Centros de Salud y Acción Comunitaria: Estado de situación de los CeSACs dependientes del Ministerio de Salud del GCBA en el contexto de la pandemia de Covid-19

A partir de la declaración de la Emergencia Sanitaria, a nivel nacional y jurisdiccional, motivada en la pandemia por CoVID- 19, el funcionamiento del sistema de salud de la Ciudad se ha visto sensiblemente modificado. El establecimiento de protocolos, dictados por las autoridades ejecutivas de la Ciudad ha implicado cambios profundos en el funcionamiento cotidiano y la atención que brindan las instituciones de salud, la labor de los/as trabajadores/as y la concurrencia de pacientes, además de pautas de cuidados y permisos de circulación para ambas poblaciones, en el contexto de la cuarentena preventiva y obligatoria. A propósito de esta situación sin precedentes, es interés de esta Defensoría del Pueblo conocer el impacto que ésta pueda producir en cuanto a la afectación de los derechos de la población que recibe atención en los efectores de salud (hospitales, centros de salud), como así también en relación a las condiciones en las cuales los/as trabajadores/as de la salud desarrollan su tarea. Con esta motivación, entre el 13 y el 17 de abril, se realizó un relevamiento en los Centros de Salud y Acción Comunitaria (CeSAC), dependientes del Ministerio de Salud del GCBA. El trabajo estuvo a cargo de integrantes de la Coordinación Operativa de Salud y de la Conducción Ejecutiva de Derechos Sociales. El mismo fue telefónico y se entrevistó al personal directivo o a cargo. El interés estuvo puesto en los siguientes ejes: o la modalidad de funcionamiento y atención en el efector, o el acceso de la población a la atención integral de su salud, o condiciones seguras de trabajo para el personal, o provisión de insumos, vacunas y medicamentos, o protocolo ante casos sospechosos de CoVID-19, o situación relativa a dengue, o requerimiento o preocupaciones sobre la situación del CeSAC.

Prevalence of Sexually Transmitted Infections and Risk Factors Among Young People in a Public Health Center in Brazil: A Cross-Sectional Study.

INTRODUCTION: Sexually transmitted infections (STI) significantly affect the health of sexually active people, especially young people, and can cause low sexual dysfunction, low self-esteem, infertility, increased transmission of HIV, and death. METHODS: We reviewed the medical records of a cross-section of users of a public health services center and verified the prevalence of STI and its associated predictors for male and female individuals 13-24 years of age in an interior county of southern Brazil. RESULTS: The records of 1703 adolescents and young adults, stratified by age (13-18 and 19-24 years, respectively) and sex, admitted between April 1, 2012, and March 31, 2017, were reviewed in this retrospective study. Epidemiological, clinical, and laboratory data of medical records were analyzed using the chi-square test and odds ratio, with confidence interval of 95% by the Stata® 9.0 program. During the study period, a total of 3448 patients were attended to; of these, 1703 (49.39%) were 13-24 years of age, with 86.56% of those 19-24 years having at least 1 STI. The prevalence of STI among men and women, respectively, was 35.40% and 47.67% for condylomata, 8.46% and 7.00% for herpes, 26.35% and 18.80% for syphilis, and 20.06% and 6.27% for urethral discharge syndrome. The risk for STI acquisition was the highest in young adults (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.17-2.06, P = .002), female individuals (OR 1.51, 95% CI 1.14-2.00, P = .004), those with multiple sexual partners (OR 1.62, 95% CI 1.22-2.16, P < .001), and those not using or irregularly using prophylactics (OR 1.62, 95% CI 1.22-2.16, P < .001). CONCLUSIONS: The findings revealed a significant prevalence of STI among young people in public health service. The predictors associated with STI in these patients were being female, having multiple partners in the last year, and not using or irregularly using prophylactics. These predictors confirm the necessity to implement more aggressive strategies to prevent the occurrence of STI in specific populations with higher disease risk, thereby minimizing costs and damage caused by the infections.

