Predictors of HIV Status Disclosure to Sexual Partners Among People Living with HIV in Brazil.

The objective of this study was to identify the factors associated with the non-disclosure of HIV seropositivity among people living with HIV/AIDS undergoing antiretroviral treatment. A cross-sectional study was carried out in five HIV clinics in the interior of the state of São Paulo, Brazil. Logistic regression analysis was used to determine independent predictors of HIV status disclosure. It was found that 68.5% revealed their HIV seropositivity to their most recent sexual partner. The variables "casual partner" [OR 19.08, 95% CI (4.08, 20.23), p = 0.001], "sexual partners with negative HIV or unknown HIV" [OR 4.54, 95% CI (1.58, 1.01), p = 0.005], "multiple sexual partners" [OR = 3.17, 95% CI (1.34, 7.35), p = 0.009], and "lack of communication with the partner on HIV prevention"[OR = 8.3, 95% CI (3.88, 16.61), p = 0.001] were independently associated with non-disclosure of the diagnosis. Future HIV prevention interventions should encourage open communication between sexual partners.

RESUMEN: El objetivo de este estudio fue identificar los factores asociados con la no divulgación de la seropositividad al VIH entre las personas que viven con el VIH / SIDA en tratamiento antirretroviral. Se realizó un estudio transversal en cinco clínicas de VIH en el interior del estado de São Paulo, Brasil. Se utilizó un análisis de regresión logística para determinar predictores independientes de la revelación del estado del VIH. Se encontró que el 68,5% reveló su seropositividad al VIH a su pareja sexual más reciente. Las variables "pareja casual" [OR 19,08, IC 95% (4,08, 20,23), p = 0,001], "parejas sexuales con VIH negativo o VIH desconocido" [OR 4,54,95% IC 95% (1,58, 1,01), p = 0,005], "múltiples parejas sexuales" [OR 3,17, IC del 95% (1,34, 7,35), p = 0,009] y "falta de comunicación con la pareja sobre la prevención del VIH" [OR 8,3, IC 95% (3,88, 16,61), p = 0,001] se asociaron de forma independiente con la no divulgación del diagnóstico. Las futuras intervenciones de prevención del VIH deberían fomentar la comunicación abierta entre las parejas sexuales.

Serodiscordance predictors among couples in the HIV context: implications for health care.

BACKGROUND: After HIV diagnosis, people maintain, reestablish their sexual lives, or build new relationships, often with HIV seronegative partners. Therefore, understanding the factors concerning couple-vulnerability is essential in order to design effective HIV preventive strategies. We examined HIV serodiscordant couples prevalence and their associated factors from a Brazilian city. METHODS: This is a cross-sectional analytical study carried out with people living with HIV (PLHIV) who had an active sex life and were engagement in HIV health care follow-up. Data were collected using a semi-structured questionnaire during individual interviews. We analyzed data using bivariate and multiple logistic regression analyses. RESULTS: There was 72.0% of HIV serodiscordant partnerships. Those who inconsistently used condoms (aOR: 0.3[0.13-0.7]) and/or had HIV detectable viral load (aOR: 0.29 [0.12-0.7]) were less likely to have an HIV serodiscordant sexual partner. On other hand, the lack of HIV transmission counseling by the health service (aOR: 5.08 [2.02-12.76]), or those who had a casual partner (aOR: 8.12 [1.7-38.8]) or a steady and casual one concomitantly (aOR: 24.82 [1.46-420.83]), were more likely to indicate an HIV serodiscordant partnership. CONCLUSION: The findings showed a high prevalence of serodiscordant partnerships in PLHIV. Greater visibility among couples in the health services is needed as well as a reassessment in order to provide PLHIV and their sexual partners with care strategies, by the health professionals.

Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study.

OBJECTIVE: To analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques. DESIGN: Ecological study. SETTINGS: This study was conducted in Brazil SAMPLE: A total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0-23 months and born from mothers living in Brazil were included in this study. PRIMARY OUTCOME MEASURES: The CS incidence rates were calculated by triad (2007-2010, 2011-2014 and 2015-2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan. RESULTS: From 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk. CONCLUSION: This study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.

