The HIV epidemic in Colombia: spatial and temporal trends analysis.

BACKGROUND: Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. METHODS: Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS: While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0-14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45-64 group. The high-high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. CONCLUSION: Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0-14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the 'coffee belt' regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

[Building the gerontological performance of nurses in Family Health Programs]. / Construindo o fazer gerontológico pelas enfermeiras das Unidades de Estratégia Saúde da Família.

The goal of this article is to analyze the development of gerontological nurses working in the Family Health Program in a municipal district in Belém, PA. Data have been collected through interviews with 14 nurses between 08/2009 and 02/2010 and have been analyzed using the content analysis method to generate topics. One such topic is the theme of this article: building gerontological work, and the sub-topics are the following: nursing consultation, home visits, family care, and seeking partnerships for integrated actions. According to the results, it may be inferred from nurses performing gerontological tasks that work is hampered primarily by urban violence, the inefficient functional structure of services and poor specific geriatric training. However, nurses have built a special "making of gerontology" by creating strategies of integrated actions according to each new situation that has been presented.

AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis.

Despite considerable therapeutic advances in the care of people living with human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) and an overall reduction of 47% in the AIDS mortality rate in the last decade, the AIDS-mortality rates remains high. The social determinants of health (SDH) have a direct influence on the dynamics of this phenomenon. However, changes in SDH caused by the implemented policies against HIV have been poorly investigated. Moreover, the Brazilian rainforest has had the highest and continuously increasing AIDS mortality rate in Brazil since the 1980s. In this study, AIDS mortality in a province of the Brazilian rainforest was examined by using temporal and spatial analyses. METHODS: In this ecological study, data from 2007 to 2018 were extracted from the Mortality Information System provided by the State Department of Public Health of Pará. For the temporal analysis, the integrated autoregressive model of moving average (ARIMA) and locally weighted polynomial regression (STLF) were used to forecast AIDS mortality from 2019 to 2022. For the spatial analysis, spatial autocorrelation and geographically weighted regression (GWR) analyses were employed. RESULTS: The samples consisted of 6,498 notifications for AIDS-related deaths. From 2007 to 2013, the AIDS mortality rates showed an upward trend, followed by a stabilization until 2018 and an upward forecasted trend from 2019 to 2022. High mortality rates and high-high clusters were found in economic pole municipalities. Furthermore, AIDS mortality risk was directly associated with per capita income and demographic density, except in the southwestern region of Pará, which exhibited an inverse association with population density. CONCLUSION: Although the policies against HIV may have contributed to the stabilization of AIDS mortality rates from 2013 in Pará, the upward forecasted trend until 2022 raises an alert and concern to health authorities to provide reinforcement of the policies. The geographic variability of AIDS mortality promoted by SDH provides subsidies to health authorities to implement SDH-focused strategies for AIDS mortality reduction.

[Nurse's assessment of oral health of elderly people: OHAT validity and reliability]. / Avaliaçãcao da saúde bucal de idosos por enfermeiros: validade e confiabilidade do instrumento asbto.

The aim of the study was to apply the Oral Health Assessment Tool (OHAT)for determination of the reliability and validity indexes, when utilized by nursing staff The OHAT was administered to 50 elderly individuals. The exams were performed in different periods of times by a Nurse and a Dental Surgeon (DS). The determination of internal consistency was verified through Cronbach's Alpha Coeficient and ANOVA. For the determination of stability and reliability, the percentage agreement and Kappa test were considered. There was no statistical difference among the final averages obtained by the DS and the nurse (p=0.41). There was a higher internal consistency in the exams performed by the DS. The Kappa value of the instrument reached 0.46, being considered moderate. The OHAT instrument can be used by nurses as a screening tool however, previous training is needed for criteria standardization.

Nursing process for elderly women susceptible to falls from the perspective of the Pender's Model.

