Self-care Level of Adults With Arterial Hypertension in Outpatient Follow-up in Brazil: A Cross-sectional Study.

BACKGROUND: Self-care is essential for minimizing the long-term progression of hypertension (HTN) and improving global health outcomes. However, little is known about the predictors of HTN self-care among adults with HTN in Brazil. OBJECTIVE: The aim of this study was to evaluate the self-care practices and the association of sociodemographic and clinical factors of adults with HTN in Brazil. METHODS: This was a cross-sectional study conducted by telephone with 120 adults with HTN monitored in a specialized outpatient clinic of a teaching hospital. Sociodemographic and clinical information was collected by a questionnaire survey. Self-care was assessed by the Self-care of Hypertension Inventory version 2. Multiple regression and Kendall's correlation analyses were performed to determine possible predictors. RESULTS: Low levels of self-care were observed across maintenance, management, and confidence measures. A weak correlation was observed between self-care maintenance and education (-0.13), the time of diagnosis (0.16), and the number of medications (0.15); self-care management and family income (0.13) and cognitive function (0.17); and self-care confidence and systolic (-0.15) and diastolic (-0.18) blood pressure values and time of diagnosis (0.16). In multiple regression analysis, self-care confidence was a predictor of self-care maintenance ( ß = 0.30; 95% confidence interval, 0.10-0.36) and management ( ß = 0.20; 95% confidence interval, 0.03-0.46). CONCLUSION: Confidence was essential in the maintenance and management of self-care and is central to the control of HTN. Self-care interventions must consider the different aspects that may affect self-care, highlighting improving self-care confidence as a main goal.

Satisfaction with oral health and associated factors among homeless people in Midwest Brazil.

BACKGROUND: Self-perceived oral health has been extensively investigated, but studies on homeless people are scarce, and there is currently no evidence from Latin America. OBJECTIVE: To investigate the prevalence and factors associated with satisfaction with the oral health of homeless individuals in one Brazilian capital of the Midwest region. SUBJECT AND METHODS: A cross-sectional study was carried out with 351 adult individuals attending a temporary public shelter who were interviewed about sociodemographic and psychosocial aspects, drugs use and oral health. The outcome was satisfaction with oral health (satisfied/dissatisfied). Pearson's chi-square test and Poisson regression with robust variance were used for statistical analysis. RESULTS: The prevalence of dissatisfaction with oral health was 68.9% (95% CI = 63.9-73.6). After adjusting for covariates, dissatisfaction was more frequent among individuals who were married/in a stable relationship (PR = 1.18; 95% CI = 1.02-1.36), with felt need for treatment (PR = 2.27; 95% CI = 1.23-4.17) or complete prosthesis (PR = 1.35; 95% CI = 1.18-1.55), and those who used illicit drugs in the past six months (PR = 1.22; 95% CI = 1.06-1.39). CONCLUSION: The prevalence of dissatisfaction with oral health in the homeless individuals studied was high and associated with their marital status, use of illicit drugs and self-reported need for dental treatment and complete prosthesis.

Epidemiology of HIV, syphilis, and hepatitis B and C among manual cane cutters in low-income regions of Brazil.