Use of recommended personal protective equipment among Brazilian health professionals during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic is one of the biggest health crises in the world and the use of personal protective equipment (PPE) is significant measures to prevent the transmission of SARS-CoV-2. However, PPE needs to be used properly by healthcare professionals. OBJECTIVE: To analyze the use of PPE among Brazilian health professionals and associated factors during a period of the COVID-19 pandemic. METHODS: An analytical cross-sectional study was carried out from October to December 2020. For data collection, the respondent-driven sampling technique was used, adapted for social media, with a link to an online survey form. RESULTS: The study considered 12,086 Brazilian health professionals. Most (69%) used PPE recommended for the care of patients with suspected or diagnosed COVID-19. Factors associated with the use of PPE were: working in an Intensive Care Unit (ICU) or in a field hospital, receiving training, being provided with sufficient, high-quality PPE by the workplace and being an odontologist compared to nursing professionals. For procedures that generate aerosols in the context of COVID-19, 54.1% of them used the recommended PPE, the associated factors were: being married or in a stable relationship compared to a single/divorced professional, working in an ICU, being offered training, providing sufficient, high-quality PPE, and being an odontologist compared to nursing professionals. CONCLUSIONS: For the care of patients with COVID-19, 69% of health professionals used PPE properly, and several factors interfered with the use of this equipment.

HIV epidemic among Brazilian women who have sex with women: An ecological study.

The influences of public policies fighting HIV among women who have sex with women is scarcely studied. This study aimed to analyse the time series of human immunodeficiency virus (HIV) epidemic, between 2007 and 2020, among Brazilian women who have sex with women, in order to evaluate the effect of Brazilian policies for fighting HIV in this subpopulation compared to women who have sex with men (WSM). This ecological study employed HIV and acquired immunodeficiency syndrome (AIDS) new cases among women who have sex strictly with women (WSW), women who have sex with men and women (WSMW), and WSM reported to the Sistema de Informação de Agravos de Notificação from 2007 to 2020. Crude Brazilian and regional annual age-adjusted HIV/AIDS population-level incidence rates were calculated for WSW, WSMW and WSM. The rates were then analyzed using the Joinpoint regression model. A total of 102,890, 757, and 1,699 notifications of WSW, WSMW, and WSM living with HIV/AIDS were reported during the study period, respectively. South Brazilian region had the greatest HIV/AIDS incidence rates among WSM and bisexual women while the North region had the greatest incidence among WSW. In the WSM population, the temporal trends showed at least one stable or an increasing trend period from 2007 to 2013 or 2014, followed by one decreasing trend in all Brazilian regions. While among the WSMW most of the regions had a stable trend period from 2007 to 2020, in WSW group most of the trends had only one decreasing period. The decreasing trends were faster in WSM than in WSW. These results suggest a low efficiency of Brazilian policies for fighting HIV among WSW and WSMW and show the necessity of implementing new policies specific to this population.

Why not the University of New Orleans? Social disorganization and sexual violence among internally displaced women of Hurricane Katrina.

Researchers have reported that natural disasters lead to an increase in sexual violence against women and this is echoed by the current situation in Haiti. This is a social pattern throughout the world during periods of war, as well as natural disasters such as tsunamis, famine, and hurricanes. This article examines the prevalence of sexual violence experienced by women students at the University of New Orleans (UNO) before and after Hurricane Katrina using the CORE Alcohol and Drug Survey. Two hundred and thirty seven women participated in the pre-Katrina study and 215 women participated in the post-Katrina study. We hypothesized that, due to the trauma of this disaster, there would be a higher prevalence of sexual aggression against women after Katrina than there was before Katrina. Our analyses yielded no significant differences in any of the measures of sexual violence toward women (nine CORE survey items) pre to post Katrina, so our hypothesis was not supported. We suggest that social organization and cultural attenuation--often indicators of sexual assault in FEMA Greenfield communities--were mitigated by social cohesion found on the UNO campus post-Katrina.

Evaluation of cardiovascular risk factors in people living with HIV in São Paulo, Brazil.

