Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Plan nacional para la promoción de la donación voluntaria de sangre en el Perú, 2018-2021: Documento técnico / National plan for the promotion of voluntary blood donation in Peru, 2018-2021: Technical document

El documento contiene: la finalidad, base legal, ámbito de aplicación, disposiciones generales y específicas, recursos, presupuestos, financiamiento, monitoreo y evaluación y responsabilidades del plan nacional para la promoción de la donación voluntaria de sangre en el Perú.

Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina: the views of public and private sector representatives / Análisis de una iniciativa voluntaria para reducir el sodio en productos procesados y ultra-procesados en Argentina: perspectivas de los representantes del sector público y privado / Análise de uma iniciativa voluntária para reduzir o teor de sódio em produtos alimentícios processados e ultra-processados na Argentina: as perspectivas de representantes dos setores público e privado

Abstract: The Less Salt, More Life program was the first voluntary salt reduction initiative in Argentina. This article analyzes the perspectives of the stakeholders involved in this voluntary agreement between the Ministry of Health and the food industry to gradually reduce sodium content in processed foods. This exploratory case study used a qualitative approach including 29 in-depth interviews with stakeholders from the public and private sectors and identified the role of the different stakeholders and their perceptions regarding the challenges encountered in the policy process that contribute to the debate on public-private partnerships in health policies. The article also discusses the initiative's main challenges and controversies.

El programa Menos Sal, Más Vida fue la primera iniciativa voluntaria para la reducción de la sal en Argentina. Este artículo analiza las perspectivas de los representantes del sector público y privado involucrados en este acuerdo voluntario, entre el Ministerio de Salud y la industria alimentaria, para reducir gradualmente el contenido de sodio en las comidas procesadas. Este estudio de caso se basó en una aproximación cualitativa, incluyendo 29 entrevistas en profundidad, con las partes interesadas del sector público y privado e identificó el papel de los mismos y sus percepciones respecto a los desafíos enfrentados durante el proceso, con el fin de contribuir al debate de las colaboraciones público-privadas en políticas de salud. El artículo también discute los principales desafíos y controversias.

O programa Menos Sal, Mais Vida foi a primeira iniciativa voluntária para reduzir o teor de sal em produtos alimentícios na Argentina. O artigo analisa as perspectivas dos atores envolvidos nesse acordo voluntário entre o Ministério da Saúde e a indústria alimentícia para reduzir gradualmente o teor de sódio nos alimentos processados. O estudo de caso exploratório utilizou uma abordagem qualitativa com 29 entrevistas em profundidade com representantes dos setores público e privado, e identificou o papel dos diversos atores e suas percepções quanto aos desafios enfrentados no processo político, contribuindo para o debate sobre parcerias público-privadas em políticas de saúde. O artigo também discute os principais desafios e controvérsias dessa iniciativa.

Study on economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing.</p><p><b>METHODS</b>People living with HIV/AIDS were divided into two groups, HIV infected patients and AIDS patients. The data about their direct medical expenditure, direct non-medical expenditure and indirect economic loss in the past year were collected. Univariate and multivariate analysis were conducted to identify the potential influencing factors.</p><p><b>RESULTS</b>The median of direct medical expenditure and total costs for 133 HIV infected patients were 1,200 yuan RMB and 1,972 yuan RMB respectively. The median of direct medical expenditure and total costs for 145 AIDS patients were 1 060 yuan RMB and 2 826 yuan RMB respectively. The differences in direct medical expenditure and total costs between HIV infected patients and AIDS patients showed no statistical significance. The results from univariate analysis indicated that the sample source influenced total costs significantly. Multivariate analysis showed that onset time and CD level were negatively correlated with direct medical expenditure. The patients infected through heterosexual contact had more direct medical expenditure than those infected through homosexual contact. The patients receiving HIV test in hospitals had more direct medical expenditure than those receiving volunteer counseling and testing.</p><p><b>CONCLUSION</b>Further efforts should be made to expand HIV testing and treatment coverage in order to detect HIV infections as early as possible. Early antiretroviral treatment should be given to HIV infected patients to maintain their immunity and reduce their medical expenditure.</p>