Salud

Cobertura de atención de salud de la población; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud y acción comunitaria; y datos de atención social a niños, niñas y adolescentes

Salud

Tipo de cobertura de la atención medica de la población de la Ciudad de Buenos Aires, gráfico de la distribución de hospitales con internación y centros de salud comunitarios, y datos de la atención social a niños, niñas, y adolescentes.

Comparison of Initial Pediatric Outpatient Echocardiogram Indications between Community and Academic Practice.

OBJECTIVE: To compare the appropriateness and diagnostic yield of initial outpatient transthoracic echocardiography (TTE) between a community pediatric cardiology practice and an academic children's hospital. STUDY DESIGN: Initial outpatient pediatric TTE ordered by pediatric cardiologists between January and March 2014 at a community practice (Packard Children's Health Alliance [PCHA]; n = 238) and an academic tertiary center (Lucile Packard Children's Hospital [LPCH]; n = 76) were evaluated based on appropriate use criteria (AUC) released in December 2014. Multivariate logistic regression was used to identify predictors of "rarely appropriate" indications and abnormal TTE findings. RESULTS: Of 314 TTEs, 165 (52.5%) were classified as "appropriate," 40 (12.7%) were classified as "may be appropriate," 100 (31.9%) were classified as "rarely appropriate," and 9 (2.9%) were unclassifiable. The proportion of abnormal findings did not differ between the 2 practice settings (5.3% for LPCH vs 7.6% for PCHA; P = .61). TTEs performed at PCHA were significantly more likely to be "rarely appropriate" (OR, 2.57; 95% CI, 1.28-5.15; P = .008). Children aged <1 year (OR, 1.90; 95% CI, 1.03-3.50; P = .04) and ordering providers with <10 years since the completion of their fellowship (OR, 2.15; 95% CI, 1.20-3.87; P = .01) were associated with "rarely appropriate" indications. "Appropriate" TTEs were associated with abnormal findings (OR, 8.69; 95% CI, 1.77-42.68; P = .008). CONCLUSION: The community practice was independently associated with greater inappropriate ordering of initial outpatient pediatric TTEs compared with the academic practice. The assessment of practice patterns following AUC release should account for physician and practice-related factors that could influence differences in TTE ordering patterns.

Salud

Población por tipo de cobertura médica; distribución de hospitales con internación por tipo y especialidad, y de Centros de Salud y Acción Comunitaria, año 2017; atención social a niños, niñas y adolescentes; y Actividades deportivas en polideportivos del GCBA, de niños y adolescentes.

Prevalence of Substance Use Among Patients of Community Health Centers in East Los Angeles and Tijuana.

BACKGROUND: Given the increased use of psychoactive substances on the United States-Mexico border, a binational study (Tijuana, Mexico-Los Angeles, USA) was conducted to identify the prevalence of substance use in primary care settings. OBJECTIVES: To compare the prevalence and characteristics of patients at risk for substance use disorders in Tijuana and East Los Angeles (LA) community clinics with special attention paid to drug use. METHODS: This was an observational, cross-sectional, analytical study, comparing substance use screening results from patients in Tijuana and LA. The settings were 2 community clinics in LA and 6 in Tijuana. Participants were 2,507 adult patients in LA and 2,890 in Tijuana eligible for WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screening during March-October 2013. Patients anonymously self-administered the WHO ASSIST on a tablet PC in the clinic waiting rooms. RESULTS: Of eligible patients, 96.4% completed the ASSIST in Tijuana and 88.7% in LA (mean 1.34 minutes and 4.20 minutes, respectively). The prevalence of patients with moderate-to-high substance use was higher in LA than Tijuana for each substance: drugs 19.4% vs. 5.7%, alcohol 15.2% vs. 6.5%, tobacco 20.4% vs. 16.2%. LA patients born in Mexico had 2x the odds and LA patients born in the United States had 6x the odds of being a moderate-to-high drug user compared to Tijuana patients born in Mexico. CONCLUSIONS: Moderate-to-high drug use is higher in LA than in Tijuana but rates are sufficiently high in both to suggest that screening for drug use (along with alcohol and tobacco use) should be integrated into routine primary care of community clinics in both cities.

