Tendencia de consejerías en actividad física y enfermedades cardiometabólicas en el Maule, Chile: estudio previo a pandemia por COVID-19 entre 2012 y 2019 / Trend in Physical Activity Counseling and Cardiometabolic Diseases in Maule, Chile: COVID-19 Pre-Pandemic Study between 2012 and 2019

BACKGROUND: Physical activity (PA) practice reduces the adverse effects of COVID-19. PA counseling promotes healthy lifestyles and prevents cardiometabolic diseases. AIM: To assess the trend in cases of PA counseling and the cardiometabolic disease between 2012 and 2019 (before COVID-19) in a southern Chilean region. MATERIAL AND METHODS: Records of Maule Region Health Service for 731.163 men, and 829.097 women aged < 10 to ≥ 65 years were analyzed. The average annual percentage change (AAPC) during the study period and the annual percentage change (APC) during intermediate periods, were calculated. RESULTS: There was a significant decrease in PA counseling in women in the study period (AAPC: −13.6%). In the 2012-2017 period a significant decrease in counseling for total, men and women were observed (APC: −18.1, −16.5 and −19.1%, respectively). Obesity increased significantly in total, men and women in the 2012-2019 period (AAPC: 10.1, 8.5 and 10.7%, respectively). The same trend was observed for hypertension (AAPC: 8.1, 8.5 and 7.6% respectively) and elevated blood glucose (AAPC: 10, 11.5 and 9.6%, respectively). CONCLUSIONS: In the study period PA counseling decreased along with an increase in obesity, hypertension and high blood glucose. Increasing PA counseling is a mainstay in the prevention of cardiometabolic diseases and probably to prevent contagion and complement the treatment of COVID-19.

Consejería personalizada de enfermería para la mejora del cumplimiento terapéutico, calidad de vida y cifras tensionales en el paciente hipertenso / Personalized nursing counseling for the improvement of therapeutic compliance, quality of life and blood pressure in hypertensive patients

Resumen

Introducción: el diagnóstico y el control de la presión arterial son un desafío para las instituciones y el personal de salud. El reto es intervenir con estrategias que reduzcan las cifras tensionales, que mejoren la calidad de vida y el cumplimiento terapéutico de las personas que padecen hipertensión arterial.

Objetivo: evaluar los efectos de la consejería de enfermería personalizada en la disminución de cifras de presión arterial sistólica y diastólica, con el propósito de mejorar el cumplimiento terapéutico y la percepción de calidad de vida en los pacientes hipertensos.

Metodología: estudio de intervención con 96 pacientes hipertensos asignados a un grupo con consejería personalizada y un grupo sin consejería; se realizaron tres mediciones de presión arterial sistólica (PAS) y presión arterial diastólica (PAD), el cumplimiento terapéutico y percepción de la calidad de vida con los instrumentos de Marjory Gordon, Morisky-Green y MINICHAL.

Resultados: la edad promedio fue 58.02 > 9.6 años, en los pacientes con consejería la PAS disminuyó 15 mm Hg y la PAD 6 mm Hg. En el grupo sin consejería, la PAS disminuyó 5 mm Hg y la PAD aumentó 4 mm Hg. En el estado de ánimo, el grupo con consejería personalizada presentó una disminución de 3.2 en promedio frente a 0.15 del grupo sin consejería.

Conclusiones: la consejería personalizada fue útil para mejorar el control de la presión arterial, el cumplimiento terapéutico y la percepción de la calidad de vida del paciente hipertenso.

Abstract

Introduction: The diagnosis and control of blood pressure are both a challenge for health institutions and personnel. The challenge is to intervene with strategies that reduce the blood pressure, that improve the quality of life and the therapeutic compliance of the people who suffer high blood pressure.

Objective: To evaluate the effects of personalized nursing counseling in the reduction of systolic and diastolic blood pressure figures, with the purpose of improving the therapeutic compliance and the perception of quality of life in hypertensive patients.

Methods: Intervention study with 96 hypertensive patients assigned to a group with personalized counseling and a group without counseling, three measurements of systolic blood pressure (SBP) and diastolic blood pressure (DBP), therapeutic compliance and perception of the quality of life with the instruments of Marjory Gordon, Morisky-Green and MINICHAL.