Cómo aumentar la actividad física de los niños durante el período del recreo en las escuelas / Increasing children's physical activity during school recess periods

OBJETIVOS: Analizamos si la participación de las escuelas en el Programa de Mejoramiento del Recreo (PMR) en la primavera del año 2011 estuvo asociada a tasas más altas de actividad física intensa en los niños. MÉTODOS: En el PMR, un coordinador dirige a los niños para que practiquen juegos adecuados para la edad a fin de aumentar su nivel de actividad física. Durante el recreo en 25 escuelas primarias públicas de la ciudad de Nueva York (15 participantes en el PMR, 10 no participantes en el PMR) los investigadores observaron algunas áreas predeterminadas (n = 1 339 observaciones) y registraron el número de niños que estaban sedentarios, caminando o muy activos. RESULTADOS: Tras el análisis estadístico con múltiples variables se encontró que la participación en el PMR era una variable predictiva significativa (P = 0,027) de la tasa de actividad física intensa (porcentaje de niños muy activos en las áreas de observación) cuyas medias de los mínimos cuadrados fueron de 41% en las escuelas participantes en el PMR y de 27% en escuelas no participantes en el PMR. En las escuelas participantes en el PMR se siguió registrando una tasa significativamente superior incluso cuando el coordinador de juegos no estaba en el área de observación, lo que sugiere un cambio en la cultura del recreo en las escuelas que participan en este programa. CONCLUSIONES: La tasa de actividad física intensa en las escuelas participantes en el PMR fue 14 puntos porcentuales (o 52%) superior a la tasa registrada en las escuelas no participantes en el PMR. Esta intervención de bajo costo podría ser un agregado valioso a las herramientas para combatir la obesidad infantil y podría valer la pena reproducirla en otros sitios.

OBJECTIVES: We examined whether schools' participation in the Recess Enhancement Program (REP) in the spring of 2011 was associated with higher rates of children's vigorous physical activity. METHODS: In REP, a coach guides children through age-appropriate games aimed at increasing their physical activity. During recess at 25 New York City public elementary schools (15 REP, 10 non-REP), researchers visually scanned predetermined areas (n = 1339 scans), recording the number of sedentary, walking, and very active children. RESULTS: Multivariate statistical analysis found that participation in REP was a significant predictor (P = .027) of the rate of vigorous physical activity (percentage very active in scan area) whose least-squares means were 41% in REP schools and 27% in non-REP schools. A significantly higher rate in REP schools persisted when the coach was not in the scan area, suggesting a change in the recess culture of REP schools. CONCLUSIONS: The rate of vigorous physical activity in REP schools was 14 percentage points, or 52%, higher than the rate in non-REP schools. This low-cost intervention might be a valuable addition to the tools for combating childhood obesity and worth replicating elsewhere.

Extensão Médica Acadêmica: um projeto da Faculdade de Medicina da Universidade de São Paulo para treinamento clínico e humanização do cuidado em saúde de alunos da medicina, nutrição e fisioterapia / “Extensão Médica Acadêmica”: healthcare humanization and clinical training of medicine, nutrition and physical therapy students from the School of Medicine of University of São Paulo

