Self-rated health and perceived violence in the neighborhood is heterogeneous between young women and men.

BACKGROUND: Self-rated health (SRH) is the general perception of an individual's own health and a key indicator to measure health in population-based studies. Few studies have examined the association between perceived urban violence and SRH among young adults. There were an estimated 475,000 deaths in 2012 as a result of homicide on the world. Sixty percent of these deaths occurred among males aged 15-44 years, making homicide the third leading cause of death for this population group. This study aimed to determine and quantify the association between sex-specific perception of violence in the neighborhood and SRH among young adults. METHODS: Participants included 955 young adults (18-29 years) residing in Belo Horizonte, Minas Gerais, Brazil between 2008 and 2009. Logistic regression analysis was used to estimate the strength of the associations. The perceived urban violence score was constructed from variables that assessed the respondents' insecurity and perception of fear and danger of suffering some form of violence in the neighborhood using exploratory factor analysis. RESULTS: 18,3% of respondents rated their health as fair/ poor/very poor. Among women, fair/ poor/very poor SRH was associated with age between 25 and 29 years, low socioeconomic status score, being dissatisfied with weight, not exercising regularly, not having a healthy diet, and having some chronic disease. Men who rated their health as fair/poor/very poor more frequently smoked, were dissatisfied with their weight, did not exercise regularly, consumed fewer fruits and vegetables, and had some chronic disease compared to men who rated their health as very good/good. In the final model, after adjusting for confounding variables, perceived violence in the neighborhood was associated with poor SRH in young women only (OR = 1.52; 95% CI: 1.04-2.21). CONCLUSION: The results indicate that public and health policies should implement interventions on the neighborhood physical and social environment to improve the perception of safety and have a positive impact on people's health, especially women.

[Assessment of factors associated with patients' comprehension of treatment at the start of antiretroviral therapy]. / Evaluación de factores asociados a la comprensión del tratamiento en pacientes que inician la terapia antirretroviral.

OBJECTIVE: The aim of this study was to evaluate factors associated with patients' comprehension of antiretroviral therapy (ART). METHOD: Cross-sectional analysis in which patients at 2 HIV/AIDS public referral centers (Belo Horizonte, Brazil) were interviewed after initiating ART. Information was recorded on variables related to the patient's characteristics, the treatment prescribed, and the healthcare professional involved. A score indicating the patients' level of comprehension regarding the medications prescribed was obtained using a latent trait model estimated by the item response theory. RESULTS: A total of 406 patients were interviewed. Mean (SD) age was 35 (10) years, 227 were men (56%), 302 of Afro-American ethnicity (77%), and 213 had <8 years of education (53%). The regression model determined that 52.25% of the variability of comprehension was explained by the individual's characteristics. Variables associated (P<0.05) with poorest understanding about ART were lower education (<8 years), lack of knowledge about treatment duration and clinical severity, inadequate information provided by physicians, inability to understand pharmaceutical information, daily number of tablets, and the ART regimen prescribed. CONCLUSION: Comprehension of information about the ART regimen prescribed varies considerably between individuals. Nonetheless, several factors were found to be associated with the level of understanding: characteristics of the patient (education, clinical severity), characteristics of treatment (daily number of tablets, ART regimen prescribed), and contribution of healthcare professionals (information from physicians and pharmacists). Strategies to reinforce information about ART should be a priority for patients with a low level of understanding.

Evaluación de factores asociados a la comprensión del tratamiento en pacientes que inician la terapia antirretroviral / Assessment of factors associated with patients¿ comprehension of treatment at the start of antiretroviral therapy

Objetivo: el objetivo del estudio fue evaluar los factores asociados con el nivel de comprensión de la terapia antirretroviral (TARV). Método: estudio transversal en el que los pacientes de 2 servicios públicos de referencia para el tratamiento del virus de la inmunodeficiencia humana (VIH)/sida (Belo Horizonte, Brasil) fueron entrevistados después de iniciar la TARV. Se recogió información acerca de las variables relacionadas con las características del paciente, del tratamiento prescrito y de los profesionales sanitarios. La puntuación de la comprensión de los medicamentos prescritos se estimó mediante un modelo de trazo latente por la teoría de respuesta al ítem. Resultados: se entrevistaron 406 pacientes con una edad media (desviación estándar) de 35 (10) años, de los que 227 fueron varones (56%), 302 de etnia afroamericana (77%) y 213 con una escolaridad <8 años (53%). El modelo de regresión mostró que un 52,25% de la variabilidad de la comprensión era explicado por el individuo. Las variables asociadas con un menor nivel de comprensión (p<0,05) fueron: menor escolaridad (<8 años); desconocimiento de la duración de la TARV; gravedad clínica; información médica inadecuada; incapacidad de entender la información farmacéutica; número diario de comprimidos, y esquema de TARV prescrito. Conclusión: hay una alta variabilidad individual en la comprensión de la información acerca de la TARV. Sin embargo, hay factores relacionados con las características del paciente (escolaridad y gravedad clínica), del tratamiento (dosis diaria y esquema TARV) y de los profesionales sanitarios (información del médico y del farmacéutico) asociados con el grado de comprensión. Se deberían priorizar las estrategias de refuerzo de la información acerca de la TARV en los pacientes con un bajo nivel de comprensión (AU)

Objective: The aim of this study was to evaluate factors associated with patients¿ comprehension of antiretroviral therapy (ART). Method: Cross-sectional analysis in which patients at 2 HIV/AIDS public referral centers (Belo Horizonte, Brazil) were interviewed after initiating ART. Information was recorded on variables related to the patient's characteristics, the treatment prescribed, and the healthcare professional involved. A score indicating the patients¿ level of comprehension regarding the medications prescribed was obtained using a latent trait model estimated by the item response theory. Results: A total of 406 patients were interviewed. Mean (SD) age was 35 (10) years, 227 were men (56%), 302 of Afro-American ethnicity (77%), and 213 had <8 years of education (53%). The regression model determined that 52.25% of the variability of comprehension was explained by the individual's characteristics. Variables associated (P<0.05) with poorest understanding about ART were lower education (<8 years), lack of knowledge about treatment duration and clinical severity, inadequate information provided by physicians, inability to understand pharmaceutical information, daily number of tablets, and the ART regimen prescribed. Conclusion: Comprehension of information about the ART regimen prescribed varies considerably between individuals. Nonetheless, several factors were found to be associated with the level of understanding: characteristics of the patient (education, clinical severity), characteristics of treatment (daily number of tablets, ART regimen prescribed), and contribution of healthcare professionals (information from physicians and pharmacists). Strategies to reinforce information about ART should be a priority for patients with a low level of understanding (AU)