HIV serodifference: the "unsaid" in the social representations of health professionals.

OBJECTIVE: To analyze social representations from the perspective of the silent zone of health professionals regarding HIV serodifference. METHOD: This is a qualitative study, based on the theoretical-methodological framework of Social Representations, with the Theory of the Central Nucleus and Mute Zone by Jean Claude Abric. 51 professionals from specialized services from the metropolitan region of a capital in the northeast of Brazil participated, from October to December 2020. Interviews were applied using the free word association replacement technique, with prototypical and similarity analyzes processed in the Iramuteq software. RESULTS: The results showed that the central nucleus demonstrated the veiled presence of stigmas and lack of knowledge when dealing with HIV serodifference, represented by the expressions prejudice, lack of knowledge, fear, insanity, and love. FINAL CONSIDERATIONS: The social representations attributed to the central core are anchored in prejudice, ignorance, fear, and insanity. Such meanings signal the need for improvements in the knowledge of health professionals involved in the health care network, in order to enable the praxis of care, and to confront the stigmas that permeate serodifference and cause distance between partners and health services.

HIV serodifference: the "unsaid" in the social representations of health professionals / Serodiferencia del VIH: las representaciones sociales "tácitas" de los profesionales de la salud / Sorodiferença ao HIV: o "não dito" das representações sociais de profissionais de saúde

ABSTRACT Objective: To analyze social representations from the perspective of the silent zone of health professionals regarding HIV serodifference. Method: This is a qualitative study, based on the theoretical-methodological framework of Social Representations, with the Theory of the Central Nucleus and Mute Zone by Jean Claude Abric. 51 professionals from specialized services from the metropolitan region of a capital in the northeast of Brazil participated, from October to December 2020. Interviews were applied using the free word association replacement technique, with prototypical and similarity analyzes processed in the Iramuteq software. Results: The results showed that the central nucleus demonstrated the veiled presence of stigmas and lack of knowledge when dealing with HIV serodifference, represented by the expressions prejudice, lack of knowledge, fear, insanity, and love. Final considerations: The social representations attributed to the central core are anchored in prejudice, ignorance, fear, and insanity. Such meanings signal the need for improvements in the knowledge of health professionals involved in the health care network, in order to enable the praxis of care, and to confront the stigmas that permeate serodifference and cause distance between partners and health services.

RESUMEN Objetivo: Analizar las representaciones sociales desde la perspectiva de la zona silenciosa de los profesionales de la salud sobre la serodiferencia por VIH. Método: Se trata de un estudio cualitativo, basado en el marco teórico-metodológico de las Representaciones Sociales, con la Teoría del Núcleo Central y Zona Muda de Jean Claude Abric. Participaron 51 profesionales de servicios especializados de la región metropolitana de una capital del nordeste de Brasil, de octubre a diciembre de 2020. Las entrevistas se aplicaron mediante la técnica de sustitución libre de asociaciones de palabras, con análisis de prototipos y similitudes procesados en el software Iramuteq. Resultados: Los resultados mostraron que el núcleo central demostró la presencia velada de estigmas y desconocimiento al abordar la serodiferencia de VIH, representada en las evocaciones prejuicio, desconocimiento, miedo, locura y amor. Consideraciones finales: Las representaciones sociales atribuidas al núcleo central están ancladas en el prejuicio, la ignorancia, el miedo y la locura. Estos significados señalan la necesidad de entrenamiento para ampliar los conocimientos de los profesionales de la salud envueltos en la red de atención a la salud, para que sea posible la praxis del cuidado, y así se pueda enfrentar a los estigmas que permean la serodiferencia y generan distancias entre las parejas y los servicios de salud.

RESUMO Objetivo: Analisar as representações sociais na perspectiva do "não dito" de profissionais de saúde sobre a sorodiferença ao HIV. Método: Trata-se de um estudo qualitativo, fundamentado no referencial teórico-metodológico das Representações Sociais, com a Teoria do Núcleo Central e Zona Muda de Jean Claude Abric. Participaram 51 profissionais de serviços especializados da região metropolitana de uma capital do nordeste brasileiro, no período de outubro a dezembro de 2020. Aplicou-se entrevistas com a técnica de substituição da associação livre de palavras. Quanto aos procedimentos analíticos foram realizadas as análises prototípica e de similitude processadas no software Iramuteq. Resultados: Os resultados evidenciaram que o núcleo central demonstrou a presença velada de estigmas e déficit de conhecimento ao tratar da sorodiferença ao HIV, representados nas evocações preconceito, desconhecimento, medo, loucura e amor. Considerações finais: Os significados atribuídos ao núcleo central sinalizam a necessidade de capacitação dos profissionais de saúde envolvidos na rede de atenção à saúde, a fim de possibilitar a práxis do cuidado, e o enfrentamento dos estigmas que permeiam a sorodiferença e provocam o distanciamento entre parceiros e serviços de saúde.

