Syphilis in riverine communities: prevalence and associated factors.

OBJECTIVE: To estimate the prevalence of syphilis and associated factors in riverine communities. METHOD: This is a cross-sectional and analytical study carried out with 250 riverside dwellers living in five communities in the city of João Pessoa, state of Paraíba. Data were collected through interviews and rapid screening tests to investigate syphilis. Bivariate, logistic regression and weight of evidence analysis were performed to identify the association between risk factors and behavior variables and rapid test positivity. RESULTS: he prevalence of syphilis was 11.6% (95%CI: 7.5-15.6). Riverside dwellers who have a previous history of Sexually Transmitted Infection (OR 8.00; 95%CI: 2.76-23.2), history of imprisonment (OR 7.39; 95%CI: 1.61-33.7) and who reported having more than two sexual partners in the last 12 months (OR 4.31; 95%CI: 1.55-11.9) were more likely to be positive for syphilis. CONCLUSION: High prevalence of syphilis among riverside dwellers and the presence of behavioral factors that increase vulnerability to acquiring the infection. The need to invest in preventive and screening strategies for syphilis in populations considered vulnerable is highlighted.

Syphilis in riverine communities: prevalence and associated factors / Sífilis en comunidades ribereñas: prevalencia y factores asociados / Sífilis em comunidades ribeirinhas: prevalência e fatores associados

Abstract Objective: To estimate the prevalence of syphilis and associated factors in riverine communities. Method: This is a cross-sectional and analytical study carried out with 250 riverside dwellers living in five communities in the city of João Pessoa, state of Paraíba. Data were collected through interviews and rapid screening tests to investigate syphilis. Bivariate, logistic regression and weight of evidence analysis were performed to identify the association between risk factors and behavior variables and rapid test positivity. Results: he prevalence of syphilis was 11.6% (95%CI: 7.5-15.6). Riverside dwellers who have a previous history of Sexually Transmitted Infection (OR 8.00; 95%CI: 2.76-23.2), history of imprisonment (OR 7.39; 95%CI: 1.61-33.7) and who reported having more than two sexual partners in the last 12 months (OR 4.31; 95%CI: 1.55-11.9) were more likely to be positive for syphilis. Conclusion: High prevalence of syphilis among riverside dwellers and the presence of behavioral factors that increase vulnerability to acquiring the infection. The need to invest in preventive and screening strategies for syphilis in populations considered vulnerable is highlighted.

RESUMEN Objetivo: estimar la prevalencia de sífilis y factores asociados en comunidades ribereñas. Método: estudio transversal y analítico realizado con 250 ribereños residentes en cinco comunidades en el municipio de João Pessoa, Paraíba, Brasil. Los datos fueron recolectados por medio de entrevista y pruebas serológicas rápidas de triaje para investigación de sífilis. Se realizaron análisis bivariado, análisis de regresión logística y análisis del peso de la evidencia (Weight of Evidence) para identificar la asociación entre las variables de factores y de comportamiento de riesgo y la positividad de la prueba serológica rápida. Resultados: la prevalencia de sífilis fue un 11,6% (IC95%: 7,5-15,6). Ribereños que poseen historia anterior de Infección Sexualmente Transmisible (OR 8,00; IC95%: 2,76-23,2), histórico de cárcel (OR 7,39; IC95%: 1,61-33,7) y que relataron tener más de dos parejas sexuales en los últimos 12 meses (OR 4,31; IC95%: 1,55-11,9) demostraron mayores riesgos de presentar resultado positivo para la enfermedad. Conclusión: alta prevalencia de sífilis entre los ribereños y presencia de factores comportamentales que aumentan la vulnerabilidad a la adquisición de la infección. Se refuerza la necesidad de inversión en estrategias preventivas y de identificación de sífilis en poblaciones consideradas vulnerables.

RESUMO Objetivo: estimar a prevalência de sífilis e fatores associados em comunidades ribeirinhas. Método: estudo transversal e analítico realizado com 250 ribeirinhos residentes em cinco comunidades no município de João Pessoa, estado da Paraíba. Os dados foram coletados por meio de entrevista e testes rápidos de triagem para investigação da sífilis. Realizaram-se análise bivariada, de regressão logística e análise do peso da evidência (Weight of Evidence) para identificar a associação entre as variáveis de fatores e de comportamento de risco e a positividade do teste rápido. Resultados: a prevalência de sífilis foi de 11,6% (IC95%: 7,5-15,6). Ribeirinhos que possuem história prévia de Infecção Sexualmente Transmissível (OR 8,00; IC95%: 2,76-23,2), histórico de prisão (OR 7,39; IC95%: 1,61-33,7) e que relataram ter mais de dois parceiros sexuais nos últimos 12 meses (OR 4,31; IC95%: 1,55-11,9) apresentaram maiores chances de apresentar resultado positivo para sífilis. Conclusão: alta prevalência de sífilis entre os ribeirinhos e presença de fatores comportamentais que aumentam a vulnerabilidade à aquisição da infecção. Reforça-se a necessidade do investimento de estratégias preventivas e de rastreamento de sífilis em populações consideradas vulnerabilizadas.