BACKGROUND: In recent decades the epidemic of asymptomatic sexually transmitted infections has extended deep into Brazil, including small towns and rural areas. The purpose of this study was to investigate the epidemiology of HIV, syphilis, and hepatitis B (HBV) and hepatitis C viruses (HCV), and to evaluate immunization coverage against hepatitis B in a group of rural workers in Brazil. METHODS: In 2016, a cross-sectional study was conducted with 937 manual sugarcane cutters of the Midwest and Northeast Regions of Brazil. All individuals were interviewed and screened for HIV, syphilis, HBV and HCV. Correlating factors with lifetime HBV infection were investigated using logistic regression. Positive Predictive Values, Negative Predictive Values, sensitivity and specificity were also calculated relative to vaccination against Hepatitis B, comparing anti-HBs titers to vaccination reports. RESULTS: Most reported previous hospitalization (55%), occupational injuries (54%), sharing of personal items (45.8%), alcohol consumption (77.2%), multiple sexual partners in previous 12 months (39.8%), and no condom use during sexual intercourse in last 12 months (46.5%). Only 0.2% reported using injection drugs. Anti-HIV-1 was detected in three individuals (0.3%). Serological markers of lifetime syphilis (treponemal test) were detected in 2.5% (95% CI: 1.6-3.6) of participants, and active syphilis (treponemal test and VDRL) present in 1.2%. No samples were positive for anti-HCV. The prevalence of lifetime HBV infection (current or past infection) was 15.9%, and 0.7% (95% CI 0.4 to 1.5) were HBsAg-positive. Previous hospitalization (OR 1.53, CI 1.05-2.24, p < 0.01) and multiple sexual partners in the last 12 months (OR 1.80, CI 1.25-2.60, p < 0.01) were predictors for lifetime HBV infection. Although 46.7% (95% CI 43.4-49.9) of individuals reported having been vaccinated against hepatitis B, only 20.6% (95% CI 18.1-23.3) showed serological evidence of previous hepatitis B vaccination (positive for anti-HBs alone). CONCLUSIONS: The high prevalence of syphilis and HBV compared to the general population and the high frequency of risk behaviors show the potential for sexual and parenteral dissemination of these agents in this rural population. In addition, the low frequency of hepatitis B vaccinated individuals suggests a need for improved vaccination services.

Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil.

BACKGROUND: The aim of this study was to compare sociodemographic characteristics, patterns of drug use, and risky sexual behaviour among female and male users of crack cocaine. METHODS: Between 2012 and 2013, we conducted a cross-sectional study of 919 crack cocaine users (783 men and 136 women) in Central Brazil using face-to-face interviews. Blood samples were collected to test for syphilis. The Chi-Square Automatic Interaction Detector (CHAID) was used to explore the differences between genders. We implemented two models: the first model included previous incarceration and variables related to patterns of drug use, and the second model included variables related to sexual risky behaviours and syphilis exposure. RESULTS: Women consumed more crack cocaine than men on a regular basis; however, poly-drug use was more common among men. More women than men reported exchanging sex for money and/or drugs and inconsistent condom use during sexual intercourse; women also reported more sexual partners. In addition, the frequency of sexual violence was higher for women than men. A higher proportion of women than men were positive for syphilis (27.2% vs. 9.2%; p < 0.001). The CHAID decision tree analysis identified seven variables that differentiated the genders: previous incarceration, marijuana use, daily crack cocaine consumption, age at first illicit drug use, sexual violence, exchange of sex for money and/or drugs, and syphilis exposure. CONCLUSION: Our findings demonstrate a difference in patterns of crack cocaine consumption and sexual risky behaviours between genders, thus indicating a need for gender-specific interventions in this population.

Human T-lymphotropic virus 1/2 infection among prisoners of a major penitentiary complex of Goiás State, Central-West Brazil.

Introduction: Studies on human T-lymphotropic virus 1/2 (HTLV-1/2) infection are scarce in incarcerated population. Therefore, this study estimated the prevalence of HTLV-1/2 infection among prisoners of the major penitentiary complex of Goiás State, Central-West Brazil, comparing it with available data from other Brazilian regions. Methods: A cross-sectional study was conducted with 910 prisoners of the major penitentiary complex in the State of Goiás, Central-West Brazil. All participants were interviewed, and their serum samples were tested for anti-HTLV-1/2 using an enzyme-linked immunosorbent assay (ELISA; Murex HTLV-I + II, DiaSorin, Dartford, UK). Seropositive samples were submitted for confirmation by a line immunoassay (INNO-LIA HTLV I/II, Fujirebio, Europe N.V., Belgium). Results: The majority of participants were males (83.1%), between 25 and 39 years old (56.1%; mean age: 31.98 years), self-reported brown ethnicity (56.2%) and reported 9 years or less of formal education (41.4%). Most reported using non-injectable illicit drugs and various sexual behaviors that present risk for sexually transmitted infections (STIs). The prevalence of anti-HTLV-1/2 was 0.33% (95% CI: 0.07-0.96), HTLV-1 (0.22%) and HTLV-2 (0.11%). The two HTLV-1 seropositive prisoners reported high-risk sexual behaviors, and the HTLV-2 seropositive individual was breastfed during childhood (> 6 months) by her mother and three other women. Conclusion: These data revealed a relatively low seroprevalence of HTLV-1/2 in prisoners in Central-West Brazil, and evidence of HTLV-1 and HTLV-2 circulation in the major penitentiary complex of Goiás State. Given the prevalence of high-risk sexual behaviors, there is a crucial need to intensify education and health programs in prisons to effectively control and prevent HTLV-1/2 and other STIs.