Consumo de café enriquecido com cacau e canela por mulheres hipertensas (Ecardio-CACACA): protocolo de estudo / Consumption of coffee enriched with cocoa and cinnamon by hypertensive women (Ecardio-CACACA): study protocol

Objetivo: Analisar o efeito do consumo de diferentes fórmulas de café enriquecidas com cacau e canela sobre biomarcadores cardiovasculares, glicêmicos e antropométricos em mulheres hipertensas, durante 12 semanas. Métodos: Ensaio clínico randomizado duplo-cego, do tipo fatorial, a ser realizado em Unidades Básicas de Saúde, em uma cidade do interior do Ceará, com uma amostra de 90 pessoas. Os participantes elegíveis passarão por duas avaliações (antes e depois) para mensuração de biomarcadores cardiovasculares clínicos e laboratoriais, glicêmicos e antropométricos. A randomização será por estratos, de acordo com o estágio da hipertensão, e a alocação será por blocos. Os participantes serão orientados a tomar as fórmulas de café duas vezes ao dia (café da manhã e almoço), em concentrações de 10g (café), 5g (cacau) e 3g (canela), preparados com 50 mL de água quente. Para análise dos dados, será considerada a ANOVA de medidas repetidas (> 2 grupos), e em caso de associações estatisticamente significantes (P< 0,05), será realizada regressão linear. Com isso, pretende-se conhecer qual é a fórmula de café enriquecido mais eficaz para o controle e/ou redução de biomarcadores cardiológicos, glicêmicos e antropométrico. Descritores: Café; Cacau; Cinnamomum zeylanicum; Hipertensão; Estudo clínico

Objective: To analyze the effect of consuming different coffee formulas enriched with cocoa and cinnamon on cardiovascular, glycemic and anthropometric biomarkers in hypertensive women, during 12 weeks.Methods:Double-blind randomized clinical trial, of the factorial type, to be carried out in Basic Health Units, in a city in the interior of Ceará, with a sample of 90 people. Eligible participants will undergo two assessments (before and after) to measure clinical and laboratory cardiovascular, glycemic and anthropometric biomarkers. Randomization will be by strata, according to the stage of hypertension, and allocation will be by blocks. Participants will be instructed to drink coffee formulas twice a day (breakfast and lunch), in concentrations of 10g (coffee), 5g (cocoa) and 3g (cinnamon), prepared with 50 mL of hot water. For data analysis, repeated measures ANOVA (> 2 groups) will be considered, and in case of statistically significant associations (P< 0.05), linear regression will be performed. With this, it is intended to know which is the most effective fortified coffee formula for the control and/or reduction of cardiological, glycemic and anthropometric biomarkers. Descriptors: Coffee; Cacao; Cinnamomum zeylanicum; Hypertension; Clinical study

Spatiotemporal risk assessment and COVID-19 trend estimation in a federative unit in northeastern Brazil.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. METHODS: An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions. RESULTS: Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. CONCLUSIONS: The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.

Visceral leishmaniasis and HIV coinfection in Brazil: epidemiological profile and spatial patterns.

BACKGROUND: Geographical overlap of human visceral leishmaniasis (HVL) and HIV infection favors occurrences of HVL/HIV coinfection. The increasing numbers of cases of HVL/HIV coinfection are a worldwide concern and knowledge of the factors involved can help in developing preventive measures. METHODS: We aimed to identify spatial patterns and describe the epidemiological profile of HVL/HIV coinfection in Brazil from 2007 to 2015. This was an ecological study, in which thematic maps were created through geoprocessing tools, based on secondary data obtained from open-access platforms, to identify priority areas for interventions for controlling HLV/HIV coinfection, using the TerraView 4.2.2 software. RESULTS: We found spatial autocorrelations between the HVL/HIV rates of neighboring municipalities according to the global Moran index (0.10; p<0.01). The highest HVL/HIV rate was in the central-western region. Among the epidemiological characteristics according to the regions, an increasing trend in the annual variation rate was observed, with positive values over the years and statistical significance (p<0.05) in the North with 1.62 (95% CI 0.57 to 2.69; p=0.02) and Northeast with 6.41 (95% CI 2.60 to 10.37; p=0.006). Similarly, increasing trends were observed in the states of Maranhão with 21.34 (95% CI 13.99 to 9.16; p<0.001) and Sergipe with 5.44 (95% CI 0.61 to 10.50; p=0.04). CONCLUSIONS: Our results showed spatial overlap between occurrences of HVL and HIV with spatial patterns of HVL/HIV coinfection, thus revealing that the numbers of cases reported are increasing. Identifying areas with higher coinfection indices contributes to applying interventions and control measures among targeted populations, to prevent new cases.