INTRODUCTION: HIV infection as a chronic disease has emerged from treatment advances over the past three decades. From this perspective, the diseases associated with AIDS are not a main threat for patients who use Antiretroviral Therapy (ART). A new set of HIV associated complications have emerged resulting in comorbidities related to aging and ART exposure as cardiovascular disease (CVD). This study aimed to evaluate the cardiovascular risk factors in people living with HIV (PLWH) in Brazil. METHODOLOGY: This was a cross-sectional study carried out at all Specialized Care Services for people living with HIV in the Southeast of Brazil. A sociodemographic and clinical questionnaire was used and cardiovascular risk assessed through the Framingham Score. Data analysis was performed by Chi-square, Fisher's exact test and logistic regression. RESULTS: The majority were male, over 40 years old and they showed a mean age of 44 years. Current hypertension, diabetes, altered body mass index, presence of metabolic syndrome and altered abdominal circumference were also associated with cardiovascular risk. After regression analysis, male sex, older age, smoking, diabetes, hypertension and metabolic syndrome were related as predictive factors for a higher cardiovascular risk. CONCLUSIONS: The results demonstrate that combination of the prevention of modifiable risk factors with considerable changes in lifestyle are determining factors for success in the therapeutic of PLWH. High levels of motivation are essential for behavioral changes, and nurses are ideally position to provide safe care with nonpharmacological strategies for CVD risk reduction.

Risk of Colorectal Polyps and Malignancies Among Predominantly Rural Hispanics.

Colorectal cancer is the fourth most frequently diagnosed cancer. However, due to variations in diet, it was hypothesized that risk of adenomatous or hyperplastic polyps or malignancies would be lower among Hispanics. Participants (n = 1671) underwent a colonoscopy. Results were grouped into one of four groups: normal, hyperplastic polyps only, adenomatous polyps, and malignancies. As expected, Hispanics had a lower risk of hyperplastic (p = .031, OR = 0.47) and adenomatous polyps (p = .031, OR = 0.66) than non-Hispanic Whites. Comparison between malignancies was not possible as no Hispanics had a malignancy. Contrary to expectations, risk of hyperplastic and adenomatous polyps and malignancies were no different between non-Hispanic Blacks and Whites. Among rural and mostly rural populations, Hispanics had a lower risk of hyperplastic and adenomatous polyps.

Perceived stress and worldview influence sleep quality in Bolivian and United States university students.

OBJECTIVE: This study investigated predictors of poor sleep quality among American and Bolivian students. DESIGN: A cross-sectional survey was designed and administered to undergraduate university students. SETTING AND PARTICIPANTS: Psychology classes from 2 public universities (Texas, USA, and Bolivia) were convenience sampled (n = 80 American students; 60 Bolivian students). MEASUREMENTS: We used a sleep quality index and the Perceived Stress Scale. We added questions concerning worldview, sleep hygiene, sleep deficiency, health behaviors, and demographics. RESULTS: Five variables predicted poor sleep quality: perceived stress, sleep hygiene, sleep deficiency, worldview, and site. Greater stress positively associated with poorer sleep in both cultures. Yet, Bolivian students reported significantly more stress than American students but experienced significantly better sleep quality. Worldview, a measure of optimism or pessimism about the world, negatively associated with sleep quality in both cultures. CONCLUSION: Three variables that predict sleep quality (worldview, sleep hygiene, and sleep deficiency) did not differ significantly between countries. Only perceived stress differed by country but contrary to the predicted direction. Thus, this work reveals new avenues for future work to the investigation of sleep in different cultures. Lastly, we offer recommendations to ameliorate poor sleep in university students.

Construção e validação de um e-book sobre risco cardiovascular em pessoas vivendo com o vírus da imunodeficiência humana / Elaboración y validación de un libro electrónico sobre riesgo cardiovascular en personas que viven con el virus de la inmunodeficiencia humana / Construction and validation of an e-book about cardiovascular risk in people living with the human immunodeficiency virus