A Extensão Médica Acadêmica (EMA) foifundada em 1998 na FMUSP visando à formação de médicos que valorizam o exame clínico e o relacionamentohumano. É um projeto de voluntariado atualmente organizado por estudantes de medicina, fisioterapia e nutrição da USP. O EMA é sustentado por três pilares: ensino, assistência e pesquisa. O projeto é realizado aos sábados em dois bairros carentes da cidade de SãoPaulo, e tem como objetivo oferecer um atendimento ambulatorial gratuito de qualidade, que priorize cuidados em saúde e humanização na relação médico-paciente. Os pacientes são atendidos por alunos e os casos sãodiscutidos com profissionais de saúde, e durante a semana são realizadas reuniões com todos os membros doprojeto, na Faculdade de Medicina da USP, contribuindo para a consolidação e aprofundamento dos conceitos em saúde. Este modelo de ensino complementa os estudos em sala de aula, pois permite o desenvolvimento de habilidades geralmente pouco exploradas durante o início da graduação tradicional. O EMA incentiva seus alunos a valorizarem a relação médico-paciente desde o primeiroano da graduação. Assim, o projeto tem êxito em reunir pessoas dispostas a lidar com pacientes, aprender sobresaúde e ensinar outros estudantes. Como resultado, muitos de seus membros continuam a participar do projeto após o término da faculdade, tornando-se orientadores comprometidos a passar adiante o conhecimento adquirido durante sua prática profissional...

The Academic Medical Extension (EMA) is a volunteer project of the School of Medicine of University of São Paulo organized by students of Medicine, Physical Therapy and Nutrition of University of São Paulo. It was founded in 1998 in order to provide a better academic development to students who value physical examination and human relations, besides providing to students in the beginning of graduation an early contact with patients and promotingan exchange of information between those three areas of health. EMA is sustained by three pillars: assistance,education and research, thus constituting an alternative tocommunity-based education and assistance with a focus on humanization. The project is carried in two regions in the city of São Paulo and aims to offer these needy populationsa free ambulatory care with quality, promote health and prevention. On Saturdays, undergraduate students see the patients and discuss the clinical case with a health professional; once a week, they attend a meeting with their group, which includes students of the three areas of health. During this meeting, the students report the clinical case and are assisted by other students to conduct the case and teachwhat they’ve learnt about the patient, collaborating with the establishment and deepening of the concepts in health. The project seeks to encourage their students since the first yearof college to value the physician-patient relationship. Thus, it brings together people willing to work ithout the intention to earn a profit, but to learn more about health and to teachother students. As a result, members still participate in the project after graduation, as doctors committed to pass on their experience and knowledge...

Effects of a Volunteer-Run Peer Support Program on Health and Satisfaction with Social Support of Older Adults Living Alone

PURPOSE: The purpose of the study was to evaluate effectiveness of a peer support program conducted by older community volunteers for older adults living alone. METHODS: Thirty volunteers trained as peer supporters were matched with low-income, older adults living alone in the community on gender. Visits occurred on a weekly basis over the 12 month study period, and the volunteers provided peer support for health management to solitary older adults. Data were collected, before the start of the program and again 6 and 12 months after its initialization, from intervention and control groups regarding physical health, general health, mental health, depression, social functioning, and satisfaction with social support. Repeated measures ANOVA was used to analyze data. RESULTS: By the end of the program, socially isolated older adults in the intervention group had significantly higher scores in physical health and general health than elders in the control group. Significant interaction effects between time and group were found for depression, social functioning, and satisfaction with social support. CONCLUSION: The peer support program undertaken by older community volunteers was effective in improving physical health, general health, depression, social functioning, and satisfaction with social support in socially isolated, low-income, older adults.

Voluntariado ambiental: um estudo exploratório / Voluntariado ambiental: un estudio exploratorio / Environmental volunteerism: an exploratory study

O voluntariado ambiental é um exemplo de confluência dos comportamentos pró-sociais e pró-ambientais. A presente pesquisa objetivou identificar categorias temáticas do discurso e funções do voluntariado em uma organização voluntária. Foi aplicado o Inventário das Funções do Voluntariado (IFV) junto a quatro voluntários e conduzidas entrevistas semi-estruturadas com três deles. Foram identificados quatro eixos temáticos: características e perfil do voluntário, organização voluntária, crise ambiental e percepção da sociedade. O IFV permitiu identificar semelhanças e diferenças quanto ao gênero e idade. Discute-se a importância das gratificações para a inserção e manutenção do voluntariado e apontam-se sugestões para gestores e para futuras pesquisas.