OBJECTIVES: to describe the strategy of applying the nursing process guided by Pender's Health Promotion Model to elderly women susceptible to falls with a view to promoting a self-efficacy behavior for fall prevention. METHODS: application of the nursing process to eleven elderly women who had already experienced falls, living in a neighborhood in the outskirts of Belem, state of Pará, which involved interviews to obtain their nursing history and group meetings using the focus group technique to develop the other phases of the nursing process: nursing diagnosis, nursing interventions, and nursing assessment. RESULTS: despite the risk factors for falls, the intervention model adopted in this study allowed elderly women to enhance their self-efficacy. FINAL CONSIDERATIONS: the model proved to be suitable for the participation of elderly women in actions to build fall prevention behaviors, with a view to healthier lifestyles.

The Family Health Strategy Influence on the Human Papillomavirus Vaccine Acceptance in a Peripheral Community of the Brazilian Amazon Region.

Introduction: The coverage of the human papillomavirus (HPV) vaccine remains low worldwide. The Family Health Strategy (FHS) in Brazil has an important role in health promotion in communities. Given the FHS's close contact with assisted communities, the coverage of the HPV vaccine should be high in children. This study aims to investigate the acceptance of the HPV vaccine of parents or guardians of a peripheral community of the Brazilian Amazon region assisted by the FHS and influencing factors. Methods: A cross-sectional community-based study recruiting the residents of a subnormal agglomerate of Belém (Pará-Brazil) and covered by the FHS was conducted. Data were collected from September 30 to November 5, 2019. The questionnaire "Knowledge and Acceptability of HPV and Its Vaccine" was used. Data were analyzed through binary and multiple regression analyses. Results: A total of 247 participants were included in this study, and 85 of which (34.4%) declared that they did not vaccinate their children. Hesitation to vaccinate was related to few years of schooling (odds ratio [OR]: 0.79, p=0.008), having sons (OR: 3.14, p=0.000), inadequate knowledge about doses of the HPV (OR: 2.44, p=0.015), and knowledge of anyone who received the HPV vaccine (OR: 7.07, p=0.000). Conclusion: Results suggested the low efficiency of FHS in increasing the HPV vaccination coverage in the assisted communities. A strategy involving a dialog with assisted families and continuous health education to health professionals should be implemented to combat fake news and increase HPV vaccination coverage.

[Long-term care institutions for the elderly and their structural coupling with the surrounding social systems]. / Acoplamento estrutural das instituições de longa permanência para idosos com sistemas societais do entorno.

This study was performed in six Long-Term Care Institutions for the Elderly (LTCIEs) that helped low-income senior citizens in three regions of the country. Its aim is to examine how LTCIEs' internal organizational system maintained structural coupling with surrounding systems. The data were collected through interviews and observation. The analysis was based on concepts of Luhmann's Social Systems Theory. As a result, the rules of belonging did not encourage aid proposals that stimulated independent life and the individuality of residents. The structural couplings with the external environment generated negative resonance within LTCIEs, such as the lack of links to programmatic actions of public primary health care, inability to maintain a multiprofessional staff, inability to fully adapt the infrastructure, and inability to bring reçatives closer to the institution's daily routine. As a positive aspect, the staff was empowered by the presence of students and their professors.

Factors associated with low knowledge about sexually transmitted infections in subnormal agglomerate, in the Brazilian Amazon.