Serum Levels of Ficolin-3 and Mannose-Binding Lectin in Patients with Leprosy and Their Family Contacts in a Hyperendemic Region in Northeastern Brazil.

The present study aimed at analyzing the serum levels of mannose-binding lectin (MBL) and ficolin-3 (FCN3) in leprosy patients and their healthy family contacts in a hyperendemic region in northeastern Brazil. A cross-sectional study was carried out with 90 patients who had been diagnosed with leprosy and 79 healthy family contacts. Serum levels of the MBL and FCN3 proteins were measured using the immunofluorometric assay (ELISA). Clinical information was determined from the patients' charts. It was observed that the leprosy patients were more likely to be male (OR = 2.17; p = 0.01) and younger than fifteen years of age (OR = 2.01; p = 0.03) when compared to the family contacts. Those under 15 years of age had higher levels of MBL (4455 ng/mL) than those over 15 years of age (2342 ng/mL; p = 0.018). Higher FCN3 levels were identified in patients with indeterminate leprosy (41.9 µg/mL) compared to those with the lepromatous form (34.3 µg/mL; p = 0.033) and in those with no physical disabilities (38.1 µg/mL) compared to those with some disability (p = 0.031). Higher FCN3 levels were also observed in the group of patients without leprosy reactions (37.4 µg/mL) compared to those with type 1 (33.7 µg/mL) and type 2 (36.1 µg/mL) reactions. The MBL levels were higher in children under 15 years of age than they were in adults. It was evidenced that higher FCN3 serum levels were associated with early and transient clinical forms and lower expression in severe forms of leprosy.

Leprosy in the context of the Family Health Strategy in an endemic scenario in Maranhão: prevalence and associated factors. / Hanseníase no contexto da Estratégia Saúde da Família em cenário endêmico do Maranhão: prevalência e fatores associados.

This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.

Este estudo objetivou descrever a prevalência da hanseníase e verificar os fatores associados às formas clínicas multibacilares em cenário da Estratégia Saúde da Família, prioritário para o controle e a vigilância da doença no nordeste brasileiro. Trata-se de estudo transversal, que utilizou dados do Sistema de Informação de Agravos de Notificação relativos aos casos de hanseníase notificados em Imperatriz, Maranhão, entre 2008 e 2017. Determinaram-se as prevalências a cada ano e para o período. Para associar as variáveis e as formas clínicas multibacilares, utilizaram-se modelos de regressão de Poisson, com nível de significância de 5%. Dos 2.476 casos de hanseníase analisados, a maioria referiu-se às formas clínicas multibacilares. A prevalência variou entre 15,6 e 7,8/10 mil habitantes, encontrando-se níveis alto e muito alto de endemicidade. As variáveis sexo masculino, faixas etárias entre 30 e 59 anos e ≥60 anos, escolaridade <8 anos, grau 2 de incapacidade física, episódio reacional tipos 1 e 2 e zona de residência urbana apresentaram associações significativas (p≤0,05) com as formas clínicas multibacilares. Tais achados podem servir de base para elaboração e implementação de medidas de controle e vigilância da hanseníase, direcionando as ações para os grupos mais vulneráveis e tornando-se mais efetivas.

Hanseníase no contexto da estratégia saúde da família em cenário endêmico do maranhão: prevalência e fatores associados / Leprosy in the context of the family health strategy in an endemic scenario in maranhão: prevalence and associated factors

Resumo Este estudo objetivou descrever a prevalência da hanseníase e verificar os fatores associados às formas clínicas multibacilares em cenário da Estratégia Saúde da Família, prioritário para o controle e a vigilância da doença no nordeste brasileiro. Trata-se de estudo transversal, que utilizou dados do Sistema de Informação de Agravos de Notificação relativos aos casos de hanseníase notificados em Imperatriz, Maranhão, entre 2008 e 2017. Determinaram-se as prevalências a cada ano e para o período. Para associar as variáveis e as formas clínicas multibacilares, utilizaram-se modelos de regressão de Poisson, com nível de significância de 5%. Dos 2.476 casos de hanseníase analisados, a maioria referiu-se às formas clínicas multibacilares. A prevalência variou entre 15,6 e 7,8/10 mil habitantes, encontrando-se níveis alto e muito alto de endemicidade. As variáveis sexo masculino, faixas etárias entre 30 e 59 anos e ≥60 anos, escolaridade <8 anos, grau 2 de incapacidade física, episódio reacional tipos 1 e 2 e zona de residência urbana apresentaram associações significativas (p≤0,05) com as formas clínicas multibacilares. Tais achados podem servir de base para elaboração e implementação de medidas de controle e vigilância da hanseníase, direcionando as ações para os grupos mais vulneráveis e tornando-se mais efetivas.