Environmental volunteerism is an example of prosocial behavior and pro-environmental behavior confluence. The objective was to characterize the volunteer in the organization: thematic categories of speech, and functions of volunteering. The Volunteer Function Inventory (VFI) was applied to four volunteers and semi-structured interviews were conducted with three of them. Four thematic axis were identified: characteristics and profile of volunteering, volunteer organization, environmental crisis and society perception. The VFI has identified similarities and differences regarding gender and age. The importance of monetary rewarding for the insertion and maintenance of volunteerism is discussed. Suggestions are provided for managers and for future research.

El voluntariado ambiental es un ejemplo de la confluencia de dos comportamientos: prosociales y proambientales. Este estudio tuvo como objetivo identificar categorías temáticas del discurso y funciones del voluntariado en una organización. Se aplicó un Inventario de las Funciones del voluntariado (IFV), a cuatro personas y se realizaron entrevistas semi-estructuradas con tres de ellos. Se identificaron cuatro hechos temáticos: características y perfil de los voluntarios, organización voluntaria, crisis ambiental y la percepción en la sociedad. El IFV ha identificado similitudes y diferencias entre género y edad. Se discute la importancia de dar gratificaciones para la inserción y mantenimiento de voluntarios e se apuntaron sugerencias para gestores y futuras investigaciones.

Feasibility of salt reduction in processed foods in Argentina / Factibilidad de reducir el contenido de sal de los alimentos procesados en la Argentina

OBJECTIVE: To assess an intervention to reduce salt intake based on an agreement with the food industry. METHODS: Salt content was measured in bakery products through a national survey and biochemical analyses. Low-salt bread was evaluated by a panel of taste testers to determine whether a reduced salt bread could remain undetected. French bread accounts for 25 percent of the total salt intake in Argentina; hence, reducing its salt concentration from 2 percent to 1.4 percent was proposed and tested. A crossover trial was conducted to evaluate the reduction in urinary sodium and blood pressure in participants during consumption of the low-salt bread compared with ordinary bread. RESULTS: Average salt content in bread was 2 percent. This study evaluated low-salt bread containing 1.4 percent salt. This reduction remained mostly undetected by the panels of taste testers. In the crossover trial, which included 58 participants, a reduction of 25 milliequivalents in 24hour urine sodium excretion, a reduction in systolic blood pressure of 1.66 mmHg, and a reduction in diastolic blood pressure of 0.76 mmHg were found during the low-salt bread intake. CONCLUSIONS: The study showed that dietary salt reduction was feasible and well accepted in the population studied through a reduction of salt content in bread. Although the effects on urinary sodium and blood pressure were moderate, a countrywide intervention could have a greater public health impact.

OBJETIVO: Evaluar una intervención destinada a reducir el consumo de sal a partir de un convenio con la industria alimentaria. MÉTODOS: Se midió el contenido de sal de los productos de panadería por medio de una encuesta nacional y análisis bioquímicos. Un grupo de catadores evaluó el pan con bajo contenido de sal para determinar si la disminución pasaba inadvertida. Dado que el pan francés representa 25 por ciento del consumo total de sal en la Argentina, se propuso someter a prueba este tipo de pan con una disminución de la concentración de sal de 2 por ciento a 1,4 por ciento. Se realizó un estudio cruzado con el fin de evaluar si los participantes presentaban una concentración urinaria de sodio más baja y una presión arterial menor durante el período en que consumieron pan con bajo contenido de sal respecto del período en que consumieron pan común. RESULTADOS: El pan común contiene un porcentaje promedio de sal de 2 por ciento. En este estudio, el pan con bajo contenido de sal contenía 1,4 por ciento, disminución que, en general, pasó inadvertida a los catadores. En el estudio cruzado, en el que participaron 58 sujetos, la eliminación urinaria de sodio disminuyó 25 miliequivalentes en 24 horas, la presión arterial sistólica bajó 1,66 mmHg y la presión arterial diastólica bajó 0,76 mmHg durante el período en que los participantes consumieron pan con bajo contenido de sal. CONCLUSIONES: El estudio demuestra que es factible reducir la ingesta de sal alimentaria y que la población estudiada considera aceptable que el pan contenga esta menor concentración de sal. Aunque los efectos sobre la concentración urinaria de sodio y la presión arterial fueron moderados, es probable que una intervención nacional tenga repercusiones más importantes para la salud pública.