BACKGROUND: Populations living in subnormal agglomerates in urban areas are more vulnerable to infections, including sexually transmitted infections (STIs). In these groups, inadequate knowledge about sexually transmitted infections can further increase the risk of contracting STIs. AIM: We investigated the factors associated with low knowledge about STIs in a peripheral population in the Brazilian Amazon. METHODS: This cross-sectional study was conducted in Belém, in the Amazon region that has a high percentage of subnormal agglomerates in an urban area and a high incidence of STIs. Random sampling was adopted which resulted in a sample of 320 participants. To assess knowledge about STIs, the self-administered Sexually Transmitted Disease Knowledge Questionnaire was used. To assess aspects of vulnerability, a questionnaire was constructed which is linked to individual, social, and programmatic factors. The chi-square test, G test, and ordinal regression analyses were all performed. FINDINGS: The sample of this study was composed of 320 participants. The mean age of the participants was 46.09 years. 37.5% (120), 50.6% (162), and 11.9% (38) showed low, medium, and high knowledge, respectively. Multiple analysis revealed that the factors associated with higher chance of having smaller knowledge about sexually transmitted infections were single/separated/divorced/widow(er) marital status (AOR: 1.80, CI: 1.15-2.84, P = 0.01); income equal to or less than one minimum wage (1.98, CI: 1.21-3.17, P = 0.00); equal to or over than 52 years old (AOR: 1.99, CI: 1.25-3.17, P = 0.00); lack of guidance by a health professional (AOR: 1.59, CI: 1.01-2.51, P = 0.04). Our results show that this community suffer from suboptimal levels of knowledge on STIs, which are linked to individual, social, and programmatic factors. Characterising the risk and vulnerabilities factors allows for carrying out appropriate interventions for populations living in subnormal agglomerates in urban area.

Sensibility in the relations and interactions of teaching and learning to be and do nursing.

This qualitative study focused on proxemic feelings and feelings of detachment and ambiguity among professors-nurses concerning their experiences. This study aimed to reveal the meanings of sensibility held by being-professor-nurse in teaching and learning to be and do nursing. The theoretical-philosophical support is based on Merleau-Ponty's existential phenomenological approach and the hermeneutics phenomenology of Paul Ricoeur was used. Nineteen professors-nurses from a Higher Education institution in the South of Brazil were interviewed between November and December 2006. Sensibility was revealed as the capacity to observe details in order to intervene in a situation the best way possible, and also as a way to break with exclusive models of the cognitive-instrumental rationality of science and technique, since sensibility is the basis for developing other ways of teaching and learning to be and do Nursing.

[Analytics of ambiguity: methodological strategy to the phenomenological research in health]. / Analítica da ambiguidade: estratégia metódica para a pesquisa fenomenológica em saúde.

The strategy presented in this paper, called Analytics of ambiguity, is connected to the necessity of understanding findings in researches based on Merleau-Ponty's phenomenology. It was developed through a study of descriptions of life experiences from ten family members, members of a Mutual Help Group for caregivers of Alzheimer's patients, conducted at a university in Florianopolis, Santa Catarina, Brazil. Such descriptions were shown through interviews based on intercorporeal experience, during the writing of a Doctoral Dissertation in Nursing. The application of the Analytics of ambiguity to this study is consistent with other similar studies and opens up possibilities for the understanding of findings in phenomenological researches, specifically those based on the experiential ontology of Merleau-Ponty, for it enables us to recognize consciousness as something non-perceptible and perception as an always ambiguous process.

[Systematized care for elders with dementia living in a long-stay institution]. / Cuidado sistematizado a idosos com afeccão demencial residentes em instituição de longa permanência.

This study aimed to systematize a basic model of nursing care based on the taxonomy from the North American Nursing Diagnosis Association (NANDA), tested in elderly patients with dementia affection, living in a Long-Stay Institution (ILPIs) in the countryside of Bahia, Brazil. Nine elder residents were selected at the Institution by the application of the Mini Test on Mental State in two stages, with an interval of six months, which confirmed dementia affection. Data were collected through multidimensional assessment tools for the elder provided by the Ministry of Health. In order to elaborate a caring plan, in accordance with the steps of the nursing process, nursing diagnoses were grouped into four categories: motor behavior cognition and memory, communication and other health physical problems. The caring plans have been implemented and evaluated. Testing and systematization of the basic model from nursing care based on NANDA has been possible among institutionalized demented elder inferring its applicability to other ILPIs.