Salud

Población con cobertura médica, en el año 2015; distribución de hospitales con internación por tipo y especialidad; y actividades deportivas en polideportivos del GCBA de niños y adolescentes.

Dual-Routine HCV/HIV Testing: Seroprevalence and Linkage to Care in Four Community Health Centers in Philadelphia, Pennsylvania.

OBJECTIVE: Despite common risk factors, screening for hepatitis C virus (HCV) and HIV at the same time as part of routine medical care (dual-routine HCV/HIV testing) is not commonly implemented in the United States. This study examined improvements in feasibility of implementation, screening increase, and linkage to care when a dual-routine HCV/HIV testing model was integrated into routine primary care. METHODS: National Nursing Centers Consortium implemented a dual-routine HCV/HIV testing model at four community health centers in Philadelphia, Pennsylvania, on September 1, 2013. Routine HCV and opt-out HIV testing replaced the routine HCV and opt-in HIV testing model through medical assistant-led, laboratory-based testing and electronic medical record modification to prompt, track, report, and facilitate reimbursement for tests performed on uninsured individuals. This study examined testing, seropositivity, and linkage-to-care comparison data for the nine months before (December 1, 2012-August 31, 2013) and after (September 1, 2013-May 31, 2014) implementation of the dual-routine HCV/HIV testing model. RESULTS: A total of 1,526 HCV and 1,731 HIV tests were performed before, and 1,888 HCV and 3,890 HIV tests were performed after dual-routine testing implementation, resulting in a 23.7% increase in HCV tests and a 124.7% increase in HIV tests. A total of 70 currently HCV-infected and four new HIV-seropositive patients vs. 101 HCV-infected and 13 new HIV-seropositive patients were identified during these two periods, representing increases of 44.3% for HCV antibody-positive and RNA-positive tests and 225.0% for HIV-positive tests. Linkage to care increased from 27 currently infected HCV--positive and one HIV-positive patient pre-dual-routine testing to 39 HCV--positive and nine HIV-positive patients post-dual-routine testing. CONCLUSION: The dual-routine HCV/HIV testing model shows that integrating dual-routine testing in a primary care setting is possible and leads to increased HCV and HIV screening, enhanced seropositivity diagnosis, and improved linkage to care.

Racial and Ethnic Disparities among Pediatric Patients at Community Health Centers.

OBJECTIVES: To assess racial/ethnic disparities in pediatric utilization of community health centers (CHCs) among a nationally representative sample. STUDY DESIGN: Using the 2009 Health Center Patient Survey, a nationally representative sample of CHC patients, demographic characteristics, health conditions, and service utilization were examined for patients under 18 years old (n = 590). Negative binomial and logistic regression models assessed disparities in access to routine care, ambulatory service intensity, and hospital utilization. RESULTS: Racial/ethnic disparities were not present for well-child visits or dental checkups. However, disparities in ambulatory care service intensity and hospital use were observed. Compared with white children, Hispanic children had fewer CHC visits (incidence rate ratio [IRR] 0.62; 95% CI 0.41-0.95), and fewer visits to other ambulatory providers (IRR 0.30; 95% CI 0.15-0.61). Black children had fewer CHC visits (IRR 0.46; 95% CI 0.31-0.70) and fewer visits to other ambulatory providers (IRR 0.23; 95% CI 0.06-0.91), and were also less likely to have been hospitalized (OR 0.04; 95% CI 0.01-0.26). CONCLUSIONS: Study limitations included the cross-sectional study design, the self-reported data, and the age of the data. Nevertheless, this study demonstrates that there are fewer disparities among children who visit CHCs in comparison with national trends, but there is still room for improvement. Future initiatives should address remaining challenges in ensuring access to care for all children in underserved communities.

Profiles of medicinal cannabis patients attending compassion centers in rhode island.