Resumo Objetivo Construir e validar um e-book sobre risco cardiovascular em pessoas vivendo com o vírus da imunodeficiência humana. Métodos Estudo metodológico fundamentado na teoria da pesquisa avaliativa com análise de resultado. Envolveu a produção tecnológica compreendendo as fases de análise e planejamento, modelagem, implementação e avaliação. Foram discutidos os fatores de risco cardiovascular e as estratégias para reduzi-los. O e-book foi validado por especialistas de todo o país entre outubro de 2017 e agosto de 2018 por meio do Índice de Validade de Conteúdo. Resultados Como o e-book foi escrito para atender as necessidades da população, adotou-se uma linguagem acessível para facilitar a compreensão do conteúdo. Vários aspectos do e-book foram avaliados por especialistas. Em seguida, foram analisadas as críticas e/ou sugestões mais frequentes. Após análise do IVC global, foi encontrada uma taxa de concordância de 80,5%. Todos os itens tiveram índices de concordância satisfatórios, com IVC de 86,6% para impressão geral, 96,8% para objetivo, 92,0% para conteúdo e 90,4% para relevância. Conclusão O e-book foi avaliado em diversos aspectos pelos especialistas, encontrando um índice de concordância global de 80,5%. As sugestões foram acatadas com o objetivo de garantir um material mais completo, coeso, de fácil leitura e atualizado. De acordo com a avaliação dos especialistas, o material se mostrou válido para utilização por pessoas vivendo com HIV, no entendimento de seu risco cardiovascular e conhecimento de hábitos mais saudáveis que ajudem na prevenção de doenças cardiovasculares.

Resumen Objetivo Elaborar y validar un libro electrónico sobre riesgo cardiovascular en personas que viven con el virus de la inmunodeficiencia humana. Métodos Estudio metodológico fundamentado en la teoría de la investigación evaluativa con análisis de resultado. Incluyó la producción tecnológica, que comprendió las fases de análisis y planificación, creación de modelo, implementación y evaluación. Se discutieron los factores de riesgo cardiovascular y las estrategias para reducirlos. El libro electrónico fue validado por especialistas de todo el país entre octubre de 2017 y agosto de 2018, mediante el Índice de Validez de Contenido. Resultados Como el libro electrónico se escribió para cubrir las necesidades de la población, se adoptó un lenguaje accesible para facilitar la comprensión del contenido. Varios aspectos del libro electrónico fueron evaluados por especialistas. Luego, se analizaron las críticas o sugerencias más frecuentes. Después de analizar el IVC global, se observó un índice de concordancia del 80,5 %. Todos los ítems tuvieron índices de concordancia satisfactorios, con un IVC del 86,6 % en impresión general, 96,8 % en objetivo, 92,0 % en contenido y 90,4 % en relevancia. Conclusión Se evaluaron diversos aspectos del libro electrónico por parte de especialistas y se observó un índice de concordancia global del 80,5 %. Se acataron las sugerencias con el objetivo de garantizar un material más completo, cohesivo, de fácil lectura y actualizado. De acuerdo con la evaluación de los especialistas, el material demostró ser válido para ser utilizado por personas que viven con el VIH, para la comprensión de su riesgo cardiovascular y el conocimiento de hábitos más saludables que ayuden a prevenir enfermedades cardiovasculares.

Abstract Objective To build and validate an e-book about cardiovascular risk in people living with the human immunodeficiency virus. Methods Methodological study based on the evaluation research theory with analysis of outcome. It involved technological production comprising the phases of analysis and planning, modeling, implementation, and evaluation. Cardiovascular risk factors and strategies to reduce them were discussed. The e-book was validated with experts from all over the country between October 2017 and August 2018 using the Content Validity Index. Results As the e-book was written to meet the needs of the population, accessible language was used for an easier understanding of the content. Several aspects of the e-book were evaluated by experts. Afterwards, the most frequent criticisms and/or suggestions were analyzed. A concordance rate of 80.5% was observed after analysis of the global CVI. All items had satisfactory agreement rates, with a CVI of 86.6% for general impression, 96.8% for objective, 92.0% for content and 90.4% for relevance. Conclusion The e-book was evaluated in several aspects by experts and a global agreement index of 80.5% was found. Suggestions were accepted aiming at ensuring a more complete, cohesive, easy to read and updated material. According to the evaluation between experts, the material proved to be valid for use by people living with HIV in order to understand their cardiovascular risk and to know healthier habits that may help in prevention of cardiovascular diseases.

Vitamin D3 Treatment Influences PGE2 and TGFß in Normal and Increased Breast Cancer Risk Women.