A new combination rule for Spatial Decision Support Systems for epidemiology.

BACKGROUND: Decision making in the health area usually involves several factors, options and data. In addition, it should take into account technological, social and spatial aspects, among others. Decision making methodologies need to address this set of information , and there is a small group of them with focus on epidemiological purposes, in particular Spatial Decision Support Systems (SDSS). METHODS: Makes uses a Multiple Criteria Decision Making (MCDM) method as a combining rule of results from a set of SDSS, where each one of them analyzes specific aspects of a complex problem. Specifically, each geo-object of the geographic region is processed, according to its own spatial information, by an SDSS using spatial and non-spatial data, inferential statistics and spatial and spatio-temporal analysis, which are then grouped together by a fuzzy rule-based system that will produce a georeferenced map. This means that, each SDSS provides an initial evaluation for each variable of the problem. The results are combined by the weighted linear combination (WLC) as a criterion in a MCDM problem, producing a final decision map about the priority levels for fight against a disease. In fact, the WLC works as a combining rule for those initial evaluations in a weighted manner, more than a MCDM, i.e., it combines those initial evaluations in order to build the final decision map. RESULTS: An example of using this new approach with real epidemiological data of tuberculosis in a Brazilian municipality is provided. As a result, the new approach provides a final map with four priority levels: "non-priority", "non-priority tendency", "priority tendency" and "priority", for the fight against diseases. CONCLUSION: The new approach may help public managers in the planning and direction of health actions, in the reorganization of public services, especially with regard to their levels of priorities.

Persistence of metabolic syndrome and its impact on glucose metabolism in overweight and obese children and adolescents.

OBJECTIVE: To verify the effects of metabolic syndrome (MS) and its relation to insulin resistance (IR) in children and adolescents with overweight or obesity after 24 months of follow-up. DESIGN: Studies of repeated measures from April 2009 to April 2012. For both measurements, the evaluations performed were anthropometry, MS diagnosis, fasting blood glucose, glucose homeostasis model assessment (HOMA-IR), and insulin level; at a second evaluation, glycated hemoglobin (HbA1c) was used as an additional indicator of glucose metabolism alterations. Logistic regression between syndrome persistence and its components with glucose metabolism alterations was performed for each of its indicators. The SPSS version 17.0 software (95% CI) was used. LOCATION: Center for Childhood Obesity, Campina Grande, Brazil. SUBJECTS: Children and adolescents (n=133), aged 2-18 years, with overweight or obesity. RESULTS: There was a significant decrease in MS during the study period, with persistence of the syndrome in 17.3% of the individuals. The presence of at least one alteration in glucose metabolism occurred in 45.1% of children and adolescents. The systolic and diastolic blood pressure, and the average levels of HOMA-IR showed significant decrease at the end of 24 months (p<0.01), and an elevated waist circumference (WC) remained associated with IR (p<0.01). CONCLUSION: There was observed no relationship of IR or other indicator of glycemic disorders by persistence of MS. An elevated WC remained associated with IR after controlling for the effects of the following variables: gender, age group, and other MS components.

[Term base for nursing practices with elderly women with HIV/AIDS]. / Banco de termos para a prática de enfermagem com mulheres idosas com HIV/aids.

The aim of this study was to create a term base for nursing practices with elderly women with HIV/AIDS. This documental descriptive research was conducted at the Universidade Federal de Paraíba, from August 2012 to July 2013, based on a list of terms from the Integrated Plan to Combat the Feminization of AIDS and other STDs. These terms were cross-mapped with those of the International Classification for Nursing Practices 2011 (CIPEr 2011) and use of these terms in nursing practices was confirmed with the help of 15 participants. The base comprised 106 constant terms and 69 non-constant terms in the CIPEr 2011. Results revealed the need to reconsider nursing care for elderly women with HIV/AIDS in light of epidemiological changes in relation to aging and feminization of the disease. The term base will support the construction of more appropriate wording for nursing diagnoses, results and interventions for elderly women with HIV/AIDS.

[Care management for tuberculosis: from education to the nurse practice]. / Gestão do cuidado à tuberculose: da formação à prática do enfermeiro.

The study aimed to analyze the relation between the training of the nurse and the actions directed to the management of the care to the tuberculosis. With qualitative nature, it was performed in one of the cities of the metropolitan region of João Pessoa-PB. The subjects were ten nurses of the Health Family Strategy. The data collection was performed in February 2010 using a semi structured interview script. To examine the empiric material it was used the technique of content analyzes. In the testimonies of the nurses there was predominance of the thematic TB in the hospital space; they approach either the superficiality and the distance of the care to TB related to the relation between the theory and the practice, and the absence of direct care to the patient of TB during training; according to them, the organization of the services points to a mechanicist and task based practice. One concluded that there is necessity of training institutions to come close to the health services, in a dialogic relation, to organize better the learning spaces.