Little is understood regarding medicinal marijuana dispensary users. We sought to characterize socio-demographics and reasons for medicinal marijuana use among medical cannabis dispensary patients in Rhode Island. Participants (n=200) were recruited from one of two Compassion Centers in Rhode Island and asked to participate in a short survey, which included assessment of pain interference using the Brief Pain Inventory (BPI). The majority of participants were male (73%), Caucasian (80%), college educated (68%), and had health insurance (89%). The most common reason for medicinal marijuana use was determined to be chronic pain management. Participants were more likely to have BPI pain interference scores of > 5 if they were older (OR: 1.36, 95% CI: 1.04-1.78) or reported using cannabis as a substitute for prescription medications (OR: 2.47, 95% CI: 1.23-4.95), and were less likely to have interference scores of >5 if they had higher income levels (OR: 0.53, 95% CI: 0.40-0.70) or reported having ever received treatment for an alcohol use disorder. One-fifth of participants had a history of a drug or alcohol use disorder. Most participants report that medicinal cannabis improves their pain symptomology, and are interested in alternative treatment options to opioid-based treatment regimens.

[Epidemiology of pediatric respiratory consultations in Santiago de Chile, from 1993 to 2009]. / Epidemiología de las consultas pediátricas respiratorias en Santiago de Chile desde 1993 a 2009.

OBJECTIVE: This paper describes the analytical methodology and overall distribution of these consultations-particularly respiratory consultations-for children under 15 years of age in Santiago de Chile, Chile. The aim is to understand differences by age groups, as well as seasonal trends and trends over the years. METHODS: The research covered the distribution of consultations and their evolution over a period of 17 years. Information was collected on a daily basis from all pediatric consultations, grouped into nonrespiratory and acute respiratory categories, in seven sentinel centers of Santiago de Chile. RESULTS: Between January 1993 and December 2009, 1 947 477 cases of pediatric illnesses were recorded, of which 1 188 029 (61.0%) were for respiratory causes. Of those, 656 567 (33.7%) were for acute lower respiratory tract illnesses, 418 932 (21.5%) were for broncho-obstructive syndrome, and 48 669 (2.5%) were for pneumonia. Pneumonia and broncho-obstructive syndrome were more frequent in children under age 5. Lower respiratory tract illnesses, broncho-obstructive syndrome, and pneumonia showed a significant downward trend during the period observed. Lower respiratory tract illnesses are the leading cause of pediatric morbidity in primary health care, while broncho-obstructive syndrome is the leading specific reason for pediatric consultations. CONCLUSIONS: These results point to the need to allocate or reallocate resources for programs for promotion, education, prevention, and treatment of these illnesses with the targeting necessary to address seasonal variations.

Epidemiología de las consultas pediátricas respiratorias en Santiago de Chile desde 1993 a 2009 / Epidemiology of pediatric respiratory consultations in Santiago de Chile, from 1993 to 2009

OBJETIVO: El presente trabajo se propone describir la metodología de análisis y la distribución global de las consultas de morbilidad -particularmente las de tipo respiratorio- en menores de 15 años de edad de la ciudad Santiago de Chile, Chile, con el objetivo de conocer sus diferencias según grupos etarios, su comportamiento estacional y su evolución a lo largo de los años. MÉTODOS: Se investigó la distribución de las consultas de morbilidad pediátrica (CP) -en especial las respiratorias- y su evolución en un período de 17 años. En siete centros centinela de Santiago de Chile se recolectó prospectivamente información diaria de todas las CP, agrupadas en infecciones no respiratorias e infecciones respiratorias agudas (IRA). RESULTADOS: Entre enero de 1993 y diciembre de 2009 se registraron 1 947 477 CP, de las cuales 1 188 029 (61,0%) fueron por causa respiratoria: 656 567 (33,7%) por enfermedad respiratoria aguda de vía aérea baja (IRAb), 418 932 (21,5%) por síndrome bronquial obstructivo (SBO) y 48 669 (2,5%) por neumonía. Neumonía y SBO fueron más frecuentes en menores de 5 años. Las IRAb, SBO y neumonía presentaron una significativa tendencia a la disminución durante el período observado. Las IRA constituyen la primera causa de CP en atención primaria de salud y el SBO es la primera causa específica de consulta pediátrica. CONCLUSIONES: Estos resultados enfatizan la necesidad de asignar o redestinar recursos en programas de promoción, educación, prevención y tratamiento de estas enfermedades, con la debida focalización que determina su variación estacional.

