consistency of the tool. Results. We obtained 497 adherence scores. Of these, 307 (61.8%) users qualified as adherent, 141 (28.4%) as semi-adherent, and 49 (9.8%) as non-adherent. A higher probability of optimal adherence was found in groups aged 60 years and older (odds ratio [OR]: 1.6; CI95%: 0.8-3.5), with no difference between men and women (OR: 0.9; CI95%: 0.7-1.4). Spearman's test reported a relationship (r = 0.8) between viral load levels and final score, and Cronbach's alpha yielded modest internal consistency (α = 0.7). Conclusions. A tool was developed to measure adherence to ART in a resource-poor environment. The tool shows modest levels of internal consistency and a strong correlation between viral load and adherence.

RESUMO Objetivo. Desenvolver uma ferramenta para medir os níveis de adesão à terapia antirretroviral (TARV) em um ambiente de poucos recursos, com base na combinação de quatro métodos de medição de adesão. Métodos. Revisão retrospectiva de 500 prontuários de pessoas que vivem com HIV, selecionadas aleatoriamente de outubro de 2017 a janeiro de 2020. A adesão à TARV foi medida pela combinação de quatro métodos (porcentagem de cobertura da TARV prescrita, coleta de TARV na farmácia, nível de carga viral e adesão autorrelatada). Foram realizados testes de qui-quadrado com P < 0,05 para diferenças estatisticamente significativas e regressão logística binária para identificar probabilidades de adesão ótima e subótima. Foram realizados testes de Spearman para a correlação de categorias e alfa de Cronbach para medir a consistência interna do instrumento. Resultados. Foram obtidos 497 índices de adesão. Entre eles, 307 (61,8%) usuários foram classificados como aderentes, 141 (28,4%) como semiaderentes e 49 (9,8%) como não aderentes. Foi encontrada maior probabilidade de adesão ótima nos grupos de 60 anos ou mais (odds ratio [OR]: 1,6; IC95%: 0,8-3,5), sem diferença entre homens e mulheres (OR: 0,9; IC95%: 0,7-1,4). O teste de Spearman constatou uma relação (r = 0,8) entre os níveis de carga viral e a pontuação final, e o teste alfa de Cronbach mostrou uma consistência interna modesta (α = 0,7). Conclusões. Foi desenvolvida uma ferramenta para medir a adesão em um ambiente de poucos recursos. A ferramenta apresenta níveis modestos de consistência interna e forte correlação de categoria entre carga viral e adesão.