Abstract This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.

Histórico familiar de câncer gástrico em pacientes dispépticos indicados à triagem endoscópica / Antecedentes familiares de cáncer gástrico en pacientes dispépticos derivados a triaje endoscópico / Family history of gastric cancer in dyspeptic patients referred for endoscopic screening

Resumo Objetivo Identificar o histórico familiar de primeiro grau de câncer gástrico em pacientes com sintomas dispépticos atendidos em um serviço público de endoscopia. Métodos Estudo transversal, realizado com pacientes dispépticos que tinham indicação para realizar o exame de endoscopia digestiva alta. A associação entre o histórico familiar de câncer gástrico e os resultados do exame endoscópico foi verificada por meio dos testes de Qui-quadrado ou Fisher, e medida seu efeito por meio da razão de chance e intervalo de confiança em analises uni e multivariadas. Utilizou-se regressão logística na análise dos dados. Resultados Observou-se que dos 751 pacientes dispépticos investigados, 44 (5,9%) possuíam histórico familiar de câncer gástrico, destes a maioria era do sexo feminino (70,5%), com idade maior ou igual a 45 anos (56,8%). Os pacientes com histórico familiar de câncer gástrico tinham maiores chances de não apresentarem diagnostico endoscópico de úlcera péptica (p=0,05; RC=2,33; IC=0,99-5,48). Além de maiores chances de alterações na mucosa gástrica (p=0,05; RC=1,06; IC=1,04-1,08) e infecção pela Helicobacter pylori (p=0,04; RC=1,79; IC=0,94-3,39) mesmo após ajustes nas análises. Conclusão A alteração endoscópica da mucosa gástrica e a infecção pela Helicobacter pylori em pacientes com sintomas dispépticos, mostraram associação independente com o histórico familiar de câncer gástrico. Diante disso, faz-se necessário a elaboração de protocolos de assistência à saúde para melhor investigação e vigilância dos familiares de câncer gástrico, bem como ações de educação em saúde para orientar os pacientes a respeito do rastreio e prevenção do câncer gástrico.

Resumen Objetivo Identificar los antecedentes familiares de primer grado de cáncer gástrico en pacientes con síntomas dispépticos atendidos en un servicio público de endoscopía. Métodos Estudio transversal llevado a cabo con pacientes dispépticos que habían sido derivados a realizar un estudio de endoscopía digestiva alta. La relación entre los antecedentes familiares de cáncer gástrico y los resultados del estudio endoscópico fue verificada mediante la prueba χ2 de Pearson o de Fisher, y su efecto fue medido a través de la razón de momios y del intervalo de confianza en análisis uni y multivariados. Se utilizó la regresión logística en el análisis de los datos. Resultados Se observó que de los 751 pacientes dispépticos investigados, 44 (5,9 %) tenían antecedentes familiares de cáncer gástrico, de los cuales la mayoría era de sexo femenino (70,5 %), de 45 años o más (56,8 %). Los pacientes con antecedentes familiares de cáncer gástrico tenían mayores chances de no presentar diagnóstico endoscópico de úlcera péptica (p=0,05; RC=2,33; IC=0,99-5,48). Además de mayores probabilidades de alteraciones en la mucosa gástrica (p=0,05; RC=1,06; IC=1,04-1,08) e infección por Helicobacter pylori (p=0,04; RC=1,79; IC=0,94-3,39), inclusive después de ajustes en los análisis. Conclusión La alteración endoscópica de la mucosa gástrica y la infección por Helicobacter pylori en pacientes con síntomas dispépticos mostraron relación independiente con los antecedentes familiares de cáncer gástrico. Ante este escenario, es necesaria la elaboración de protocolos de atención a la salud para una mejor investigación y observación de los familiares de cáncer gástrico, así como también acciones de educación en salud para orientar a los pacientes sobre la detección y prevención del cáncer gástrico.