Correlation between functional independence and risk of falls in older adults at three long-term care facilities. / Correlação entre independência funcional e risco de quedas em idosos de três instituições de longa permanência.

OBJECTIVE: To verify the correlation between functional independence and the risk of falls in a group of institutionalized older adults. METHOD: A cross-sectional, observational, quantitative study conducted in three Long-Term Care Facilities for older adults in the Municipality of Belém, involving both genders and assessed using the Katz Index and Tinetti Index. Pearson's Chi-squared test was used for analysis, adopting a p-value significance level of < 0.05. The data correlation was performed using the Pearson correlation test with a significance of 5% (p<0.05). RESULTS: Forty-eight (48) older adults participated. Most were classified as functionally independent (89.6%) and with a low risk of falls (58.3%). There was a moderate correlation between functional independence and low risk of falls. CONCLUSION: The more independent the older adult is, the lower the risk of falls. Therefore, it is necessary to plan individualized care, considering its peculiarities and limitations, so that older adults can preserve their functional independence for longer.

The association between knowledge about HIV and risk factors in young Amazon people.

OBJECTIVES: analyze the association between the level of HIV knowledge among young people from Amazonas region, their sociodemographic profile and infection risk factors. METHODS: cross-sectional analytical study, which used a structured questionnaire containing questions about sociodemographic, behavioral aspects and HIV knowledge. Data were grouped by sex and underwent ordinal and binary logistic regression analysis. RESULTS: the students had an HIV knowledge deficit, associated with a low educational level of their parents and low family income. The most frequent risk factors were lack of knowledge on the part of female students regarding proper male condom use, their infrequent use in sexual relations and failure to do HIV testing. There was an association between level of knowledge and use of dating apps by female students. CONCLUSIONS: there was no association between level of knowledge and the preponderant risk factors, but the students' knowledge deficit rendered them more vulnerable to infection.

[Maurice Merleau-Ponty's phenomenology as a theoretical-philosophical framework in teaching research in nursing]. / Fenomenologia de Maurice Merleau-Ponty como referencial teórico-filosófico numa pesquisa de ensino em enfermagem.

This paper aims at describing the theoretical-philosophical appraoch used in the development of the qualitative research that constituted the thesis "Meanings of sensibility for being a nursing teacher-nurse in teaching and learning to be and do nursing in light of Maurice Merleau-Ponty's phenomenology. This approach made it possible to seek subsidies for the questions that result from life experience, since the philosopher recognizes the body inserted in the world as a constitution of the subjectivity and expression of speech. According to the Merleau-Pontyan thought, it is possible to comprehend the language as gesture and body expression in the perceptive experiences of the other when interviews are done with the participants. The results indicate the importance of phenomenology as it helped the researchers to figure out their own ways, know the feelings, behaviors, and the relations with the other in a dynamic world, which is in constant transformation and that develops a dialogue and makes connections with life.

[Profile of the caregiver of dependent elderly family members in a home environment in the city of Porto, Portugal]. / Perfll do familiar cuidador de idoso fragilizado em convívio doméstico da grande Região do Porto, Portugal.

This descriptive research aims to identify the profile of the family caregiver using the World Health Organization's QPFC and WHOQOL-Bref (instrument application methods) in a sample of 120 family caregivers of dependent elderly patients who represented the population of three Healthcare Centers in the area of the Great Porto, Portugal. Data were collected in the period between January 2005 and March 2005. Results indicated that female caregivers with 55 years of average age, who had other family care giving duties besides caring for the elderly family member, were the majority. The circumstances surrounding care giving, in the perspective of the elderly patient and the other family demands, generated negative consequences to the caregiver's life and health. However, at the same time, caregivers expressed positive perceptions and rewarding feelings when caring for the elderly family member. In a nutshell, it is essential for nurses to consider the binomial caregiver and dependent elderly patient, since both demand special healthcare attention from healthcare services.