OBJECTIVE: This paper describes the analytical methodology and overall distribution of these consultations-particularly respiratory consultations-for children under 15 years of age in Santiago de Chile, Chile. The aim is to understand differences by age groups, as well as seasonal trends and trends over the years. METHODS: The research covered the distribution of consultations and their evolution over a period of 17 years. Information was collected on a daily basis from all pediatric consultations, grouped into nonrespiratory and acute respiratory categories, in seven sentinel centers of Santiago de Chile. RESULTS: Between January 1993 and December 2009, 1 947 477 cases of pediatric illnesses were recorded, of which 1 188 029 (61.0%) were for respiratory causes. Of those, 656 567 (33.7%) were for acute lower respiratory tract illnesses, 418 932 (21.5%) were for broncho-obstructive syndrome, and 48 669 (2.5%) were for pneumonia. Pneumonia and broncho-obstructive syndrome were more frequent in children under age 5. Lower respiratory tract illnesses, broncho-obstructive syndrome, and pneumonia showed a significant downward trend during the period observed. Lower respiratory tract illnesses are the leading cause of pediatric morbidity in primary health care, while broncho-obstructive syndrome is the leading specific reason for pediatric consultations. CONCLUSIONS: These results point to the need to allocate or reallocate resources for programs for promotion, education, prevention, and treatment of these illnesses with the targeting necessary to address seasonal variations.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infection in men attending STD clinics in Brazil.

INTRODUCTION: The study aimed to assess the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and identify demographic, behavioral and clinical factors correlated with such infections in men attending six sexually transmitted disease clinics in Brazil. METHODS: Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing for NG and CT by DNA-PCR. RESULTS: A total of 767 (92.9%) men were included in the study. The mean age was 26.5 (SD 8.3) years-old. Prevalence of Chlamydia infection was 13.1% (95%CI 10.7%-15.5%) and gonorrhea was 18.4% (95%CI 15.7%-21.1%). Coinfection prevalence was 4.4% (95%CI 2.95%-5.85%) in men who sought attendance in STI clinics. Factors identified as associated with C. trachomatis were younger age (15-24) [OR=1.4 (95%CI 1.01-1.91)], present urethral discharge [OR=4.8 (95%CI 1.52-15.05)], genital warts [OR=3.0 (95%CI 1.49-5.92)] and previous history of urethral discharge [OR=2.4 (95%CI 1.11-5.18)]. Variables associated with gonorrhea were younger age (15 to 24) [OR=1.5 (95%CI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95%CI 5.53-17.79)], genital warts [OR=18.3 (95%CI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95%CI 1.06-22.73)]. CONCLUSIONS: These findings have important implications for education and prevention actions directed toward men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.

Análise do Sistema de Informação do Programa de Controle do Câncer de Mama (SISMAMA) mediante avaliação de 1.000 exames nas cidades de Barra Mansa e Volta Redonda / Analysis of the Breast Cancer Control Program Information System (SISMAMA), with review of 1,000 mammograms in the cities of Barra Mansa and Volta Redonda

OBJETIVO: Fazer uma análise do Sistema de Informação do Programa de Controle do Câncer de Mama (SIS-MAMA), implantado em 2009 pelo Ministério da Saúde. MATERIAIS E MÉTODOS: Tratou-se de um estudo retrospectivo, feito mediante análise de 1.000 fichas de requisição e resultado de mamografias realizadas pelo Sistema Único de Saúde (SUS) nos municípios participantes desta pesquisa, no período de tempo compreendido entre agosto e outubro de 2009. Foram analisados a qualidade das informações enviadas através do processamento desses dados e os desvios gerados pelo não preenchimento ou pelo inadequado preenchimento dos dados nessas fichas. RESULTADOS: O problema mais frequentemente encontrado foi a omissão de dados nas fichas, principalmente no quesito cirurgias anteriores, constatando-se 302 omissões (30,2 por cento). CONCLUSÃO: Apesar do Sistema necessitar de alguns ajustes, pelo lapso temporal transcorrido entre sua criação até sua implementação, esses ajustes não afetam diretamente a validade do Sistema, encontrando-se como principal fator de erros na alimentação do banco de dados do Ministério da Saúde o não preenchimento de informações relevantes para o fechamento dos laudos, e a falta de familiarização e capacitação dos profissionais envolvidos nesse processo e no repasse de dados do resultado da mamografia.