Abstract Objective To identify first-degree relative history of gastric cancer in patients with dyspeptic symptoms receiving care at a public endoscopy service. Methods A cross-sectional study, performed with dyspeptic patients referred for an upper gastrointestinal endoscopy. The association between the family history of gastric cancer and the findings of the endoscopic examination was verified using the Chi-square or Fisher tests, and its effect was shown using odds ratio and confidence interval in univariate and multivariate analyses. Logistic regression was used to analyze the data. Results Among the 751 dyspeptic patients enrolled, 44 (5.9%) had a family history of gastric cancer, mostly females (70.5%) aged 45 years or older (56.8%). Patients with a family history of gastric cancer were more likely to have no endoscopic diagnosis of peptic ulcer (p=0.05; OR=2.33; CI=0.99-5.48). In addition, higher chances of gastric mucosal changes (p=0.05; RC=1.06; CI=1.04-1.08) and Helicobacter pylori infection (p=0.04; RC=1.79; CI=0.94-3.39) were found, even after adjusting the analyses. Conclusion The endoscopic gastric mucosal changes and Helicobacter pylori infection in patients with dyspeptic symptoms showed an independent association with family history of gastric cancer. Therefore, it is necessary to develop health care protocols for better investigation and surveillance of gastric cancer relatives, as well as health education actions to guide patients regarding screening and prevention of gastric cancer.

Factors Associated with Multibacillary Leprosy in a Priority Region for Disease Control in Northeastern Brazil: A Retrospective Observational Study.

BACKGROUND: Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. OBJECTIVE: To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. METHOD: This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. RESULTS: From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). CONCLUSION: Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.

Atividade sexual na lesão medular: construção e validação de cartilha educativa / Actividad sexual en la lesión medular: construcción y validación de libreta educativa / Sexual activity of people with spinal cord injury: development and validation of an educational booklet

Resumo Objetivo Descrever o processo de construção e validação de uma cartilha educativa sobre atividade sexual de pessoas com lesão medular. Métodos Estudo metodológico em quatro etapas: pesquisa documental em blogs, revisão integrativa, construção da cartilha educativa, validação de conteúdo com 11 juízes, validação de aparência técnica com 3 juízes e validação de aparência com 37 pessoas do público-alvo. Considerou-se o Índice de Validade de Conteúdo (IVC) mínimo de 0,80. Resultados A cartilha apresentou IVC global de 0,91 pelos juízes profissionais de saúde; 0,87 pelos juízes designers gráficos; e 0,94 na validação de aparência pelo público-alvo. Entretanto, os juízes e público-alvo propuseram sugestões de melhorias da cartilha, que foram acatadas e modificadas para versão final do material. Conclusão A cartilha apresentou conteúdo e aparência adequados para promoção da atividade sexual saudável e satisfatória da pessoa com lesão medular.

Resumen Objetivo Describir el proceso de construcción y validación de una libreta educativa sobre actividad sexual de personas con lesión medular. Métodos Estudio metodológico en cuatro etapas: investigación documental en blogs, revisión integrativa, construcción de la cartilla educativa, validación de contenido con 11 expertos, validación de apariencia técnica con 3 expertos y validación de apariencia con 37 personas del público objetivo. Se consideró un Índice de Validez de Contenido (IVC) mínimo de 0,80. Resultados La libreta obtuvo IVC global de 0,91 de los jueces profesionales de salud; 0,87 de los jueces diseñadores gráficos; y 0,94 en validación de apariencia del público objetivo. Expertos y público objetivo sugirieron mejoras en la libreta, acatadas y aplicadas para la versión final del material. Conclusión La libreta presentó contenido y apariencia adecuados para promoción de actividad sexual saludable y satisfactoria en portadores de lesión medular.

Abstract Objective To describe the process of development and validation of an educational booklet about the sexual activity of people with spinal cord injury. Methods Methodological study performed in four steps: documentary search in blogs, integrative review, development of the educational booklet, and face and content validation, namely content validation with 11 referees, technical face validation with three referees, and face validation with 37 people from the target audience. The minimum value established for the content validity index (CVI) was 0.80. Results The booklet presented a global CVI of 0.91 after evaluation by healthcare professionals, 0.87 after inspection by graphic designers, and 0.94 after examination by members of the target audience. Despite the significantly high indexes, referees and people from the target audience proposed suggestions to improve the booklet, which were accepted and incorporated into the final version of the material. Conclusion The booklet showed content and face adequate to promote healthy and satisfactory sexual activity of people with spinal cord injury.

The effect of flour from the rind of the yellow passion fruit on glycemic control of people with diabetes mellitus type 2: a randomized clinical trial.