Voluntary reduction of trans-fatty acids in Latin America and the Caribbean: current situation / Disminución voluntaria del contenido de ácidos grasos trans en América Latina y el Caribe: situación actual

As part of the Pan American Health Organization/World Health Organization Trans-Fat-Free Americas initiative, 12 representatives from food industries in Latin America and the Caribbean signed a declaration stating their intention to voluntarily eliminate industrially produced trans-fatty acids (TFA) from the Americas. A year later, in order to document the extent of the voluntary reduction, each declarant was asked to describe all reformulations and reductions in the TFA content of their products. After up to six requests for data, only three declarants provided such information in detail, and three others offered an overall summary of their reformulations. Additionally, three declarants reported the barriers that limit this process: availability of oil substitutes, cost, and consumers' sensory acceptance. The content of TFA and saturated fat in the food supply in the Americas should be regulated and strictly monitored in order to adequately evaluate a reduction of TFA in the region.

Como parte de la iniciativa "Las Américas sin grasas trans" de la Organización Panamericana de la Salud/Organización Mundial de la Salud, 12 representantes de empresas alimentarias de América Latina y el Caribe firmaron una declaración en la que se comprometieron a eliminar voluntariamente los ácidos grasos trans (AGT) de los alimentos producidos industrialmente. Un año después, a fin de verificar el progreso en este sentido, se solicitó a cada firmante que describiera todas las reformulaciones y la disminución del contenido de AGT de sus productos. Después de solicitar los datos hasta seis veces en algunos casos, solo tres de las empresas firmantes suministraron información detallada y otras tres ofrecieron un resumen general de las distintas reformulaciones incorporadas. Además, tres proporcionaron información acerca de los obstáculos que dificultan este proceso: la disponibilidad de sucedáneos del aceite, el costo y la aceptación de los consumidores. Es preciso reglamentar y vigilar con rigurosidad el contenido de AGT y grasas saturadas de los alimentos comercializados en la Región de las Américas con el fin de efectuar un seguimiento adecuado de la disminución de los AGT.

Relationship between the attraction of participation methods with voluntary activities among volunteers of Red Crescent society of Kohgiluyeh and Boyer-Ahmad in 2010

The process of attracting volunteers' participation is different from the past due to the increasing spread of science and technology, so appropriate actions should be taken in order to properly invite people to join voluntary activities. Because this research includes attitudes and practices of volunteers in Red Crescent society of Kohgiluyeh and Boyer-Ahmad in form of volunteer groups, the results can be used for designing appropriate strategies in order to continue to attract public participation. This descriptive study was done on 400 volunteers in Red Crescent society of Kohgiluyeh and Boyer-Ahmad in 2010. A Likert-style questionnaire was designed by the researchers. The questionnaire was composed of 40 questions. Independent variable namely attraction of public participation included three sub-scale [face to face methods, advertising techniques and making group techniques]; and dependent variable, i.e. voluntary activities covered 4 subscales [voluntary activities of support groups, skills groups, participation and also guidance groups].Correlation between these variables was identified. The results indicated, in view of respondents, there was a significant relationship between participation in voluntary activities with methods of attracting participation by using Qui square Test [p <0.05]. The methods of participation have a high impact on voluntary activities. Public participation in voluntary activities can be provided according to each group special conditions, cultural characteristics and facilities both individually and together as a group

Directiva administrativa para el voluntariado en salud / Administrative directive for volunteering in health

La directiva contiene la finalidad, objetivos, base legal, ámbito de aplicación, disposiciones generales, disposiciones específicas, disposiciones finales, responsabilidades y anexos para el voluntariado en salud.