Cardiovascular risk factors in the elderly: a 10-year follow-up survival analysis.

AIMS: Cardiovascular risk factors present a high prevalence and have an impact on the morbimortality of the elderly; however, studies evaluating the impact of cardiovascular risk factors in the elderly have had short follow-up times and have not allowed specific analyses of the effects of these factors in the aged population, including how they affect the survival of the elderly. This study aimed to analyse the survival of elderly individuals living in the community, considering the presence of cardiovascular risk factors. METHODS AND RESULTS: A prospective 10-year follow-up was initiated in 2008 with a cohort of 418 elderly people living in a community in Central Brazil. The Kaplan-Meier method and the Cox proportional hazards model were used to examine the association between survival and cardiovascular risk factors. The mean age of the participants was 70.6 (±7.1) years; most participants were hypertensive (81.6%) and participated in irregular physical activity (44%), and 43.3% smoked. After a mean follow-up of 8.38 (±2.82) years, 59.3% had survived and 34.1% had died; among the deaths, 14.1% were due to cardiovascular causes. Age [hazard ratio (HR) 1.067, 95% confidence interval (CI) 1.027-1.109], hypertension (HR 3.178, 95% CI 1.144-8.826), and smoking (HR 2.235, 95% CI 1.253-3.987) were confirmed as risk factors for reduced survival, whereas physical activity was a protective factor (HR 0.456, 95% CI 0.206-1.007). CONCLUSION: The results from this study highlight the need for educational policies towards hypertension and smoking prevention among elderly people, and participation in physical activity needs to be encouraged.

Evaluation of the effectiveness of nursing interventions in research from Brazilian postgraduation programs.

PURPOSE: The purpose of this study was to evaluate research from Brazilian postgraduate students who provide evidence of effectiveness for Nursing Interventions Classification (NIC). METHODS: We conducted a literature review study of thesis and dissertations available in the Brazilian Digital Library of Dissertations and Theses (D/T) in May 2021 regardless of the year they were conducted. In those studies that did not utilize the NIC in the effectiveness evaluation, the cross-mapping methodology was employed between NIC and the interventions used by the authors of the studies. RESULTS: Using a systematic process, we identified 91 studies. Twenty-seven met a priori inclusion and exclusion criteria. We found an increase in studies that focused on nursing interventions in the last 10 years (n = 19), a large proportion of clinical trials (n = 16), and the majority of articles from the Southeast region of Brazil (n = 20). The areas of focus were adult and elderly care, and with a special interest in the behavioral domain (n = 11). Two sensitivity criteria were identified in all D/T (n = 27), and each study presented evidence of effectiveness of a minimum of three criteria simultaneously. CONCLUSIONS: Based on the effectiveness criteria, the Brazilian scientific production in postgraduate programs carried out by nurses provides evidence of the effectiveness for NIC nursing interventions. IMPLICATIONS FOR NURSING PRACTICE: It is recommended to conduct further research that uses the NIC in the planning, conduct, and evaluation of interventions, based on effectiveness criteria of nursing sensitivity.

Dental pain in adult and elderly homeless people: Prevalence, associated factors, and impact on the quality of life in Midwest Brazil.

OBJECTIVES: To investigate the prevalence and factors associated with dental pain and its impact on the quality of life of adult and elderly homeless people in Midwest Brazil. METHODS: A cross-sectional study was conducted with 353 individuals aged ≥18 attending a public homeless shelter in a Brazilian state capital (Goiânia). Data on sociodemographic, psychosocial, drug use and oral health-related factors, and quality of life [Oral Impact on Daily Performance scale (OIDP)] were collected through interviews. Pearson's Chi-square tests and robust Poisson regression were used for statistical analysis. RESULTS: The prevalence of dental pain in the past 6 months was 50 percent. Most of the respondents reported very severe pain and self-management including medication and tooth extraction. In the adjusted regression, the prevalence of pain was 1.48 times higher among individuals who last visited the dentist within the past 2 years, compared to those who had visited more than 2 years ago; and nearly five times higher among those with a perceived need for dental treatment, compared to those with no need. The prevalence of oral impact on daily performance was 80.1 percent and the most affected activities were "difficulty eating" and "feeling ashamed to smile or speak." The adjusted prevalence of impact was higher among individuals who had dental pain, regardless of their sociodemographic characteristics. CONCLUSIONS: The prevalence, intensity, and self-management of dental pain were high among the Brazilian homeless people studied. Reporting of pain was associated with factors related to dental care and negatively affected their quality of life.

Symptomatic Sexually Transmitted Infections in Brazil's Emerging Rural Populations.

We used a cross-sectional study in 2011 to estimate prevalence and risk behaviors for self-reported symptomatic sexually transmitted infections (STI) in rural settlers in Midwestern Brazil. There were 353 individuals recruited who had been living in the settlement for more than 6 months. The endpoint variable was having reported vaginal discharge, urethral discharge, genital ulcers, or anogenital warts in the previous 12 months. Univariate and multivariate Poisson regressions were performed to identify STI correlates. A prevalence of 22.4% of self-reported symptomatic STI was found. Being female, homosexual, and/or having lived in camps were associated with self-report of STI (p < .05). The high prevalence of self-reported symptomatic STI among settlers suggested that this was a key population in the epidemiology of STI in rural regions and demands the strengthening of health promotion actions in this vulnerable population, especially for women, homosexuals, and those who previously lived in camps.

Vulnerability to sexually transmitted infections in women who sell sex on the route of prostitution and sex tourism in central Brazil.

OBJECTIVE: to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS: a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS: most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION: the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.

[Risk behaviors for sexually transmitted diseases among truck drivers in Brazil]. / Comportamentos de risco para doenças sexualmente transmissíveis em caminhoneiros no Brasil.

OBJECTIVE: To evaluate the frequency of sexually transmitted diseases (STD) and associated risk factors based on self-reporting by long-haul truck drivers in Brazil. METHOD: From October 2005-October 2006, 641 long-haul truck drivers that travel federal highway BR-153, traversing the country from south to north, were interviewed. A structured interview was used to collect sociodemographic data. The truck drivers also completed a self-administered questionnaire on risk behaviors and STD history. The data were adjusted and analyzed using logistic regression. RESULTS: Of 641 drivers interviewed, 620 (96.7%) provided answers on STD history. Of these, 35.6% (95% confidence interval (CI) = 31.9-39.6) reported past or current STD. Being 30 years of age or older was statistically associated with having a history of STD. In addition, truck drivers who reported using amphetamines (odds ratio (OR) = 1.7; 95%CI = 1.1-2.6), having been incarcerated (OR = 2.2; 95%CI = 1.2-4.2), and sexual relations with sex professionals (OR = 1.9; 95%CI = 1.3-2.8) had increased odds for having a history of STD. CONCLUSION: These results confirm that Brazilian truck drivers are highly vulnerable to STD and show the importance of prevention programs targeting this specific group, one that is constantly on the move and may efficiently disseminate STD.

[Analysis of factors associated with non-acceptance of hepatitis B vaccine among low income adolescent students]. / Análise de fatores associados à não aceitação da vacina contra hepatite B em adolescentes escolares de baixa renda.

To evaluate the predictor factors for non-acceptance of hepatitis B vaccine among low-income adolescent students in the Goiânia Metropolitan Region, Goiás State, Brazil. In this study, 304 HBV-susceptible individuals enrolled in two schools were interviewed, and the HBV vaccine was offered. Only 195 (64%) of adolescents accepted the first dose of vaccine. On the other hand, 182/195 (93.3%) received the full HBV vaccine scheme. School factors played a role in vaccine acceptance, as School B and night classes were independently associated with non-acceptance of hepatitis B vaccination. The findings of this study ratify the low acceptance of hepatitis B vaccine among adolescents, highlighting the need for health education programs aiming at this group for hepatitis B vaccinations, while buttressing the importance of school-based vaccination strategies for attaining full HBV immunization of this target population.