BACKGROUND: The single or combined use of herbal and dietary products with medications has shown benefits in the metabolic modulation of carbohydrates, in the restoring of the function of pancreatic beta cells, and in insulin resistance. To analyze the effect of the use of flour made from the rind of the yellow passion fruit on the glycemic control of people with diabetes mellitus type 2. METHODS: An open, prospective, randomized clinical trial was undertaken with 54 participants over an eight-week period. The participants from the case group were advised to ingest 12 g of the flour, three times daily; before breakfast, lunch and dinner. RESULTS: After eight weeks of use of the flour made from the rind of the yellow passion fruit, we did not identify significant statistical differences in the values for capillary blood glucose (p = 0.562), fasting blood glucose (p = 0.268) or glycated hemoglobin (p = 0.229) between the study groups. In the case group, we identified an increase (29.6%-37%) of the people with normal HbA1c; however, this did not have statistical relevance (p = 0.274). DISCUSSION: Based in our findings, we believe it is important to extend the time of exposure to the intervention and increase the rigor in the monitoring of adherence in future studies on this topic. Only in this way will we be able to make confident inferences in relation to the use of flour made from the rind of theyellow passion fruit as a therapeutic tool for glycemic and/or metabolic control in persons with DM 2. CONCLUSIONS: In the sample in question, the use of the flour made from the rind of the yellow passion fruit, over an eight-week period, did not improve the glycemic control of people with type 2 diabetes. Trial registration: U1111.1187.3616. Registered 6 September, retrospectively registered, in the Brazilian Clinical Trials Registry.

Fatores influenciadores do conhecimento dos estudantes de enfermagem sobre hanseníase: estudo transversal / Factors influencing nursing students' knowledge about hansen's disease: a cross-section study

Aim: to identify the factors that influence Nursing students' knowledge about Hansen's disease. Method: this is a cross-section study with a quantitative approach, performed from May to June 2016. The sample was composed by 167 Nursing students of a public university located in the Northeastern region of Brazil. Result: the majority of students knows the main aspects of the disease. Factors such as being single, not having another occupation or income, to live with few other people, and search for information with professor were associated to a higher level of understanding about leprosy. Female students demonstrated less chances to know about Hansen's disease. Conclusion: Nursing students know about leprosy, however there are still questions regarding the transmission of the illness.(AU)

Objetivo: identificar os fatores que influenciam o conhecimento de estudantes de Enfermagem sobre hanseníase. Método: estudo transversal, com abordagem quantitativa, realizado no período de maio a junho de 2016. A amostra foi constituída por 167 estudantes de Enfermagem de uma universidade pública do Nordeste do Brasil. Resultado: a maioria dos estudantes conhece os principais aspectos da doença. Fatores como ser solteiro, não possuir outra ocupação nem atividade remunerada, morar com poucas pessoas e buscar informações com os professores estavam associados ao maior conhecimento sobre hanseníase. Estudantes do sexo feminino demonstraram menores chances de conhecer a doença. Conclusão: os estudantes de Enfermagem possuem conhecimento sobre hanseníase, porém ainda existem dúvidas quanto ao modo de transmissão da doença.(AU)

Incidência de hanseníase em menores de 15 anos acompanhados no Município de Imperatriz, Maranhão, entre 2004 e 2010 / Incidence of leprosy in patients aged 15 or younger cared in the Municipality of Imperatriz, Maranhão, between 2004 and 2010

Objetivou-se estimar a incidência global e em casos índices de hanseníase e traçar o perfil sócio demográfico em menores de 15 anos no município de Imperatriz, Maranhão. Realizou-se um estudo longitudinal retrospectivo dos casos de hanseníase no município, utilizando-se dados obtidos das notificações do agravo junto ao SINAN NET. A população do estudo compreendeu 284 casos novos notificados no período entre 2004 e 2010. A análise dos dados utilizou os testes Qui-quadrado de Pearson ou o Exato de Fischer. Evidenciou-se elevados coeficientes de detecção no ano de 2005 (83,38/ 100.000 hab.), incapacidade física no diagnóstico em 2004 (39,62%.) e de contatos examinados (24,44%). Houve predomínio de casos no sexo masculino (51,06%), cor parda (55,65%), faixa etária de 10­14 anos (60,22%) e com escolaridade média de 6­11 anos (59,8%). A maioria das formas clínicas notificadas foi do tipo indeterminada (40,13 %), tendo como predominante o grau de incapacidade física II (21,1 %). Não foram estatisticamente significantes as diferenças proporcionais entre as formas clínicas (p-valor=0,056); ao passo que a escolaridade apresentou associação significativa (p<0,0001) com a ocorrência da doença entre menores de 15 anos de idade. Conclui-se que a hanseníase continua uma doença de fácil disseminação, considerando a frequência de casos novos.