Voluntariado e negociacao de protocolos de vacinas anti-HIV no Brasil / Volunteers and negotiation of anti-HIV vaccine protocols in Brazil

O estudo acompanhou a rotina de um ensaio clinico de vacinas experimentais anti-HIV no Rio de Janeiro, Brasil, focalizando os processos de recrutamento, selecao e seguimento dos voluntarios. Utilizaram-se tecnicas de observacao da rotina do centro de pesquisas e entrevistas a profissionais e voluntarios. Os resultados evidenciaram que o ensaio e uma atividade coletiva, em que constantes negociacoes sao necessarias entre o que e exigido pelo protocolo e o que precisa, pode ou deve ser adaptado para que ele funcione, em funcao de situacoes como: tempo prolongado de aprovacao do estudo pelas instancias regulatorias, dificuldades no recrutamento de voluntarios, ate problemas maiores como a descontinuidade das vacinacoes (ocorrida no protocolo estudado). Discute-se como a aplicacao do protocolo transborda o script tecnico-cientifico, transformando-se em um objeto fronteirico entre mundos sociais diferentes. O protocolo e adaptado segundo uma ordem local, de acordo com a dinamica das relacoes sociais, nao podendo desconsiderar-se a constante inter-relacao entre ciencia, sociedade, tecnica e politica.

This study monitored the protocol of a clinical trial for experimental anti-HIV vaccines in Rio de Janeiro, Brazil, focusing on the recruitment, selection, and follow-up of volunteers. The techniques included observation of the research center's routine and interviews with health professionals and volunteers. The results show that the trial is a collective activity, in which constant negotiations are needed between the protocol requirements and what can, should, or must be adapted in order for it to work, as a function of: prolonged time before the trial's approval by the regulatory bodies, difficulties in recruiting volunteers, and even larger problems like discontinuity in the vaccines (which occurred in a specific protocol). The article discusses how the protocol's application extends beyond the technical and scientific "script", transforming it into a boundary object between different social worlds. The protocol is adapted according to a local order, based on the dynamics of social relations and the constant interrelationship between science, society, technique, and politics.

Reported willingness and associated factors related to utilization of voluntary counseling and testing services by female sex workers in Shandong Province, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To explore reported willingness and factors associated with utilization of voluntary counseling and testing services by female sex workers (FSWs) in China and to offer recommendations to optimize use of such services.</p><p><b>METHODS</b>A questionnaire to explore willingness to use VCT was designed based on social ecological theory and formative qualitative research. A cross-sectional survey was conducted among FSWs from entertainment venues. Single and multiple logistic regression analyses were employed to examine factors associated with reported willingness to utilize VCT.</p><p><b>RESULTS</b>A total of 970 FSWs provided valid questionnaires, with 69% (669) expressing willingness to utilize VCT. Factors at the interpersonal level associated with reported willingness included knowledge about VCT, desire to get help if diagnosed as HIV positive, ability to imagine life after an HIV positive diagnosis, and perceived support for VCT from peers, managers, and family members. Availability of free antiretroviral (ARV) treatment represented a factor at policy level. Other factors included intention to leave sex work in the near future, having had a previous HIV test, and lack of a suspected STD history.</p><p><b>CONCLUSIONS</b>The rate of reported willingness to use VCT among FSWs was substantially higher than that of actual VCT utilization (11%). The next step is to explore the connection between reported willingness and actual use. Based on these findings, peer education, VCT knowledge dissemination, and free ARV treatment should be emphasized to increase FSWs' willingness to use VCT.</p>