BACKGROUND/AIM: We reported that vitamin D3 increased transforming growth factor (TGF)ß2 and decreased prostaglandin (PG)E2 in the breast of normal-risk women, suggesting a protective effect. We determined if the findings held for higher risk women. PATIENTS AND METHODS: Seventy-eight women received daily for one month/menstrual cycle: placebo, 400 international units (IU) vitamin D3, 2,000 IU vitamin D3 or 2,000 IU vitamin D3/400 mg celecoxib. Nipple aspirate fluid (NAF) and/or serum were analyzed for PGE2, TGFß1,-2, vitaminD binding protein (DBP) 25(OH)D; and plasma for celecoxib. RESULTS: 25(OH)D increased (p<0.001) in women receiving 2,000 IU vitamin D3. Two thousand IU vitamin D3 lowered NAF PGE2 in normal-risk women (p=0.029), whereas 2,000 IU vitamin D3/celecoxib lowered NAF PGE2 in high-risk women (p=0.063). Serum TGFß1 was influenced by treatment (p=0.011). NAF TGFß2 increase correlated with increase in 25(OH)D. DBP serum levels were higher than matched NAF, regardless of race, and did not appreciably change with treatment. CONCLUSION: Vitamin D3 influenced TGFß1 and -ß2 expression. PGE2 response to vitamin D3 treatment was influenced by a participant's breast cancer risk. The implications of these observations regarding breast cancer risk should be further evaluated.

Management and prevention of retrograde peri-implant infection from retained root tips: two case reports.

Fracture of root tips in the maxillary premolar region is not an uncommon finding because of the high incidence of bifid and root dilacerations. Therefore, a retained root tip may serve as a nidus of infection when a dental implant is placed. The likely result is the development of an implant periapical lesion. This case report shows the successful management of a rapidly developing implant periapical lesion caused by an undetected retained root tip. Initially, systemic antibiotics failed to subdue the infection. A retained root fragment was retrieved surgically, together with the implant, and a new wide-body implant was engaged with DFDBA mixed with tetracycline. A 5-month follow-up showed increased radiographic density, and clinical reentry revealed the formation of bone with a hard consistency. The second case demonstrates the management of a retained root tip via a guided bone regeneration technique when it is detected prior to or during implant placement. Finally, a systematic therapeutic approach is proposed based on 17 case reports on implant periapical lesion management.

Poly-helminth Infection in East Guatemalan School Children.

BACKGROUND: Soil transmitted helminths (STH) remain a global public health concern in spite of occasional dosing campaigns. AIMS: To determine baseline prevalence and intensity of STH infection in east Guatemalan school children, and describe the associated epidemiology of anemia, stunting, and wasting in this population. SETTING AND DESIGN: Ten schools in Izabal province (eastern Guatemala) were identified, and 1,001 school children were selected for this study. Half of the schools were used as clinical testing sites (blood and stool). MATERIALS AND METHODS: Anthropometric measures were collected from all children. Over 300 children were tested for anemia and 229 for helminth infection. Ova and parasite specimens were examined via Direct, Kato Katz, and McMaster techniques. Hemoglobin was measured from venipuncture following the hemacue system. STATISTICAL ANALYSIS: Correlation between infection intensities and growth indicators were examined. Chi Square or t tests were used for bivariate analysis. Multiple logistic regression was performed on significant variables from bivariate techniques. RESULTS: Over two-thirds of school children were positive for infection by any STH. Prevalence of Hookworm was 30%; Ascaris, 52%; and Trichuris, 39%, most as low-intensity infection. Over half of the children were co-infected. In bivariate analysis, anemia was significantly associated with polyparasitism. CONCLUSIONS: For a Guatemalan child who experiences a unit decrease in hemoglobin, one expects to see a 24% increase in the odds of being infected with STH, controlling for age, sex, lake proximity, and growth characteristics. Infection with more than one STH, despite low intensity, led to a significant decrease in hemoglobin.

Assessment of condom use among Bolivian truck drivers through the lens of social cognitive theory.

This study demonstrates that Bolivian long distance truck drivers are a high risk population of HIV infection and transmission, supporting other global studies involving truck drivers and their high risk. The aims of this investigation were to estimate the prevalence of high risk behaviors and to identify predictors of condom use in this population. Analysis was completed on survey results from 246 male truckers (aged 18-67). About one in three of the truck drivers (30%) reported having had a sexually transmitted infection sometime in their past. More than half (56%) reported having sex with casual partners. Other risks involved unprotected anal sex. Age and two social cognitive constructs (outcome expectations and perceived social norms) predicted condom use from logistic regression analysis. The authors discuss the need for expanded HIV/sexually transmitted infection prevention programs that incorporate social cognitions.