Results: The average age was 58.02 ± 9.6 years, in patients with counseling, SBP decreased by 15 mm Hg and DBP by 6 mm Hg. In the group without counseling the SBP decreased 5 mm Hg and the DBP increased 4 mm Hg. In the state of mind, the group with personalized counseling presented a decrease of 3.2 on average versus 0.15 of the group without counseling.

Conclusions: Personalized counseling was useful to improve control of blood pressure, therapeutic compliance and perception of the quality of life of the hypertensive patient.

High prevalence and incidence of HIV-1 in a counseling and testing center in the city of Itajaí, Brazil

ABSTRACT Itajaí is a port city in southern Brazil with one of the highest incidence and mortality rates from AIDS in the country. The prevalence and incidence of HIV infection were investigated in 1085 of 3196 new HIV-1 infection cases evaluated in the counseling and testing center of Itajaí from January 2002 to August 2008. Recent infections were assessed using the BED(tm), and polregion sequencing was performed in 76 samples. The prevalence ranged from 3.08% to 6.17% among women and from 10.26% to 17.36% among men. A total of 17% of infections were classified as recent, with annual incidence varying from 1.6% to 4.8 per 100 patient/year among women and from 2.05% to 8.5 per 100 patient/year among men. Pol sequences were obtained from 38 randomly recent infections selected individuals: 71% were infected by subtype C, 24% B, 2% D, and 2% F1. Among 38 subjects with established infection, 76% were subtype C, and 24% B. Transmitted drug resistance was detected in 18.4% of recent infection subjects (7.8% to nucleoside analog reverse-transcriptase inhibitors, 5.2% to non-nucleoside reverse-transcriptase inhibitors, and 5.2% protease inhibitors) and 5.2% of subjects with established infection had nucleoside analog reverse-transcriptase inhibitors resistance. The high prevalence and incidence of HIV infection in this region is unprecedented in studies involving cases evaluated in the counseling and testing centers in Brazil.

Consumo de tabaco y uso del consejo médico estructurado como estrategia preventiva del tabaquismo en médicos chilenos / The influence of smoking habits of Chilean physicians on the use of the structured medical advice about smoking

Background: Structured medical advice on smoking is the prevention strategy with better cost-effectiveness ratio. Aim: To evaluate smoking among health care providers affect the application of this preventive strategy. Material and Methods: We surveyed 235physicians working in public and private hospitals in different cities over the country, about their smoking habits, their views on smoking as cardiovascular risk factor and the implementation of three key points of the structured medical advice about smoking. Results: Physicians aged less than 44 years had the lower frequency of smoking and the higher frequency of ex-smokers concentrated among those aged 60 years or more. All surveyed physicians agreed that smoking is a cardiovascular risk factor. However, 21% considered that this risk appears only among those that smoke more than three cigarettes per day. Independent of their smoking habits, 18% of physicians not always ask their patients about smoking, 25% do not warn about the risk of smoking and 22% not always give advice about quitting. This last action is carried out with a significantly lower frequency by smoking physicians. Conclusions: To improve physician's compliance with their preventive role in clinical practice, it is essential to consider their own smoking habits, and the information and attitudes that they have towards smoking as a cardiovascular risk factor.

Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirão Preto, São Paulo / Características clínicas e epidemiológicas de lesões entre adolescentes atendidos em um pronto-socorro na cidade de Ribeirão Preto, São Paulo

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirão Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8 percent) were boys and 74 (41.1 percent) were girls. Their ages were: 10 to 12 (66/36.6 percent), 12 to 14 (60/33.3 percent) and 14 to 16 years (54/30 percent). The injuries had occurred in public places (47.7 percent) and at home (21.1 percent). The main types were bruises (45.1 percent) and falls (39.2 percent), involving upper limbs (46.1 percent), lower limbs (31 percent) and head/neck (13.1 percent). The injuries occurred in the afternoon (44.4 percent) and morning (30 percent), on Mondays (17.7 percent) and Thursdays (16.6 percent). Radiological examinations were performed on 53.8 percent. At the time of injury, 76.1 percent of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4 percent. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents.