The purpose of this study was to estimate the global incidence and cases indexes of leprosy and to design the socio-demographic profile in children under 15 years of age in the municipality of Imperatriz, in the state of Maranhão, Brazil. A longitudinal retrospective study of leprosy cases in the municipality was performed, using information generated by the disease reports in SINAN NET. Data collection included 284 patients reported from 2004 to 2010, classified as new cases. Data analysis used Pearson's Chi-square test or Fisher's exact test. There were high detection coefficients in 2005 (83.38/100.000 inhabitants), physical incapacity in the diagnosis in 2004 (39.62%) and in examined contacts (24.44%). There was a predominance of male (51.06%), brown color (55.65%), aged between 10-14 years (60.22%), and average schooling of 6-11 years (59.8%). Most of the clinical forms reported were of the indeterminate type (40.13%), with predominance of physical incapacity degree II (21.1%). The proportional differences between the clinical forms (p-value = 0.056) were not statistically significant, while schooling presented a significant association (p <0.0001) with the occurrence of the disease among children under 15 years of age. It can be concluded that leprosy remains a disease with easy spread when considering the rate of new cases.

Fatores que influenciam na qualidade de vida dos agentes comunitários de saúde / Factors that influence the quality of life of community health workers

Resumo Objetivo Investigar a qualidade de vida dos Agentes Comunitários de Saúde e associar os resultados às variáveis socioeconômicas. Métodos Estudo transversal realizado com 153 Agentes Comunitários de Saúde da Região Nordeste brasileira atuantes em dezembro de 2014. Utilizou-se instrumento autoaplicável composto pelo perfil sociodemográfico e o questionário 36-Item Short Form Health Survey (SF-36). Para determinar os domínios do SF-36, utilizaram-se média e desvio padrão e aplicou-se teste de Mann-Whitney, com nível de significância de 0,05. Resultados A maioria dos agentes eram mulheres (80,4%), com idade de 42 anos (±8,01); 64,1% trabalhavam na função há no mínimo 10 anos. Os domínios Dor e Estado Geral de Saúde foram os mais comprometidos. No primeiro domínio, os baixos índices das médias estavam associados a mulheres com mais de quarenta anos de idade, menos de doze anos de estudo e mais de dez anos de trabalho como Agente Comunitário de Saúde. No segundo menores índices foram associados também a mulheres, que moravam com mais de quatro pessoas no domicilio. Conclusão Detectou-se prejuízo na qualidade de vida dos Agentes Comunitários de Saúde, demonstrando baixas médias nos domínios investigados, com menores escores nos domínios Dor e Estado Geral de Saúde. Vários fatores socioeconômicos interferiram na saúde e qualidade de vida dos agentes, como sexo feminino, idade acima de 40 anos, baixa escolaridade, maior composição familiar e maior tempo de trabalho.

Abstract Objective To investigate the quality of life of community health workers and associate the results with socioeconomic variables. Methods Cross-sectional study conducted with 153 Community Health Workers of the Brazilian Northeast region active workers in December 2014. We used self-report instrument composed of sociodemographic profile and the 36-Item Short Form Health Survey (SF-36) questionnaire. To determine the domains of the SF-36, mean and standard deviation, the Mann-Whitney test was used, with a 0.05 significance level. Results Most agents were women (80.4%) aged 42 years (±8.01); 64.1% who worked in that position for at least 10 years. The Bodily Pain and General Health Perception domains were the most affected ones. In the first domain, the low rates of means were associated with women over forty years old, less than twelve years of study and more than ten years as a Community Health Worker. In the second domain, the lowest mean levels were associated with women living with more than four people in the household. Conclusion We detected a loss in quality of life of community health workers, demonstrating low means in the investigated areas, with lower scores for Pain and General Health Perceptions. Several socioeconomic factors interfere with the health and quality of life of workers, as being female, aged over 40, low education level, higher family composition and greater working time.