Functional capacity assessment of long-lived older adults from Amazonas.

OBJECTIVE: To evaluate the functional capacity of long-lived older adults from Amazonas. METHOD: A cross-sectional epidemiological study was carried out with 116 older adults aged 80 years or older, registered in a primary health care unit in Belém, in the state of Pará, Brazil. The Functional Independence Measure (FIM) was used for functional capacity assessment and the Mini-Mental State Examination (MMSE) for cognitive screening. Univariate and bivariate analyses were carried out, in addition to the Pearson's chi-square test. RESULTS: The older adults presented modified independence in the self-care, sphincter control and locomotion dimensions, and needed supervision for mobility/transfers. In mobility, men presented complete independence. Modified independence was found in the 80-89 age group. It was observed that, the lower the education level, the worse the cognitive performance. CONCLUSION: In spite of their advanced age, long-lived older adults still present functional capacity for activities of daily living, even though they required supervision for high energy expenditure tasks, such as mobility and transfers.

[Physical activity and mental health status among elderly people]. / Atividade física e estado de saúde mental de idosos.

OBJECTIVE: To evaluate the association between physical activity level and mental health status among elderly people. METHODS: This was a population-based survey with a probabilistic sample of 875 elderly people from a city of Southern Brazil, in 2002. The International Physical Activity Questionnaire and the Brazil Old Age Schedule questionnaire were applied. The mental health problems evaluated were depressions and dementia. Total physical activity (leisure-time, occupation, transportation and housework). After descriptive and bivariate analyses, adjusted analyses were performed by means of logistic regression, with adjustment for the factors of total physical activity, leisure-time activity and depression and dementia scores. RESULTS: There were statistically significant inverse associations between dementia and depression with total physical activity and leisure-time physical activity. The odds ratio for total physical activity adjusted for dementia among sedentary subjects in comparison with active subjects was 2.74 (95% CI: 1.85; 4.08), while the respective value adjusted for depression was 2.38 (95% CI: 1.70; 3.33). CONCLUSIONS: The results reinforce the importance of active lifestyles for preventing mental health problems among elderly people. It is inferred that the physical activity was able to reduce and/or delay the risks of dementia, although it cannot be stated that dementia is avoided through physical activity.

[The stated and non-stated on the part of the nurse-teacher being in the comprehension of sensibility]. / O dito e o não-dito do ser-docente-enfermeiro/a na compreensão da sensibilidade.

This study aims to describe the stated and non-stated information in the comprehension of sensibility on the part of the nursing teacher-nurse being in the teaching of Nursing. The theoretical- philosophical reference was sought in the Phenomenology of Maurice Merleau-Ponty, and the methodological support was based on the hermeneutic phenomenology of Paul Ricoeur. Nineteen nursing teachers-nurses from a Public Institution of Higher Education in the south of Brazil were interviewed during the months of November and December 2006. Data analysis revealed sensibility as the base for the development of doing, thinking, caring and doing research. Without sensibility, the relations and interactions in teaching in Nursing will be only techniques and theories of healthcare.

[Family, a care unit for its members: reflexive concerns]. / Família uma unidade de cuidado para seus membros: inquietações reflexivas.

This reflection has searched through a brief historic perspective, to understand the family as a care unit for its members. It has as objective, to awake a health professional's more conscientious new look for the care to elderly people in chronical condition, aiming to extend this look to the family as a unit care. This reflexion leans on Systemic Thought, that is, on the comprehension that the family isn't the sum of parts, but pressuposes the whole and the parts at the same time, thus it isn't possible to see the individual only without looking at the family as a whole in the dynamical relations and interactions between them. After the realized re-reading it became that it's necessary to rethink new strategies to approach the care to the bearer of a chronic disease such as diabetes, that embrace the whole family as focus attention of its members health, considering the complexity, intersubjectivity and instability of the new pos-modern science paradigm.