Voluntary counseling and testing (VCT) services and their contribution to access to HIV diagnosis in Brazil / Contribuição dos Centros de Testagem e Aconselhamento (CTA) para o acesso ao diagnóstico da infecção pelo HIV no Brasil

The Voluntary Counseling and Testing (VCT) Network was implemented in Brazil in the 1980s to promote anonymous and confidential access to HIV diagnosis. As a function of the population and dimensions of the local epidemic, the study assessed the network's coverage, using data from a self-applied questionnaire and data from the Information Technology Department of the Unified National Health System (SUS), UNDP, and National STD/AIDS Program. The Student t test was used for comparison of means and the chi-square test for proportions. Brazil has 383 VCT centers, covering 48.9 percent of the population and 69.2 percent of the AIDS cases. The network has been implemented predominantly in regions where the epidemic shows a relevant presence, but 85.3 percent of the cities with high HIV incidence lack VCT centers; absence of VCT was associated with more limited health infrastructure and worse social indicators. A slowdown in expansion of the network was observed, with VCT Centers implemented on average 16 years after the first AIDS case in the given municipality. The number of HIV tests performed under the SUS is 2.3 times higher in cities with VCT centers. The network's scope is limited, thus minimizing the contribution by these services to the supply of HIV diagnosis in Brazil.

A rede nacional de Centros de Testagem e Aconselhamento (CTA) foi implantada no Brasil nos anos 1980 para promover, anônima e confidencialmente, o diagnóstico do HIV. Em função da população abrangida e das dimensões da epidemia local, o estudo avaliou a cobertura dessa rede, utilizando dados de questionário auto-aplicado e de bancos de informações do DATASUS, PNUD e Programa Nacional de DST e AIDS. Aplicou-se teste t para comparações de média e qui-quadrado para proporções. Existem no Brasil 383 CTA, abrangendo 48,9 por cento da população e 69,2 por cento dos casos de AIDS. A rede está predominantemente implantada em regiões em que a epidemia é relevante, entretanto 85,3 por cento das cidades com alta incidência não possuem CTA; ausência associada à menor estrutura de saúde e piores indicadores sociais. Observa-se desaceleração na expansão da rede, sendo um CTA implantado, em média, 16 anos após o primeiro caso de AIDS no município. O número de testes realizados no SUS é 2,3 vezes maior em cidades com CTA. A abrangência da rede é reduzida, minimizando a contribuição desses serviços na oferta do diagnóstico do HIV no Brasil.

Voluntários do CVV: características sociodemográficas e psicológicas / CVV volunteers: socialdemografic and psychological characteristics

Objetivou-se identificar características sociodemográficas e psicológicas nos voluntários que oferecem, ininterruptamente, apoio emocional à comunidade em quatro Postos CVV (Porto Alegre, Novo Hamburgo, Blumenau e Florianópolis), os quais integram o Centro de Valorização da Vida, instituição não governamental reconhecida pelo Ministério da Saúde como agente de prevenção do suicídio. Participaram 100 voluntários, submetidos a uma Ficha de Dados Sociodemográficos e às Escalas Fatoriais de Extroversão, Socialização e Neuroticismo. Os resultados mostram pessoas bem-instruídas e estáveis economicamente, possibilitando a abertura para interesses solidários. Em termos psicológicos, os escores obtidos em Extroversão e Socialização sugerem sensibilidade e capacidades de comunicação e de adaptação. Em Neuroticismo, os escores evidenciam tendência à independência e à vivência de estresse sem instabilidade emocional. Os voluntários apresentam características psicológicas similares à população geral e muito apreciadas pelo CVV para execução do voluntariado.