Fatores associados ao uso de preservativo em pessoas vivendo com HIV/AIDS / Factors associated with condom use in people living with HIV/AIDS

Objetivo Identificar o uso de preservativo em pessoas que vivem com HIV/AIDS atendidas em um Serviço de Assistência Especializado em DST/HIV/AIDS e associá-los a variáveis sociodemograficas e comportamentais. Métodos Estudo transversal, realizado com 300 pessoas vivendo com HIV/AIDS com idade entre 18 e 66 anos. O teste t Student foi utilizado para comparação entre os grupos. A associação entre o uso de preservativo e os fatores sociodemograficos e comportamentais foi verificada por meio dos testes de correlação de Pearson e medida seu efeito por meio da razão de chance. Resultados Observou-se que 79,3% dos participantes relataram o uso do preservativo nas relações sexuais. Os solteiros tinham menor chance de usarem o preservativo que os casados. E não revelar a sorologia HIV positiva para o parceiro, aumenta as chances de usar o preservativo. Conclusão O uso do preservativo é uma prática frequente entre as pessoas que vivem com HIV/AIDS, mesmo quando não revelam a sorologia positiva aos parceiros, porém uma parcela significativa de pessoas solteiras têm práticas sexuais desprotegidas.

Objective Identify condom use in people living with HIV/AIS attended at a Specialized Care Service in STD/HIV/AIDS and associate it with sociodemographic and behavioral variables. Methods Cross-sectional study, involving 300 people living with HIV/AIDS between 18 and 66 years of age. Student’s t-test was used for intergroup comparison. The association between condom use and the sociodemographic and behavioral factors was verified using Pearson’s correlation tests and its effect was measured through the odds ratio. Results It was observed that 79.3% of the participants reported using condoms in sexual relations. Single people had less chance of using condoms than married women. And not revealing the HIV positive status to the partner increases the chances of using the condom. Conclusion Condom use is frequent among people living with HIV/AIDS, even when they do not reveal the positive serum status to their partners, but a significant part of the single people have unprotected sexual practices.

Assistência de enfermagem no pós-operatório imediato: estudo transversal / Nursing care in the immediate postoperative period: a cross-sectional study / Cuidados de enfermería en el post-operatorio inmediato: estudio transversal

PROBLEMA: A assistência de enfermagem no pós-operatório imediato requer atenção e um atendimento sistematizado a fim de prevenir complicações. OBJETIVO: Caracterizar a assistência de prestada ao paciente no pós-operatório imediato; identificar os cuidados oferecidos pelo enfermeiro ao paciente e correlacionar as dificuldades dos enfermeiros com utilização da Sistematização da Assistência de Enfermagem. MÉTODO: Trata-se de um estudo transversal com abordagem quantitativa, realizado no período de maio e junho de 2013 em um Hospital de Urgência e Emergência de Fortaleza/CE. A amostra foi constituída de 13 enfermeiros que atuam na sala de recuperação pós-anestésica. RESULTADO: Observou-se a predominância do cuidado com o sistema respiratório e cardiovascular. Houve associação entre a grande demanda de pacientes e a não utilização da Sistematização da Assistência de Enfermagem. CONCLUSÃO: Os cuidados não são ofertados de forma integral e os enfermeiros possuem dificuldades na utilização da Sistematização da Assistência de Enfermagem.

PROBLEM: Nursing care requires attention and systematized care in the immediate postoperative period in order to prevent complications. AIM: To characterize the care provided to patients in the immediate postoperative period; to identify the care offered by nurses to patients and correlate the difficulties of nurses in terms of the use of nursing care systematization. METHOD: This was a cross-sectional study that used a quantitative approach, conducted between May and June 2013 in an Emergency Hospital in Fortaleza, Ceará, Brazil. The sample consisted of 13 nurses working in the post-anaesthetic recovery room. RESULT: There was a predominance of care directed to the respiratory and cardiovascular system. There was an association between the large number of patients and the non-use of nursing care systematization. CONCLUSION: Care is not fully offered and nurses have difficulties in using nursing care systematization.

PROBLEMA: El cuidado de enfermería en el post-operatorio inmediato requiere una atención y un atendimiento sistematizado para prevenir complicaciones. OBJETIVO: Caracterizar el cuidado ofrecido al paciente en el post-operatorio inmediato; identificar los cuidados que el enfermero le da al paciente y correlacionar las dificultades de los enfermeros con la utilización de la Sistematización de la Asistencia de Enfermería. MÉTODO: Se trata de un estudio transversal con abordaje cuantitativo, realizado en el período de mayo y junio de 2013 en un Hospital de Urgencia y Emergencia de Fortaleza/CE. La muestra fue constituida por 13 enfermeros que actúan en la sala de recuperación post-anestésica. RESULTADO: Se observó la predominancia del cuidado con el sistema respiratorio y cardiovascular. Hubo una asociación entre la gran demanda de pacientes y la no utilización de la Sistematización de la Asistencia de Enfermería. CONCLUSIÓN: Los cuidados no son ofrecidos de forma integral y los enfermeros tienen dificultades para utilizar la Sistematización de la Asistencia de Enfermería.