CONTEXTO E OBJETIVO: Lesões são importante causa de morbidade na adolescência, mas podem ser evitadas mediante o conhecimento de algumas de suas características. Este estudo visa identificar as lesões mais frequentes entre adolescentes atendidos em um serviço de pronto-atendimento. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo e descritivo sobre adolescentes atendidos no Pronto-Atendimento do Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto (FMRP), entre 01/01/2009 e 30/9/2009. MÉTODOS: Analisou-se idade, sexo, tipo de lesão, local, dia e período do ocorrido, parte do corpo acometida, cuidados recebidos, se o adolescente estava acompanhado no momento da lesão e se havia recebido alguma orientação quanto à prevenção de acidentes. RESULTADOS: Dos 180 adolescentes 106 (58,8 por cento) eram rapazes e 74 (41,1 por cento) moças, com idades entre 10 a 12 anos (66/36,6 por cento), 12 a 14 anos (60/33,3 por cento) e 14 a 16 anos (54/30 por cento). 47,7 por cento das lesões aconteceram em locais públicos e 21,1 por cento, em casa. Os principais foram contusões (45,1 por cento) e quedas (39,2 por cento), acometendo membros superiores (46,1 por cento), membros inferiores (31 por cento) e cabeça/pescoço (13,1 por cento). As lesões ocorreram nos períodos da tarde (44,4 por cento) e manhã (30 por cento) e às segundas-feiras (17,7 por cento) e quintas-feiras (16,6 por cento). Foram realizados exames radiológicos em 53,8 por cento dos pacientes. No momento da lesão 76,1 por cento dos adolescentes estavam acompanhados. 39,4 por cento haviam recebido algum tipo de orientação sobre prevenção de lesões. CONCLUSÕES: Embora as lesões tenham sido de baixa gravidade, é necessário incorporar atitudes preventivas de modo a diminuir os riscos e proporcionar maior segurança aos adolescentes.

Cessação de tabagismo em pacientes de um hospital universitário em Curitiba / Smoking cessation among patients at a university hospital in Curitiba, Brazil

OBJETIVO: Determinar a prevalência de tabagismo e do aconselhamento para a cessação do tabagismo em um grupo de pacientes de um hospital universitário, assim como comparar a carga tabágica entre fumantes e ex-fumantes. MÉTODOS: Estudo transversal com 629 pacientes do Hospital de Clínicas da Universidade Federal do Paraná, localizado em Curitiba. RESULTADOS: Dos 629 pacientes, 206 (32,7 por cento) eram do sexo masculino, 76 (12,1 por cento) eram fumantes, 179 (28,5 por cento) eram ex-fumantes, e 374 (59,5 por cento) eram não fumantes. A média de idade dos pacientes foi de 49,9 ± 15,0 anos (variação: 18-84 anos). Dos 76 fumantes e 179 ex-fumantes, 72 (94,7 por cento) e 166 (92,7 por cento), respectivamente, foram indagados sobre o hábito de fumar. A carga tabágica e o grau de dependência de nicotina foram maiores entre os ex-fumantes (p = 0,0292 e p = 0,0125, respectivamente). Gênero, idade ao início do tabagismo, questionamento médico sobre hábito de fumar e orientação para cessação do fumo foram semelhantes entre os dois grupos. O índice de cessação de tabagismo foi de 0,70. A prevalência de fumo pesado variou entre os gêneros e as faixas etárias - maior entre os homens e na faixa etária de 41-70 anos. CONCLUSÕES: A prevalência de tabagismo neste grupo de pacientes foi menor do que a observada em pacientes de outro hospital universitário e na população adulta de Curitiba e do Brasil. O índice de cessação do tabagismo foi maior do que o da população de Curitiba. Fumantes e ex-fumantes diferiram em relação à idade, à carga tabágica e ao grau de dependência. Fumo pesado e dependência média ou elevada não impediram cessação do tabagismo.

OBJECTIVE: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history. METHODS: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil. RESULTS: Of the 629 patients, 206 (32.7 percent) were male, 76 (12.1 percent) were smokers, 179 (28.5 percent) were former smokers, and 374 (59.5 percent) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7 percent) and 166 (92.7 percent), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket. CONCLUSIONS: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.

Quality of previous diabetes care among patients receiving services at ophthalmology hospitals in Mexico / Calidad de la atención previa de los pacientes diabéticos atendidos en hospitales de oftalmología en México

OBJECTIVE: To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without. METHODS: From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security. RESULTS: Almost half of the patients (46 percent) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51 percent), including 11 percent with visual impairment. Most patients (87.9 percent) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3 percent reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39 percent reported ever receiving nutrition counseling and only 21 percent reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage. CONCLUSIONS: In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact.

OBJETIVO: Determinar si hay diferencias en cuanto a las experiencias de atención de la diabetes, el acceso a los servicios básicos, el tratamiento y la evolución clínica entre las personas que disponen o no de seguro social de salud mediante la encuesta de una muestra amplia de pacientes que padecen diabetes mellitus tipo 2 en la Ciudad de México. MÉTODOS: Se encuestó a 1 000 pacientes con diabetes tipo 2 en la consulta externa de los tres hospitales públicos de oftalmología más importantes de la Ciudad de México. Los pacientes proporcionaron información acerca de su estado de salud y su experiencia respecto de la atención básica de diabetes; por ejemplo, el control de la glucemia mediante análisis de laboratorio y la información que recibieron acerca de la enfermedad. Se compararon los datos estadísticos entre quienes disponían de un seguro social de salud (n = 461) y quienes carecían de este tipo de seguro (n = 539). RESULTADOS: Casi la mitad de los pacientes (46 por ciento) que se atienden en estos hospitales públicos disponen de seguro social de salud, pero no pudieron acceder a otros servicios y debieron pagar de su bolsillo para recibir atención. La mitad de los entrevistados (51 por ciento) eran pacientes que habían sido considerados presuntos diabéticos a partir de los síntomas que habían referido, de los cuales 11 por ciento presentaron discapacidad visual. La mayoría de los pacientes (87,9 por ciento) refirieron que solo se controlaban mediante análisis glucemia en ayunas o análisis aleatorios (sin ayunar) de una muestra de sangre capilar; solo 5,3 por ciento refirieron que alguna vez se habían efectuado el análisis de glucohemoglobina (HbA1c). Si bien prácticamente la totalidad de los encuestados refirieron haber tenido alguna consulta médica, solo 39 por ciento informaron haber recibido orientación nutricional en alguna ocasión y solo 21 por ciento refirieron haber asistido a una o más sesiones informativas sobre la diabetes. ...

effect of dietary counselling on the health status of end-stage renal failure patients

Chronic renal failure is becoming one of the most impacting diseases on the Egyptian population, alongside with cardiovascular and hepatic diseases, diabetes mellitus and cancers. Studies support the importance of dietary management on different aspects related to end-stage renal failure [ESRF] and other studies also suggest that active nutritional counselling can improve certain important biochemical parameters and fluid overload problems in patients on maintenance haemodialysis [HD]. To assess the effect of dietary counselling on the overall health status of ESRF patients subjected to haemodialysis, particularly their renal functions. A pretest-posttest study was conducted through several phases; Phase 1: Pre-intervention assessment using; an interview questionnaire to collect socio-demographic, nutritional knowledge and dietary pattern data; Malnutrition Inflammation Score [MIS]; Karnofsky Performance Scale [KPS] and anthropometric measurements. Phase 2: Implementation of nutritional counselling sessions communicating evidence-based practices. All patients were given one-to-one nutritional counselling over a six-month period. Phase 3: Post-intervention reassessment of patients using phase one tools. A sex-stratified random sample of about 50% of all patients attending El-Harem Centre for Dialysis [82] during the period from October, 1[st] 2008 till March, 31[st] 2009 were included. Intervention participants totalled 41 ESRF patients. In this study, 97.5% of patients were considered mildly to moderately malnourished. Multiple malnutrition problems detected among these patients were protein-energy malnutrition, hypocalcaemia, anaemia and hyperphosphataemia. Nutritional counselling sessions resulted in statistically significant changes in the Malnutrition Inflammation Score [MIS] and Karnofsky Performance Scale [KPS] of the patients, the patients' nutrition related knowledge and to some extent their dietary practice. Providing one-to-one nutritional counselling is an effective intervention that can improve the ESRF patients' nutrition related knowledge and practice as well as their compliance to the dietary guidelines for the dialysis patients, which in turn can improve their health status and daily performance

Evaluation of HIV voluntary counselling and testing services in Egypt. Part 1: client satisfaction

HIV voluntary counselling and testing [VCT] services were launched in Egypt in 2005. A study of all functioning VCT centres in Egypt [7 mobile and 9 fixed] aimed to determine the profile of clients and their level of satisfaction to identify strengths and weaknesses in the service. In direct interviews with a sample of 928 clients, the main motive for seeking VCT was risky sexual behaviour [34.2%]. More females than males sought services because of partners' risky sexual behaviour. More than 90% of the clients were satisfied with the counselling service. Only 41.4% were willing to discuss the test results with their partners. Male sex, higher education level and attendance at fixed VCT centres were associated with higher satisfaction

Evaluation of HIV voluntary counselling and testing services in Egypt. Part 2: service providers' satisfaction

Voluntary counselling and testing [VCT] services are major components of HIV prevention and treatment efforts. A study in Egypt aimed to determine the satisfaction of service providers at VCTs to identify strengths and weaknesses in the service. Direct interviews with all 50 VCT team members and focus group discussions with 16 counsellors showed that the majority believed that they had received enough training [90%], but still 66% wanted further training. Only 50% reported receiving sufficient incentives. Problems that were highlighted included absence of a fixed job description, lack of administrative support, unclear working rules and regulations and lack of proper community awareness. Counsellors expressed the need for improving working environment to ensure privacy and confidentiality

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.

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.

Mudanças no âmbito da testagem anti-HIV no Brasil entre 1998 e 2005 / Changes in HIV testing in Brazil between 1998 and 2005

OBJETIVO: Analisar mudanças na realização de teste anti-HIV, as razões alegadas entre as pessoas que foram ou não testadas e o recebimento de aconselhamento. MÉTODOS: Estudos transversais conduzidos com homens e mulheres de 16 a 65 anos, com amostras representativas do Brasil urbano em 1998 (n=3.600) e 2005 (n=5.040). Características sociodemográficas, sexuais, reprodutivas e de experiências de vida e saúde foram consideradas na análise. A avaliação das possíveis diferenças nas distribuições das variáveis baseou-se nos testes qui-quadrado de Pearson e F design-based (±<5 por cento). RESULTADOS: Em 1998, 20,2 por cento dos entrevistados haviam realizado o teste e 33,6 por cento em 2005. Foram testadas 60 por cento das mulheres na faixa 25-34 anos, mas as que iniciaram a vida sexual antes dos 16 anos e reportaram quatro ou mais parceiros sexuais nos cinco anos anteriores à entrevista foram menos testadas. Não se observou aumento significativo da testagem entre homens, exceto para os de 55-65 anos, renda per capita entre 1-3 e 5-10 salários mínimos, aposentados, protestantes históricos e adeptos de cultos afro-brasileiros, moradores da região Norte/Nordeste e os que declararam parceria homo/bissexual ou não tiveram relações sexuais nos cinco anos anteriores à entrevista. Não aumentou a freqüência de testagem entre pessoas auto-avaliadas como sob alto risco para o HIV. Entre as mulheres, a freqüência de testagem pré-natal aumentou e a testagem por trabalho diminuiu entre os homens. Em 2005, metade dos testados não recebeu orientação antes ou após o teste. CONCLUSÕES: Houve expansão desigual na testagem, atingindo principalmente mulheres em idade reprodutiva, adultas e pessoas com melhores condições sociais. A testagem parece estar aumentando no País sem a devida atenção à decisão autônoma das pessoas e sem o provimento de maior e melhor oferta de aconselhamento.

OBJECTIVE: To analize changes in HIV testing, reasons reported by those who were tested or not and received counseling. METHODS: Cross-sectional studies conducted in both men and women aged 16 to 65 years based on representative samples of urban Brazil in 1998 (n=3,600) and 2005 (n=5,040). Sociodemographic, sexual, reproductive characteristics, life experiences and health data were collected and analyzed. Potential differences in the distribution of variables was analyzed using Pearson's chi-square and design-based F test (±<5 percent). RESULTS: In 1998 and 2005, 20.2 percent and 33.6 percent of interviewees had been tested, respectively. A total of 60 percent women aged 25-34 years were tested, but those who reported sexual initiation before the age of 16 and four or more sexual partners in the fi ve years prior to the interview were less tested. There was no significant increase in testing among men, except among those aged 55-65 years, per capita income between 1-3 and 5-10 monthly minimum wages, retired, historical Protestant and followers of African-Brazilian religions, living in the North/Northeast region and who reported homosexual/bisexual partners or no sexual relationship in the five years prior to the interview. Testing rates did not increase in those who self-reported as high risk for HIV. Among women, prenatal testing rate increased while work-related testing decreased among men. In 2005, half of those who were tested did not receive any advice before or after testing. CONCLUSIONS: HIV testing scaling up was unequal and was mostly seen among women at childbearing age, adults and those better off. There seems to be an increase in testing rates in Brazil but without regard for people's right to free choice and without offering more widely and better quality counseling.

Trends in the uptake of antenatal voluntary counselling and testing for HIV and HIV prevalence among childbearing women in Barbados, 1993-2004: evidence to gauge the effectiveness of HIV prevention measures / Tendencias en el interés por el asesoramiento y prueba voluntarios prenatales para el vih, y prevalencia del vih entre las embarazadas de barbados, 1993­2004: evidencia para evaluar la efectividad de las medidas para prevenir el vih

OBJECTIVES: To describe the long term trends on the uptake of antenatal voluntary counselling and testing (VCT) for Human Immunodeficiency Virus (HIV) and on the HIV prevalence among pregnant women. These data were used to gauge the impact of the National Acquired Immunodeficiency Syndrome (AIDS) Intervention Programme on preventing mother-to-child transmission (PMTCT) in Barbados. METHODS: This was a population based study. Data for this report were drawn from the HIV Surveillance Programme for the mother-to-child transmission of HIV The study population comprised all pregnant women who attended the various antenatal care clinics throughout Barbados during the period between 1993 and 2004. RESULT: The uptake of the VCT for HIV among the pregnant women in Barbados has increased from 39.9in 1993 to over 89.7in 2004 (p < 0.0001). Mean annual HIV prevalence decreased from 10.53 per thousand women screened in 1993-1996 to 8.23 during 2001-2004 (p = 0.121). Mean annual incidence rate of newly diagnosed HIV infection among the pregnant women declined from 8.83 per thousand women screened during 1993-1996 to 4.53 per thousand pregnant women screened during 2001-2004 (p = 0.004). Mean annual incidence rate of newly diagnosed HIV infection among the pregnant women aged less than 25 years during the corresponding period declined from 10.17 per thousand women aged less than 25 years screened to 4.75 per thousand women screened (p = 0.003). CONCLUSION: There has been a significant decline in the prevalence and incidence of HIV since the late-1990s. Although new infections are still occurring, the numbers are small. The decline may partly be explained by the impact of PMTCT and the general preventive measures on the spread of HIV among this population.

Objetivos. Describir las tendencias a largo plazo en relación con el interés en el asesoramiento y prueba voluntarios (APV) prenatales para el virus de la inmunodeficiencia humana VIH, así como en relación con la prevalencia del VIH entre las embarazadas. Estos datos fueron usados para evaluar el impacto del Programa Nacional de Intervención del Síndrome de Inmunodeficiencia Adquirida (SIDA) en la prevención de la transmisión de madre a hijo (PTMH) en Barbados. Métodos. Se trató de un estudio poblacional. Los datos para este reporte fueron tomados del Programa de Vigilancia del VIH para la transmisión madre a hijo del VIH. El estudio poblacional abarcó a todas las embarazadas que asistieron a las distintas clínicas de atención prenatal en todo Barbados durante el período comprendido entre 1993 y 2004. Resultado. El interés mostrado por el APV del VIH entre las embarazadas de Barbados, ha aumentado de 39.9% en 1993 a más de 89.7% en 2004 (p < 0.0001). La media anual de prevalencia del VIH disminuyó de 10.53 por cada mil mujeres sometidas a pesquisaje en 1993­1996 a 8.23 durante 2001­2004 (p = 0.121). La tasa de incidencia anual media de infección por VIH de diagnóstico reciente entre las embarazadas descendió de 8.83 por cada mil mujeres embarazadas sometidas a pesquisaje durante 1993­1999 a 4.53 por cada mil mujeres sometidas a pesquisaje durante 2001­2004 (p = 0.004). La tasa de incidencia anual media de infección por VIH de diagnóstico reciente entre las embarazadas menores de 25 años de edad durante el periodo correspondiente disminuyó de 10.17 por cada mil mujeres menores de 25 años de edad sometidas a pesquisaje, a 4.75 por cada mil mujeres sometidas a pesquisaje (p = 0.003). Conclusión. Ha habido un descenso significativo en la prevalencia e incidencia del VIH desde los finales de 1990. Aunque todavía se están produciendo nuevas infecciones, su número es pequeño. El descenso puede explicarse en parte por el impacto del PTMH y las medidas generales de prevención de la difusión del VIH entre esta población

[Effect of pre-marriage counseling on the sexual health]

Regarding the increase of sexual transmitted disease, high risk behaviour and unwanted pregnancy in one hand, and myth, incorrect believes and low knowledge about sexuality in the other hand, sexual health education is one the basic compartment of health promotion. The pre-marriage counseling is one of the best opportunities to reach our aim. This was a semi-practical study. We had considered 32 case couples and 32 control couples randomly. The couples had been chosen from those, which have been contacted to the clinics of Tehran University of medical sciences. All cases had contributed to three lectures given by the researcher. The lectures were mainly based on the different aspects of sexual health, like: family plain, safe sex, different aspects of sexuality and physiologic different in men's and women's. On the other hand the control group had taken the normal lectures, which presents in the clinics which were based on the family planning and pre-marriage experiments. Both groups [cases and controls] had been asked to fill a form six months after counseling. In this form, we had included 10 questions of sexual health and 10 demographic questions. We had finally analyzed our data by SPSS software where we had used descriptive and discriminated statistics. We have obtained a considerable difference in sexual health between the two groups by Man-Whitney test [p=0.000]. The majority of case group [96.9%] showed a good sexual health whereas the most procent of control group [59.4%] had a moderate sexual health. To improve the quality of pre-marriage counseling, the content of usual lectures should be modified in addition to consider more time for these lectures. The results revealed that the pre-marriage counseling enhances the sexual health that lead to marital satisfaction

[ effects of counseling on smoking cessation in patients suffering from COPD]

Cigarette smoking is the primary risk factor for COPD [chronic obstructive pulmonary diseases]. Smoking cessation is the most effective strategy for prevention or treatment of COPD. Counseling is a efficacious method for smoking cessation. One of the nurses' roles is counseling that they can use it in patients' care. The aim of this study is evaluating the effects of counseling in smoking cessation on patient with COPD. This study is an interventional clinical trial and the subjects consisted of 160 patients who had eligibility criteria for this study. Sampling was convenience sampling and subjects were allocated to two patients groups [Interventional and control]. In interventional group smoking cessation counseling was used during 12 weeks. Counseling consisted of individual counseling Telephone counseling and self- help material. The data were collected by the questionnaire and Fagrostrom test before study and smoking rate were recorded before, 1 and 3 months after study. Research data were analyzed with spss statistic program and use of descriptive and inferential methods, such as chi2, exact fisher test, mann-whitney and etc. The rate of smoking cessation after 1 month in interventional group was 28.8% [n=23] versus in control group was 22.5% [n=18] [p<0.0001] and after 3 month in interventional group was 41.3% [n=33] versus in control group was 26.3% [n=21] [p=0.006]. Mann-whitney test showed significant difference between smoking cessation in two groups after 1 and 3 month after study. Results supported the use of smoking cessation counseling to stop smoking on patients with COPD