The purpose was to identify social demographical and psychological characteristics on volunteers that offer, uninterruptedly, emotional support to the community in four CVV branches (Porto Alegre, Novo Hamburgo, Blumenau and Florianópolis) which are part of the ''Centro de Valorização da Vida'', a non-governmental organization recognized by the Brazilian Health Department as an agent of suicide prevention. One hundred volunteers participated, being submitted to a social demographical data formulary, Factorial Extroversion, Socialization and Neuroticism Scales. Results show people who are well educated and economically stable which favors them to social work. In psychological terms, the scores obtained in Extroversion and Socialization factors suggest sensibility and capacity of adaptation and communication. In Neuroticism factor, the scores show tendency to independency and to experience stressful situations without emotional instability. The volunteers have psychological characteristics similar to general population and appreciated by CVV.

Reasons for seeking HIV-test: evidence from a private hospital in rural Andhra Pradesh, India.

This study sought to describe the development of HIV counselling and testing services in a rural private hospital and to explore the factors associated with reasons for seeking HIV testing and sexual behaviours among adults seeking testing in the rural hospital. Data for this study were drawn from a voluntary counselling and testing clinic in a private hospital in rural Andhra Pradesh state in southern India. In total, 5,601 rural residents sought HIV counselling and testing and took part in a behavioural risk-assessment survey during October 2003-June 2005. The prevalence of HIV was 1.1%. Among the two reported reasons for test-seeking--based on past sexual behaviour and based on being sick at the time of testing--men, individuals reporting risk behaviours, such as those having multiple pre- and postmarital sexual partners, individuals whose recent partner was a sex worker, and those who reported using alcohol before sex, were more likely to seek testing based on their past sexual behaviour. Men also were more likely to seek testing because they were sick. The findings from this large sample in rural India suggest that providing HIV-prevention and care services as part of an ongoing system of healthcare-delivery may benefit rural residents who otherwise may not have access to these services. The implications of involving the private sector in HIV-related service-delivery and in conducting research in rural areas are discussed. It is argued that services that are gaining prominence in urban areas, such as addressing male heterosexual behaviours and assessing the role of alcohol-use, are equally relevant areas of intervention in rural India.

Comparación de tres estrategias de tamizaje para la prevención de la infección perinatal por VIH en Colombia: análisis de decisiones / A comparison of three screening strategies for prevention of perinatal HIV infection in Colombia: a decision analysis model

OBJETIVO: Comparar mediante un modelo de análisis de decisiones tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas según su relación costo-efectividad y proponer la más apropiada para el sistema de salud colombiano. MÉTODOS: Estudio económico basado en el análisis mediante árboles de decisión según tres estrategias de tamizaje de la infección por el VIH en mujeres embarazadas: la voluntaria, la universal y la opcional. Se consideró a todas las mujeres colombianas embarazadas sin diagnóstico de infección por el VIH que se presentaban para el parto. Se emplearon los costos médicos directos desde la realización de la prueba hasta un año después del parto, según el Sistema General de Seguridad Social en Salud. Se compararon las razones costo-efectividad y el ahorro de cada estrategia analizada. RESULTADOS: Por cada 10 000 mujeres, la estrategia universal permitió detectar 5 casos más que la estrategia voluntaria y 7 casos más que la opcional. La estrategia universal generó costos aproximados de US$ 17,00 por cada recién nacido positivo, es decir, menos de la mitad que lo calculado para la estrategia voluntaria (US$ 38,00) y menor que para la opcional (US$ 24,00). Según el análisis bifactorial, la estrategia de tamizaje universal fue menos costosa que la voluntaria y más efectiva que las otras dos estrategias, independientemente de la prevalencia, la tasa de positivos falsos del sistema de diagnóstico empleado y la tasa de aceptación materna para realizarse la prueba de tamizaje. CONCLUSIONES: La estrategia de tamizaje voluntaria, que se utiliza actualmente en Colombia, es más costosa que la universal a mediano y largo plazos y tiene menor efectividad y capacidad de prevención. Se recomienda a las autoridades nacionales de salud realizar el tamizaje de la infección por el VIH a todas las embarazadas colombianas con pruebas de tercera generación.

OBJECTIVES: To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia. METHODS: An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared. RESULTS: For every 10 000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening. CONCLUSIONS: The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing.