Basuco consumption in transgender women across three cities in Colombia. / Consumo de basuco en mujeres transgénero, de tres ciudades de Colombia.

This article aims to describe the factors associated with basuco consumption in transgender women (TW) in three cities in Colombia, South America. A cross-sectional descriptive study was carried out using Respondent-Driven Sampling (RDS) and included 688 transgender women participants from Bogotá, Medellín and Santiago de Cali. Descriptive analyses, bivariate associations, and a binomial regression were performed. The prevalence of basuco consumption among participants was 11%; factors associated with basuco consumption among TW included having a low socioeconomic level, living alone, feeling vulnerable to HIV, having had an STI in the last year, and consuming marijuana. Substance consumption in TW in Colombia is high when compared to the general population, and the literature shows that basuco consumption is intensified within a context of social vulnerability. Encouraging the development of policies and programs with a comprehensive approach to health and substance use prevention particularly among vulnerable TW considering their unique sociodemographic and economic characteristics, is warranted.

Este artículo tuvo como objetivo describir los factores asociados al consumo de basuco en mujeres transgénero de tres ciudades de Colombia. Se realizó un estudio descriptivo transversal, a través del muestreo dirigido por los entrevistados (MDE) y en el cual participaron 688 mujeres transgénero de Bogotá, Medellín y Santiago de Cali. Se realizaron análisis descriptivos, asociaciones bivariadas y una regresión de tipo binomial. La prevalencia del consumo de basuco fue de 11%, y los factores asociados a su consumo entre las MT fueron, ser de estrato socioeconómico bajo, vivir sola, percibirse vulnerable al VIH, haber tenido una ITS en el último año y consumir marihuana. El consumo de sustancias en las MT en Colombia es elevado al compararlo con población general, se evidencia que el consumo de basuco se enmarca en el contexto de vulnerabilidad social. Es necesario incentivar la creación de políticas y programas con un abordaje integral en salud, que tengan como uno de los ejes de acción la prevención del consumo de sustancias psicoactivas entre las mujeres transgénero, teniendo en cuenta sus particularidades y características sociodemográficas y económicas.

Prevalence of HIV/Hepatitis C Virus Co-Infection and Injection Risk Correlations in People Who Inject Drugs in Colombia: A Cross-Sectional Study Using Respondent Driven Sampling.

Background: In Colombia, an exponential growth of people who inject drugs (PWID) has been reported over the past decades. The main burden of disease in PWID is attributed to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and their co-infection is associated with poor prognosis, high morbidity and treatment related implications. Nevertheless, the prevalence of HIV/HCV co-infection in Colombian PWIDs is unknown. Objective: To determine the prevalence, demographic characteristics, and injecting behaviors of HIV/HCV co-infected PWID in Colombia. Methods: This was a cross-sectional study of 1,123 PWID recruited by respondent driven sampling in five Colombian cities between January and June of 2014. Each participant completed a quantitative survey, and blood samples for HIV and HCV antibody testing were obtained. A multinomial logistic regression was used for statistical analysis. Results: Average participant age was 26.3 ± 6.5 years, and the majority was male (86%). HIV or HCV mono-infection prevalence was 27.6%, while co-infection was 3.3%. Compared with PWID with mono-infection, co-infected PWID exhibited higher odds of: injecting ≥4 times daily (OR: 3.5; CI: 1.7-7.2; p < .001), cleaning needles and syringes with water (OR 3.2; CI: 1.6-6.3; p < .001), passing drug mix between syringes (OR: 2.7; CI: 1.3-5.3; p = .04), injecting on illegal indoor shooting galleries (OR: 2.4; CI: 1.0-5.3, p = .02), and getting injected by someone who charges for injecting (OR 2.3; CI: 1.0-5.2; p = .04). Conclusion: Prevalence of HIV/HCV co-infection among PWID in Colombia is lower than that reported in other countries. However, addressing the identified demographic characteristics and injection risk behaviors of co-infected PWID is essential for the implementation of broadly available harm reduction interventions as well as routine HIV/HCV testing and treatment strategies aiming to control the spread of both viruses and their associated morbidity and mortality.

Drug dealing and drug using behaviors among people who inject drugs in Colombia: A cross-sectional study.

INTRODUCTION: People who inject drugs (PWID) are highly exposed to drug-dealing networks. In Colombia, a recent dramatic increase in drug consumption has been reported. However, involvement of PWID in drug dealing, their demographics, and drug using behaviors has not been studied. METHODS: A cross-sectional study involving 1,099 PWID recruited by Respondent Driven-Sampling in five Colombian cities was conducted in 2014. Correlates of demographic characteristics, drug dealing, and injection behaviors were examined by multivariate analysis, and a binary logistic regression model. RESULTS: Drug-dealing PWID were predominantly male (86%) with a mean age of 26 years. 56% of participants-of whom 64% had low familial socioeconomic status-had been involved in drug dealing in the previous six months. Compared to non-drug-dealing PWID, drug-dealing PWID reported higher daily injection rate (AOR: 1.3), higher odds of injection equipment confiscation by the police (AOR: 1.4), and were less likely to pay for the drugs they injected (AOR: 0.6). CONCLUSIONS: Involvement of Colombian PWID in drug dealing was higher than previously reported, and drug-dealing PWID presented sociodemographic vulnerabilities and risky injection practices. Addressing these findings may lead to effective policy design and implementation, decreased drug-dealing involvement, harm reduction, and consumption prevention.

Hepatitis C and HIV in injecting drug users in Armenia, Colombia.

A constant and progressive increase in the availability of heroin in Colombia in recent decades and the intravenous use  of this drug have established the need to prevent a possible epidemic of HIV and hepatitis C. This research determined the sero-prevalence of hepatitis C and HIV according to sociodemographic characteristics and risk behaviors in people who inject drugs in Armenia, Colombia. This is a cross-sectional study on 265 users captured through respondent-driven sampling after informed consent. Sero-prevalence of hepatitis C was 22.3 % [95% CI 12.3 % -23.5 %]; for HIV infection, it was 2.6 % [95% CI 0.4 to 6.0]; 67.5% reported injecting for more than two years, 35 % shared needles and syringes, and 12.4 % had used a condom during their last sexual intercourse. Users who did not purchase syringes in drugstores in the last six months are 2.7 times [95% CI 1.32 to 5.48] more likely to contract hepatitis C; daily injection frequency was higher in HIV- positive cases [OR 2.87; 95% CI 0.55 to 15.9] but nonsignificant. One fourth of respondents are infected with HIV or hepatitis C, either as a single infection or co-infection. This study identified risk practices such as sharing needles and low condom use in the last six months, worldwide documented and discussed risk factors. This research is a first step in the search for strategies to prevent the spread of HIV infection and hepatitis C in networks of injecting drug users.

Un aumento constante y progresivo en la disponibilidad de heroína en Colombia en las últimas décadas, y el uso de esta droga vía intravenosa, ha establecido la necesidad de prevenir una posible epidemia de VIH y hepatitis C. Esta investigación determino la seroprevalencia de hepatitis C y VIH según características sociodemográficas y comportamientos de riesgo en población que se inyecta drogas en Armenia-Colombia. Estudio transversal en 265 usuarios captados a través de muestreo guiado por el encuestado previo consentimiento informado. La seroprevalencia de hepatitis C fue 22,3% [IC95% 12,3%-23,5%]; la infección por VIH fue 2,6% [IC95% 0,4-6,0]. El 67,5% reportó inyección por más de dos años, el 35% compartió jeringas y agujas y el 12,4% utilizó condón en su última relación sexual. Los usuarios que no adquirían jeringas en droguerías en los últimos seis meses tienen 2,7 [IC95% 1,32-5,48] veces el riesgo de hepatitis C; la frecuencia diaria de inyección fue mayor en los casos positivos con VIH [OR 2,87; IC95% 0,55-15,9] pero no significativa. La cuarta parte de los encuestados, están infectados por VIH o hepatitis C, en forma de infección única o coinfección. Este estudio identificó prácticas de riesgo, como compartir jeringas y baja utilización del condón en los últimos seis meses, factores de riesgo documentados y discutidos mundialmente. Esta investigación constituye un primer paso en la búsqueda de estrategias para prevenir la propagación de infecciones por VIH y hepatitis C en redes de usuarios de drogas inyectables.

[Use of the condom and knowledge on HIV prevention among the injector's drugs in two Colombian cities]. / Uso del condón y conocimientos sobre prevención del VIH entre los inyectadores de drogas de dos ciudades colombianas.

This research focuses on the use of the condom among injector drug users and the identification of their knowledge on HIV prevention that can inform interventions. A cross- sectional study was conducted, using respondent driven sampling (RDS); the sample was composed of 540 participants, of 18 years of age or older. The survey included counseling for HIV testing and the prevention of sexually transmitted diseases. In the multivariate analysis estimated a logistic regression model (explaining how to use the condom) multinomial with raw and adjusted OR. The proportion of drug-injector users who always used condoms during sexual intercourse with their partners was 21.1%. It was found that by adjusting the risk of not using a condom by ten inadequate assumptions on HIV prevention, factors that increase the risk are sharing the injection equipment (ORaj = 3. 19 [1. 29- 7.88]), having unsafe sex practices (ORaj = 3. 74 [1. 21-11. 58]) and not increasing the use of condom despite having knowledge of HIV (ORaj = 33. 59 [9. 19-122. 86]). The low use of condoms among intravenous drug users is associated with inadequate knowledge about HIV prevention.

[Validation of the abbreviated Zarit scales for measuring burden syndrome in the primary caregiver of an elderly patient]. / Validación de escalas abreviadas de zarit para la medición de síndrome del cuidador primario del adulto mayor en Medellín.

OBJECTIVE: To determine which abbreviated Zarit Scale (ZS) better evaluates the burden of the caregiver of an elderly patient in Medellin, Colombia. DESIGN: Validation study. SETTING: Primary Care setting in the city of Medellin. PARTICIPANTS: Primary caregiver of dependent elderly patients over 65 years old. PRINCIPAL MEASUREMENTS: Sensitivity, specificity, positive predictive value, and negative predictive value for the different abbreviated Zarit scales, plus performing a reliability analysis using the Cronbach Alpha coefficient. RESULTS: The abbreviated scales obtained a sensitivity of between 36.84 and 81.58%, specificity between 95.99 and 100%, positive predictive values between 71.05 and 100%, and negative predictive values of between 91.64 and 97.42%. CONCLUSIONS: The scale that better determined caregiver burden in Primary Care was the Bedard Screening scale, with a sensitivity of 81.58%, a specificity of 96.35% and positive and negative predictive values of 75.61% and 97.42%, respectively.

Factors associated with the perception of HIV vulnerability among transgender women in three Colombian cities. / Factores asociados a la percepción de vulnerabilidad al VIH en mujeres transgénero de tres ciudades de Colombia.

OBJECTIVE: To describe the perception of vulnerability to HIV and its associated factors among transgender women (TW) in Bogotá, Medellín and Santiago de Cali, Colombia. MATERIALS AND METHODS: We conducted a cross-sectional study, using respondent-driven sampling (RDS) in which 620 TW participated. Sociodemographic aspects, sexual behavior, consumption of psychoactive substances and the perception of vulnerability to HIV were studied. We carried out a descriptive analysis, in which bivariate associations were evaluated using chi-square. We also conducted a multivariate analysis and built a model using Poisson regression. RESULTS: Of the participants, 63% were 35 years old or younger, had low income, started sexual relations at an early age and worked mainly as sex workers, webcam models and hairdressers; 84.7% of the participants had received money in exchange for sex at some point. The perception of vulnerability to HIV increased among those who were single, worked in prostitution, had sexually transmitted infections in the last year, avoided preventive health services and consumed cocaine during the six months before this survey. CONCLUSION: The perception of vulnerability to HIV among the TW participants in this study is high; therefore, effective interventions are required to improve the living conditions and sexual behavior of this population.

OBJETIVO: Describir la percepción de vulnerabilidad al VIH y sus factores asociados en mujeres transgénero (MT) en Bogotá, Medellín y Santiago de Cali, Colombia. MATERIALES Y MÉTODOS: Se llevó a cabo un estudio transversal, a partir de un muestreo dirigido por encuestados (RDS), en el que participaron 620 MT. Se investigaron aspectos sociodemográficos, conductas sexuales, consumo de sustancias psicoactivas y percepción de vulnerabilidad al VIH. Se realizó un análisis descriptivo, a través de asociaciones bivariadas, utilizando chi cuadrado. También se realizó el análisis multivariado y se construyó un modelo de regresión de Poisson. RESULTADOS: El 63% de las participantes son menores de 35 años, se desempeñan principalmente como trabajadoras sexuales, modelos web cam y estilistas, tienen bajos ingresos, iniciaron relaciones sexuales a temprana edad, y el 84,7% había recibido dinero a cambio de sexo alguna vez en la vida. La percepción de vulnerabilidad al VIH aumenta entre quienes ejercen la prostitución, antecedente de infecciones de transmisión sexual en el último año, son solteras, consumieron cocaína en los seis meses previos a la encuesta y evitan los servicios de prevención. CONCLUSIONES: La percepción de vulnerabilidad al VIH entre las MT participantes del estudio es alta, por lo cual se requieren intervenciones efectivas que mejoren sus condiciones de vida y comportamientos sexuales.

[Active syphilis infection in homeless people and associated factors]. / Infección activa por sífilis en habitantes de calle y factores asociados.

OBJECTIVE: To identify the personal and sociodemographic factors associated with the syphilis infection in homeless people in Medellin city, 2016. MATERIALS AND METHODS: Quantitative, observational and cross-sectional study. it surveyed 145 homeless people between 18 and 59 years of age. The study included univariate and bivariate analysis, it used the chi square test, the prevalence ratio, confidence intervals of the 95% with level of significance less than 5%. RESULTS: For the development of the study a survey and a serological test of syphilis were applied to 145 homeless people. The 64,1% were men, the average age was 42 years (de 9,5), the predominant social stratum was low (71%), the syphilis infection in homeless people was 27.6%. the people with greater risk to acquire syphilis infection were: women (IC=1,57-4,57), single people (0,71-2,80), bazuco consumers (IC=0,86-3,06) and people with previous diagnosis of syphilis (IC=1,81-4,68). CONCLUSIONS: In the homeless people there is a higher than expected presence of syphilis. The women, single people, bazuco consumers and people with previous diagnosis of syphilis are the most predisposed individuals to acquire the infection. This situation suggests the need to increase and focus the health promotion actions. It suggests fomenting the induced demand to sexual and reproductive health services with a differential approach of the population, too.

OBJETIVO: Identificar los factores personales y sociodemográficos asociados a la infección por sífilis en habitantes de calle de la ciudad de Medellín, 2016. MATERIALES Y MÉTODOS: Se realizó un estudio cuantitativo, observacional, transversal, se encuestaron 145 habitantes de calle entre 18 y 59 años. Se incluyó el análisis univariado y bivariado; se utilizó la prueba chi-cuadrado (x2); razón de prevalencia, intervalos de confianza del 95% con nivel de significancia menor del 5%. RESULTADOS: Para el desarrollo de estudio, se aplicó una encuesta y una prueba serológica para sífilis (VDRL) a 145 habitantes de calle, de los cuales 64,1% eran hombres, la edad promedio fue de 42 años (DE 9,5), el estrato social predominante fue bajo (71%). La infección de sífilis en los habitantes fue de 27,6%. Quienes presentaron mayor riesgo de adquirir la infección fueron las mujeres (IC=1,57-4,57), los de estado civil soltero (0,71-2,80), quienes consumían basuco (IC=0,86-3,06) y quienes anteriormente habían sido diagnosticado con sífilis (IC=1,81-4,68). CONCLUSIÓN: En la población de habitantes de calle, la sífilis tiene una presencia mayor a la esperada y quienes tienen mayor disposición para adquirir la infección son las mujeres, las personas consumidoras, de estado civil soltero y que hayan adquirido la infección anteriormente, situación que sugiere un aumento y focalización de la promoción de salud y el fomento de la demanda inducida a los servicios de salud sexual y reproductiva de la población, con un alto enfoque diferencial.

Prevalence of hepatitis C virus in young people who inject drugs in four Colombian cities: A cross-sectional study using Respondent Driven Sampling.

BACKGROUND: Colombia has a growing population of young people who inject drugs (PWID). Despite the previously reported association of injection drug use with hepatitis c virus (HCV) in other countries, studies on HCV prevalence in PWID in Colombia are lacking. The objective of this study is to determine the prevalence, demographics, and correlations of risky injection behaviours in HCV seropositive PWID in four Colombian cities (Armenia, Bogotá, Cúcuta and Pereira). METHODS: This was a cross-sectional study carried out between January and June of 2014 that included 918 PWID from four Colombian cities, recruited by Respondent Driven Sampling. A survey was administered to each participant, and blood samples were collected. Binary logistic regression and multivariate analyses for each city were conducted. RESULTS: Average participant age was 26 years (SD 6.5). Of all participants, 27.3% of PWID were HCV seropositive, of which 52% were 25 years old or younger. In Pereira, increased risk of HCV infection was found for PWID that: had a history of injection drug use of 5 years or more (AOR: 3.0, CI: 1.7-7.8); were between 25 and 28 years of age (AOR: 5.2, CI: 1.0-26.3); had higher injection frequency (AOR: 2.5, CI: 1.4-4.2), and daily use of gifted, sold, or rented needles or syringes (AOR: 4.5, CI: 1.0-7.1). Additionally, in Cucuta, being HIV seropositive appeared to be greatly associated with risk of HCV seropositivity (AOR: 16.9, CI: 3.5-81.5). CONCLUSION: Although prevalence of HCV in PWID in Colombia is lower than that reported for other countries, the described demographic characteristics and diverse risky injection behaviors on each city, in the context of a young PWID population with a short injection drug use history, should be taken into account in order to guide efforts towards preventing and reducing risk of HCV infection in PWID in Colombia.

Construcción del índice de vulnerabilidad sexual de las mujeres trans

Objetivo: Construir un índice que determine la vulnerabilidad sexual de las mujeres trans. Material y Método: Estudio mixto realizado entre los años 2020 y 2021 que en su primera fase utilizó el análisis de contenido para textos que describían los conceptos básicos de vulnerabilidad, vulnerabilidad social y riesgo, apoyado con los relatos obtenidos en grupos focales y entrevistas a 14 mujeres transgénero para generar el constructo teórico de vulnerabilidad sexual de las mujeres transgénero. Para la segunda parte, a partir de la información recolectada de 417 mujeres transgénero de las ciudades de Bogotá y Cali que habían participado del estudio "Vulnerabilidad y Prevalencia de VIH en Mujeres Transgénero en tres ciudades de Colombia: Bogotá, Medellín y Santiago de Cali-2019", se seleccionaron las variables que serían parte de un análisis factorial exploratorio para construir la versión preliminar del índice. Resultados: Se construyó el índice de riesgo de vulnerabilidad sexual de las mujeres transgénero compuesto por 3 factores: apoyo social, prácticas sexuales y cuidado de la salud. El índice consta de 10 preguntas que se evalúan como 0 o 1, donde los puntajes más altos evidencian un mayor riesgo de vulnerabilidad sexual. Conclusiones: La vulnerabilidad sexual es un fenómeno construido por factores propios de la experiencia trans e influenciado por las características del contexto donde la persona habita; el índice construido cuenta con buena consistencia interna (alfa ordinal 0,90). Asimismo, se encontró concordancia entre el modelo teórico de la fase cualitativa y los resultados del análisis factorial exploratorio.

Objective: To construct an index to determine the sexual vulnerability of trans women. Materials and Methods: Mixed study conducted between 2020 and 2021, which in its first phase used content analysis for texts describing the basic concepts of vulnerability, social vulnerability and risk. This was supported by accounts from focus groups and interviews with 14 transgender women to generate the theoretical construct of sexual vulnerability of transgender women. For the second phase, from the information provided by 417 transgender women from the cities of Bogotá and Cali, who participated in the study "Vulnerability and HIV Prevalence in Transgender Women in three cities of Colombia: Bogota, Medellin and Santiago de Cali - 2019", variables were selected to be part of an exploratory factor analysis to construct the preliminary version of the index. Results: The sexual vulnerability risk index of transgender women was based on 3 factors: social support, sexual practices, and health care. The index consisted of 10 questions scored as 0 or 1, with higher scores indicating a higher risk of sexual vulnerability. Conclusions: Sexual vulnerability is a phenomenon based on factors which are specific to the trans experience and it is influenced by the characteristics of the context in which the person lives. The constructed index has good internal consistency (ordinal alpha 0.90) and shows concordance between the theoretical model of the qualitative phase and the results of the exploratory factor analysis.

Objetivo: Construir um índice para determinar a vulnerabilidade sexual de mulheres transgênero. Material e Método: Estudo misto realizado entre 2020 e 2021 que, em sua primeira fase, utilizou a análise de conteúdo para textos que descrevem os conceitos básicos de vulnerabilidade, vulnerabilidade social e risco; apoiado por relatos obtidos em grupos focais e entrevistas com 14 mulheres transgênero para gerar o construto teórico de vulnerabilidade sexual de mulheres transgênero. Para a segunda fase, a partir das informações fornecidas por 417 mulheres transgênero das cidades de Bogotá e Cali que participaram do estudo "Vulnerabilidade e Prevalência de HIV em Mulheres Transgênero em três cidades da Colômbia: Bogotá, Medellín e Santiago de Cali-2019", foram selecionadas variáveis que fizeram parte de uma análise fatorial exploratória para construir a versão preliminar do índice. Resultados: O índice de risco de vulnerabilidade sexual de mulheres transgênero foi construído com base em três fatores: apoio social, práticas sexuais e assistência à saúde. Consiste em 10 perguntas que são avaliadas como 0 ou 1, em que as pontuações mais altas evidenciam um risco maior de vulnerabilidade sexual. Conclusões: A vulnerabilidade sexual é um fenômeno baseado em fatores que são específicos da experiência trans e é influenciado pelas características do contexto em que a pessoa vive. Além disso, o índice construído tem boa consistência interna (alfa ordinal 0,90) e mostra concordância entre o modelo teórico da fase qualitativa e os resultados da análise fatorial exploratória.

Preparation of a Scale for Assessing Nursing Care Needs in Dependent People / Construcción de una escala para la valoración de necesidades de cuidado de enfermería en personas dependientes / Construção de uma escala para avaliação das necessidades de cuidados de enfermagem em pessoas dependentes

Objective: To prepare and validate a scale for assessing care needs in dependent people, based on all fourteen needs included in Virginia Henderson's theory and Maslow's Theory of Human Needs. Materials and methods: An observational study was conducted to validate a scale with a sample of 776 care-dependent individuals. Nursing professionals were in charge of writing the items. Correlations between items and factor structure were evaluated using a structural equation model. Reliability was assessed through Cronbach's alpha and McDonald's omega. Results: The correlations between all fourteen needs were satisfactory. The structure with three dimensions (physiological needs, need for safety and belonging, and need for independence) was satisfactory: CFI = 0.95, TLI = 0.94, SRMR = 0.04, and RMSEA = 0.06 (95 % CI: 0.05-0.07). The scale's reliability was satisfactory, with Cronbach's alpha = 0.870 and McDonald's omega = 0.871. Conclusions: This scale allows obtaining a classification score to determine the nursing assistance needs of dependent people. It contributes to the standardization and use of the theories about care and human needs.

Objetivos: construir y validar una escala para la valoración de la necesidad de cuidados de personas dependientes, basada en las catorce necesidades de la teoría de Virginia Henderson y la teoría de las necesidades humanas de Maslow. Metodología: estudio observacional de validación de escala con una muestra de 776 personas sujetos de cuidado. Construcción de los ítems a cargo de profesionales de enfermería. Se evaluaron correlaciones entre ítems y estructura factorial por medio de un modelo de ecuaciones estructurales. Análisis de fiabilidad mediante alfa de Cronbach y omega de McDonald's. Resultados: Las correlaciones entre las catorce necesidades fueron satisfactorias. La estructura de tres dimensiones (necesidades fisiológicas, necesidad de seguridad y afiliación y necesidad de independencia) fue satisfactoria: CFI=0,95, TLI=0,94, SRMR = 0,04 y RMSEA=0,06 (IC95% 0,05-0,07). La fiabilidad de la escala fue satisfactoria, con un alfa de Cronbach = 0,870 y un omega de McDonald's=0,871. Conclusiones: esta escala permite obtener un puntaje de clasificación para conocer la necesidad de ayuda de la persona dependiente por parte de enfermería. Es un aporte a la estandarización y el uso objetivo de las teorías sobre el cuidado y las necesidades humanas.

Objetivos: construir e validar uma escala de avaliação das necessidades de cuidado de pessoas dependentes, com base nas quatorze necessidades da teoria de Virginia Henderson e na teoria das necessidades humanas de Maslow. Metodologia: estudo observacional de validação de escala com amostra de 776 pessoas dependentes de cuidados. Construção dos itens pelos profissionais de enfermagem. As correlações entre os itens e a estrutura fatorial foram avaliadas por meio de um modelo de equação estrutural. Análise de confiabilidade com utilização dos coeficientes alfa de Cronbach e ômega de McDonald. Resultados: as correlações entre as quatorze necessidades foram satisfatórias. A estrutura de três dimensões (necessidades fisiológicas, necessidade de segurança e afiliação e necessidade de independência) foi satisfatória: CFI = 0,95; TLI = 0,94; SRMR = 0,04 e RMSEA = 0,06 (IC 95 %: 0,05-0,07). A confiabilidade da escala foi satisfatória, com alfa de Cronbach = 0,870 e ômega de McDonald = 0,871. Conclusões: esta escala permite obter um escore de classificação para avaliar as necessidades de cuidados de enfermagem de pessoas dependentes. Implica uma contribuição para a padronização e o uso objetivo de teorias sobre o cuidado e as necessidades humanas.

Use of injected heroin and risk of hepatitis C in three cities in Colombia. / Uso de heroína inyectada y el riesgo de hepatitis C en tres ciudades de Colombia.

INTRODUCTION: Hepatitis C is one of the most neglected diseases by governments internationally. OBJECTIVE: Identify the prevalence of hepatitis C and associated injection drug users in three cities of factors Colombia. METHODS: Cross-sectional study of 668 injecting drug users recruited through respondent-driven sampling, inquired about demographic characteristics and risk behaviors. Laboratory testing was used on filter paper and cases of hepatitis C viral load tests with RNA were confirmed. Hepatitis C prevalence and associated factors was estimated with Chi-square test statistics and reasons for crude and adjusted prevalence were calculated using logistic regression. RESULTS: The prevalence of hepatitis C was 17.5% and were found as factors that increase the prevalence of hepatitis: having HIV, injecting another person carrying the virus dose used was sharing a syringe, injected with a syringe and consume marijuana. As a factor that reduces the prevalence, purchase syringes in drug stores or other stores. CONCLUSION: This research evidence established consumption of drugs by injection , and the presence of hepatitis C in social networks of IDUs and highlights the importance of developing interventions for harm reduction and prevention of hepatitis C in this population these three cities.

INTRODUCCIÓN: La hepatitis C es uno de los grandes problemas de salud pública en el mundo, especialmente por su alta transmisibilidad por vía inyectada. OBJETIVO: Identificar la prevalencia de la infección por VHC, y factores asociados en usuarios de drogas psicoactivas inyectables en tres ciudades (Armenia, Bogotá y Cúcuta) de Colombia. MÉTODOS: Estudio descriptivo transversal en 668 usuarios de drogas inyectables captados a través de muestreo guiado por el respondiente, a quienes se indagó sobre características demográficas y comportamientos de riesgo. Se utilizó la prueba de Anticuerpos, tomado en papel de filtro y se confirmaron los casos de VHC, con pruebas de carga viral de RNA. Se estimó la prevalencia de VHC y los factores asociados con pruebas estadísticas Chi-cuadrado y se calcularon razones de prevalencia crudas y ajustadas con regresión logística usando RDSAT y SPSS. RESULTADOS: La prevalencia de infección por VHC fue del 17,5% y se encontraron como factores que aumentan la prevalencia de hepatitis: tener VIH, inyectarse con otra persona portadora del virus, utilizar dosis de una jeringa que estaba compartiendo, inyectarse con una jeringa casera y consumir marihuana. Como factor que reduce la prevalencia, el adquirir jeringas en droguerías u otras tiendas. CONCLUSIÓN: Se evidencia un consumo establecido de drogas por vía inyectada, poniendo de relieve la importancia de generar intervenciones para la reducción de daños y la prevención de hepatitis C en estas tres ciudades del país.

Factores asociados a la percepción de vulnerabilidad al VIH en mujeres transgénero de tres ciudades de Colombia

Objetivo: Describir la percepción de vulnerabilidad al VIH y sus factores asociados en mujeres transgénero (MT) en Bogotá, Medellín y Santiago de Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio transversal, a partir de un muestreo dirigido por encuestados (RDS), en el que participaron 620 MT. Se investigaron aspectos sociodemográficos, conductas sexuales, consumo de sustancias psicoactivas y percepción de vulnerabilidad al VIH. Se realizó un análisis descriptivo, a través de asociaciones bivariadas, utilizando chi cuadrado. También se realizó el análisis multivariado y se construyó un modelo de regresión de Poisson. Resultados: El 63% de las participantes son menores de 35 años, se desempeñan principalmente como trabajadoras sexuales, modelos web cam y estilistas, tienen bajos ingresos, iniciaron relaciones sexuales a temprana edad, y el 84,7% había recibido dinero a cambio de sexo alguna vez en la vida. La percepción de vulnerabilidad al VIH aumenta entre quienes ejercen la prostitución, antecedente de infecciones de transmisión sexual en el último año, son solteras, consumieron cocaína en los seis meses previos a la encuesta y evitan los servicios de prevención. Conclusiones: La percepción de vulnerabilidad al VIH entre las MT participantes del estudio es alta, por lo cual se requieren intervenciones efectivas que mejoren sus condiciones de vida y comportamientos sexuales.

Objective: To describe the perception of vulnerability to HIV and its associated factors among transgender women (TW) in Bogotá, Medellín and Santiago de Cali, Colombia. Materials and methods: We conducted a cross-sectional study, using respondent-driven sampling (RDS) in which 620 TW participated. Sociodemographic aspects, sexual behavior, consumption of psychoactive substances and the perception of vulnerability to HIV were studied. We carried out a descriptive analysis, in which bivariate associations were evaluated using chi-square. We also conducted a multivariate analysis and built a model using Poisson regression. Results: Of the participants, 63% were 35 years old or younger, had low income, started sexual relations at an early age and worked mainly as sex workers, webcam models and hairdressers; 84.7% of the participants had received money in exchange for sex at some point. The perception of vulnerability to HIV increased among those who were single, worked in prostitution, had sexually transmitted infections in the last year, avoided preventive health services and consumed cocaine during the six months before this survey. Conclusion: The perception of vulnerability to HIV among the TW participants in this study is high; therefore, effective interventions are required to improve the living conditions and sexual behavior of this population.

Cohesión familiar y factores relacionados en adolescentes escolarizados / Family cohesion and related factors in school adolescents

Resumen Introducción: El nivel de cohesión de un núcleo familiar permite caracterizar los vínculos y relaciones que existen entre sus miembros y constituye un insumo fundamental para el desarrollo de políticas y programas de intervención en la familia. Objetivo: Identificar factores asociados a la cohesión familiar en adolescentes del Municipio de Envigado. Materiales y métodos: Estudio transversal, de fuente de información primaria, con una muestra de 1008 estudiantes de dos colegios de Envigado. Se utilizó la escala de cohesión familiar, de Depresión de Zung, de Habilidades Sociales de Gismero, y preguntas sociodemográficas y de consumo de sustancias. Resultados: El 61,5% de los adolescentes se encontraban sin riesgo de alcoholismo, el 73,8% sin dependencia a drogas, un 16,5% tenían riesgo de depresión y un 81,7% presentaban buenas habilidades sociales. La prevalencia de cohesión familiar fue 96,6%. La satisfacción con la familia y la ausencia de depresión, se asociaron a buena cohesión familiar. Conclusiones: La presencia de depresión en el adolescente y un alto nivel de insatisfacción con el núcleo familiar son factores asociados a la falta de cohesión familiar; factores como la violencia intrafamiliar, las habilidades sociales y el consumo de sustancias psicoactivas no presentaron asociación con la variable de interés.

Abstract Introduction: The level of cohesion within a family nucleus is useful to characterize connections and relationships established between its members. It also constitutes a fundamental factor in the development of family intervention programs and policies. Objective: To identify factors associated with family cohesion in adolescents from the municipality of Envigado (Colombia). Materials and methods: A cross-sectional study using a primary source of information and a sample of 1008 students from two schools from Envigado. The following instruments were used: family cohesion scale; Zung's Depression scale; Gismero's Social Skills scale; and sociodemographic and substance use questions. Results: 61.5% of adolescents were not at risk for alcoholism, 73.8% were not drug dependent, 16.5% were at risk of depression, and 81.7% had adequate social skills. The prevalence of family cohesion was 96.6%. A feeling of satisfaction with their families and absence of depression were associated with good family cohesion. Conclusions: Depression in adolescents and a high level of dissatisfaction towards their family are factors associated with the lack of family cohesion. Factors such as domestic violence, social skills, and use of psychoactive substances did not show an association with the variable of interest.

Prevalencia y factores asociados al trastorno de estrés postraumático en personas desplazadas en Colombia / Prevalence and factors associated with post-traumatic stress disorder in displaced persons in Colombia

Resumen Introducción: el trastorno por estrés postraumático (TEPT) es un síndrome que sobreviene después de que una persona experimenta un acontecimiento traumático extremo como la violencia en sus diversas manifestaciones: doméstica, sexual, política o armada. Objetivo: determinar la prevalencia del TEPT, los factores demográficos y las condiciones del desplazamiento asociadas en población desplazada por la violencia producto del conflicto armado, en tres ciudades de Colombia: Bogotá, Medellín y Buenaventura. Método: estudio observacional, analítico con diseño cross-sectional, medición transversal, mediante disponibilidad de datos retrospectivos. La población objeto de estudio se compone de 1 026 registros de personas víctimas del conflicto armado, con edades entre 13 y 65 años, participantes del estudio primario "Salud mental en víctimas de desplazamiento forzado por la violencia en Colombia. El caso de Bogotá, Medellín y Buenaventura". Resultados: la prevalencia de vida del TEPT es de 9,9 %, siendo superior en la ciudad de Buenaventura; el trastorno presenta una asociación estadísticamente significativa con variables como la ocupación, el estado civil y la forma como se llevó a cabo el desplazamiento. Conclusiones: resaltan aspectos como la falta de ocupación, las características del desplazamiento y el bajo apoyo social como posibles factores que desencadenan o intensifican el TEPT.

Abstract Introduction: post-traumatic stress disorder (PTSD) is a syndrome that occurs after a person experiences an extreme traumatic event such as violence in its various manifestations: domestic, sexual, political, or armed. Objective: to determine the prevalence of PTSD and the demographic factors and associated displacement conditions in the population displaced by the violence resulting from the armed conflict, in three cities of Colombia: Bogotá, Medellín and Buenaventura. Method: observational, analytical study with cross-sectional design, cross-sectional measurement, through availability of retrospective data. The population under study consists of 1,026 records of people who are victims of the armed conflict, aged between 13 and 65 years, participants in the primary study "Mental disorders in displaced population victims of the armed conflict, in three cities of Colombia". Results: the lifetime prevalence of PTSD is 9.9%, higher in the city of Buenaventura; the disorder presents a statistically significant association with variables such as occupation, marital status, and the way in which the displacement occurred. Conclusions: aspects such as lack of job, displacement characteristics and low social support stand out as possible factors that trigger or intensify PTSD.

[Self-rated health in adults: influence of poverty and income inequality in the area of residence]. / Salud autorreferida: influencia de la pobreza y la desigualdad del área de residencia.

OBJECTIVE: To evaluate the influence of income inequality and poverty in the towns of Bogotá, Colombia, on poor self-rated health among their residents. METHODS: The study was based on a multipurpose survey applied in Bogotá-Colombia. A hierarchical data structure (individuals=level1, locations=level 2) was used to define a logit-type multilevel logistic model. The dependent variable was self-perceived poor health, and local variables were income inequality and poverty. All analyses were controlled for socio-demographic variables and stratified by sex. RESULTS: The prevalence of self-reported fair or poor health in the study population was 23.2%. Women showed a greater risk of ill health, as well as men and women with a low educational level, older persons, those without work in the last week and persons affiliated to the subsidized health system. The highest levels of poverty in the city increased the risk of poor health. Cross-level interactions showed that young women and men with a low education level were the most affected by income inequality in the locality. CONCLUSIONS: In Bogotá, there are geographical differences in the perception of health. Higher rates of poverty and income inequality were associated with an increased risk of self-perceived poor health. Notable findings were the large health inequalities at the individual and local levels.

Infección activa por sífilis en habitantes de calle y factores asociados / Active syphilis infection in homeless people and associated factors / Infecção ativa por sífilis em pessoas sem-teto e fatores associados

RESUMEN Objetivo Identificar los factores personales y sociodemográficos asociados a la infección por sífilis en habitantes de calle de la ciudad de Medellín, 2016. Materiales y métodos Se realizó un estudio cuantitativo, observacional, transversal, se encuestaron 145 habitantes de calle entre 18 y 59 años. Se incluyó el análisis univariado y bivariado; se utilizó la prueba chi-cuadrado (x2); razón de prevalencia, intervalos de confianza del 95% con nivel de significancia menor del 5%. Resultados Para el desarrollo de estudio, se aplicó una encuesta y una prueba serológica para sífilis (VDRL) a 145 habitantes de calle, de los cuales 64,1% eran hombres, la edad promedio fue de 42 años (DE 9,5), el estrato social predominante fue bajo (71%). La infección de sífilis en los habitantes fue de 27,6%. Quienes presentaron mayor riesgo de adquirir la infección fueron las mujeres (IC=1,57-4,57), los de estado civil soltero (0,71-2,80), quienes consumían basuco (IC=0,86-3,06) y quienes anteriormente habían sido diagnosticado con sífilis (IC=1,81-4,68). Conclusión En la población de habitantes de calle, la sífilis tiene una presencia mayor a la esperada y quienes tienen mayor disposición para adquirir la infección son las mujeres, las personas consumidoras, de estado civil soltero y que hayan adquirido la infección anteriormente, situación que sugiere un aumento y focalización de la promoción de salud y el fomento de la demanda inducida a los servicios de salud sexual y reproductiva de la población, con un alto enfoque diferencial.(AU)

ABSTRACT Objective To identify the personal and sociodemographic factors associated with the syphilis infection in homeless people in Medellin city, 2016. Materials and Methods Quantitative, observational and cross-sectional study. it surveyed 145 homeless people between 18 and 59 years of age. The study included univariate and bivariate analysis, it used the chi square test, the prevalence ratio, confidence intervals of the 95% with level of significance less than 5%. Results For the development of the study a survey and a serological test of syphilis were applied to 145 homeless people. The 64,1% were men, the average age was 42 years (de 9,5), the predominant social stratum was low (71%), the syphilis infection in homeless people was 27.6%. the people with greater risk to acquire syphilis infection were: women (IC=1,57-4,57), single people (0,71-2,80), bazuco consumers (IC=0,86-3,06) and people with previous diagnosis of syphilis (IC=1,81-4,68). Conclusions In the homeless people there is a higher than expected presence of syphilis. The women, single people, bazuco consumers and people with previous diagnosis of syphilis are the most predisposed individuals to acquire the infection. This situation suggests the need to increase and focus the health promotion actions. It suggests fomenting the induced demand to sexual and reproductive health services with a differential approach of the population, too.(AU)

Objetivo: Identificar os fatores pessoais e sociodemográficos associados à infecção por sífilis em moradores de rua da cidade de Medellín, 2016. Materiais e métodos: Realizou-se um estudo quantitativo, observacional e transversal, com 145 moradores de rua entre 18 e 59 anos. Análise univariada e bivariada foi incluída; o teste do qui-quadrado (x 2 ) foi usado; razão de prevalência, intervalos de confiança de 95% com nível de significância menor que 5%. Resultados: Para o desenvolvimento do estudo, aplicou-se inquérito e teste sorológico para sífilis (VDRL) a 145 moradores de rua, dos quais 64,1% eram homens, a idade média foi de 42 anos (DP 9,5), a O estrato social predominante era baixo (71%). A infecção de sífilis nos moradores foi de 27,6%. Aqueles que apresentaram maior risco de adquirir a infecção foram as mulheres (IC = 1,57-4,57), aquelas com estado civil solteiro (0,71-2,80), que consumiam basuco (IC = 0,86-3, 06) e aqueles com diagnóstico prévio de sífilis (IC = 1,81-4,68). Conclusão: Na população de moradores de rua, a sífilis tem uma presença maior do que o esperado e aqueles que estão mais dispostos a adquirir a infecção são mulheres, consumidoras, estado civil solteiro e que já adquiriram a infecção, situação que sugere uma aumento e direcionamento da promoção da saúde e promoção da demanda induzida por serviços de saúde sexual e reprodutiva da população, com alto foco diferencial.(AU)

[Suicidal Behavior and Attention Decifit Hyperactivity Disorder in Adolescents of Medellin (Colombia), 2011-2012]. / Comportamiento suicida de adolescentes con trastorno por déficit de atención e hiperactividad en Medellín (Colombia), 2011-2012.

BACKGROUND: Suicide is a public health problem. In Colombia, teenagers are considered a group at high risk for suicidal behavior. OBJECTIVE: To explore the possible association between suicidal behavior and attention deficit hyperactivity disorder in adolescents of Medellin. METHODOLOGY: Observational, cross-sectional, analytical study. The Composite International Diagnostic Interview was applied to a total of 447 adolescents and the sociodemographic, clinical, familiar, and life event variables of interest were analyzed. The descriptive analysis of qualitative variables are presented as absolute values and frequencies, and the age was described with median [interquartile range]. A logistic regression model was constructed with explanatory variables that showed statistical association. Data were analyzed with SPSS® software version 21.0. RESULTS: Of the total, 59.1% were female, and the median age was 16 [14-18] years. Suicidal behavior was presented in 31% of females and 23% of males. Attention deficit was present in 6.3% of adolescents. The logistic regression analysis showed that the variables that best explained the suicidal behavior of adolescents were: female sex, post-traumatic stress disorder, panic disorder, and cocaine use. CONCLUSIONS: The diagnosis and early intervention of attention deficit hyperactivity disorder in children may be a useful strategy in the prevention of suicidal behavior in adolescents.

Características socioculturales y de salud asociadas a enfermedad coronaria en mujeres. Estudio caso-control / Socio-cultural and healthcare characteristics associated with coronary artery disease in women. A case-control study / Características socioculturais e de saúde associadas à doença coronariana em mulheres. Estudo caso-controle

Resumen Introducción Las enfermedades cardiovasculares se constituyen un problema de salud pública, dentro de este grupo, la enfermedad coronaria ha mostrado incrementos especialmente en la prevalencia para infarto agudo de miocardio en mujeres de 35-54 años. La organización mundial de la salud propone estudiar el problema desde las diferencias regionales para encontrar soluciones al asunto. Objetivo Analizar la asociación entre características socioculturales y de salud con la enfermedad coronaria en mujeres de Nariño. Materiales y Métodos: Estudio de casos (mujeres con enfermedad coronaria) y controles (mujeres sin enfermedad coronaria) atendidas en instituciones de referencia para el departamento de Nariño. La muestra estuvo conformada por 35 casos y 105 controles por muestreo no probabilístico. Resultados Características como: ser fumadora, hipertensa y vivir en el área urbana mostraron mayor asociación con la enfermedad coronaria: Odd ratios= 21,11; IC 95% 3,97-112,26 y Odd ratios= 9,47; IC 95% 2,87-31,23 respectivamente. Se destaca la proporción de mujeres con enfermedad coronaria que culturalmente se caracterizan por callar su enfermedad para no preocupar. Discusión Ser fumadora e hipertensa se constituyen en determinantes para desarrollar enfermedad coronaria, situaciones que pueden ser inducidas por situaciones familiares, sociales, culturales, ocupacionales que la mujer debe enfrentar. Conclusiones La mujer con enfermedad coronaria se caracterizó por ser fumadora, hipertensa y vivir en el área urbana, lo anterior muestra que es necesario generar estrategias específicas de prevención y control en la mujer.

Abstract Introduction Cardiovascular diseases are a public health problem. In this group, coronary artery disease has shown an increase, in particular, in the prevalence of acute myocardial infarction in 35-54-year-old women. The World Health Organization suggests studying this issue based on regional differences to find solutions. Objective To analyze socio-cultural and healthcare characteristics associated with coronary artery disease in women from Nariño. Materials and Methods: Case study (women with coronary artery disease) and controls (women without coronary artery disease) served in reference institutions of Nariño. The sample was made of 35 cases and 105 controls through non-probability sampling. Results Features such as being a smoker, hypertensive and living in an urban area showed greater association with coronary artery disease: Odd ratios= 21.11; CI 95% 3.97-112.26 and Odd ratios= 9.47; CI 95% 2.87-31.23, accordingly. A proportion of women with coronary artery disease stand out as culturally characterized by keeping their illness a secret not to worry others. Discussion Being a smoker and hypertensive are key factors to develop coronary heart disease; these situations can be induced by family, social, cultural and occupational issues faced by women. Conclusions Women with coronary artery disease were characterized as being smokers, hypertensive and living in an urban area; it is thus necessary to generate specific prevention and control strategies for women.

Resumo Introdução As doenças cardiovasculares são um problema de saúde pública e, dentro desse grupo, a doença coronariana tem apresentado um aumento, principalmente, na prevalência de infarto agudo do miocárdio em mulheres de 35 a 54 anos. A Organização Mundial da Saúde propõe estudar o problema a partir de diferenças regionais para encontrar soluções ao problema. Objetivo Analisar a associação entre características socioculturais e de saúde com doença coronariana em mulheres de Nariño. Materiais e Métodos: Estudo de casos (mulheres com doença coronariana) e controles (mulheres sem doença coronariana) tratadas em instituições de referência no departamento de Nariño. A amostra foi composta por 35 casos e 105 controles por amostragem não probabilística. Resultados Características como: ser fumante, hipertensa e moradora da área urbana apresentaram maior associação com a doença coronariana: razão de possibilidades = 21,11; IC95% 3,97-112,26 e razão de possibilidades = 9,47; IC 95% 2,87-31,23, respectivamente. Destaca-se o número de mulheres com doença coronariana que são culturalmente caracterizadas por silenciarem sua doença para não preocupar. Discussão Ser fumante e hipertensa são fatores determinantes para o desenvolvimento da doença coronariana, situações que podem ser induzidas por situações familiares, sociais, culturais, ocupacionais que a mulher deve enfrentar. Conclusões A mulher com doença coronariana se caracterizou por ser tabagista, hipertensa e por morar em uma área urbana, o exposto anteriormente demonstra que é necessário gerar estratégias específicas de prevenção e de controle nas mulheres.

[Prevalence of Alcohol Abuse and Dependence in Adults With Social Phobia in Medellin]. / Prevalencia de abuso y dependencia de alcohol en adultos con fobia social en Medellín.

INTRODUCTION: Having a social phobia may lead to consuming alcohol for greater social assertiveness, running the risk of leading to an abuse disorder or alcohol dependence. The aim of the study was to estimate prevalence of pathological comorbidity between social phobia and alcohol consumption in adults of the city of Medellin, and the behavior of comorbidity by gender, age, presence of a father figure in childhood, and education. METHODS: Secondary analysis of the database of the first Mental Health Population Survey conducted in the city of Medellin in 2011 and 2012 based on the methodology of the World Mental Health Survey guidelines and coordinated by WHO-HARVARD. RESULTS: The lifetime prevalence of abuse and dependence in people with social phobia was 24.1% and 11.2%, respectively. For people with social phobia the prevalence was 13% for abuse and 4.4% for dependence (OR=2.11 for abuse, OR=2.46 for dependence). Annual prevalence of people with social phobia who abused or were dependent on alcohol was 7.8% and 5.9%, respectively, compared to those who do not suffer from this disorder, with a prevalence of 3.4% and 1.7%, respectively (OR=2.39 for abuse and OR=3.57 for dependence). DISCUSSION: There was significant correlation in the annual and lifetime prevalence between social phobia and the pathological consumption of alcohol. Statistically significant relationships were found for the variables associated with social phobia, however, more work is needed to confirm or refute these associations.