OBJECTIVE: To analyze the Breast Cancer Control Program Information System (SISMAMA) implemented in 2009 by the Brazilian Health Ministry. MATERIALS AND METHODS: This was a retrospective study involving the analysis of 1,000 requisition forms and results of mammograms performed by SUS - Sistema Único de Saúde (the Brazilian unified public health system) in the cities participating in the present study, during the period from August to October/2009. The study covered the qualitative analysis of the information sent through the data processing and the deviations resulting from the failure or inappropriateness in the forms filling. RESULTS: The most frequent issue was data omission, particularly regarding data on previous surgeries, achieving 302 omissions (30.2 percent). CONCLUSION: Despite the necessity of adjustments because of the time elapsed between the system creation and implementation, such adjustments do not affect directly the system's validity. Errors in data input in the Health Ministry database corresponded to the failure in the provision of information relevant for reports completion, and the lack of familiarity and capacity of professionals involved in this process and in the forwarding of data regarding mammography results.

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infection in men attending STD clinics in Brazil / Prevalência de Neisseria gonorrhoeae e infecção pela Chlamydia trachomatis em homens atendidos em clínicas de DST no Brasil

INTRODUCTION: The study aimed to assess the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and identify demographic, behavioral and clinical factors correlated withsuch infections in men attending six sexually transmitted disease clinics in Brazil. METHODS: Multicentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing for NG and CT by DNA-PCR. RESULTS: A total of 767 (92.9 percent) men were included in the study. The mean age was 26.5 (SD 8.3) years-old. Prevalence of Chlamydia infection was 13.1 percent (95 percentCI 10.7 percent-15.5 percent) and gonorrhea was 18.4 percent (95 percentCI 15.7 percent-21.1 percent). Coinfection prevalence was 4.4 percent (95 percentCI 2.95 percent-5.85 percent) in men who sought attendance in STI clinics. Factors identified as associated with C. trachomatis were younger age (15-24) [OR=1.4 (95 percentCI 1.01-1.91)], present urethral discharge [OR=4.8 (95 percentCI 1.52-15.05)], genital warts [OR=3.0 (95 percentCI 1.49-5.92)] and previous history of urethral discharge [OR=2.4 (95 percentCI 1.11-5.18)]. Variables associated with gonorrhea were younger age (15 to 24) [OR=1.5 (95 percentCI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95 percentCI 5.53-17.79)], genital warts [OR=18.3 (95 percentCI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95 percentCI 1.06-22.73)]. CONCLUSIONS: These findings have important implications for education and prevention actions directed toward men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.

INTRODUÇÃO: Nosso objetivo foi acessar a prevalência de Neisseria gonorrhoeae e Chlamydia trachomatis e identificar fatores demográficos, comportamentais e clínicos correlacionados a essas infecções em homens atendidos em clínicas de doenças sexualmente transmissíveis no Brasil. MÉTODOS: Estudo multicêntrico, transversal conduzido em homens que procuraram atendimento em clínicas de DST. O estudo incluiu clínicas de DST em seis cidades distribuídas nas cinco regiões geográficas do Brasil em 2005. Pacientes coletaram 20ml do primeiro jato de urina para testar NG e CT por DNA-PCR. RESULTADOS: Um total de 767 (92,9 por cento) homens foi incluído no estudo. A média de idade foi 26,5 (DP 8,3) anos. A prevalência de infecção por CT foi 13,1 por cento (IC95 por cento 10,7 por cento-15,5 por cento) e NG de 18,4 por cento (IC95 por cento 15,7 por cento-21,1 por cento). A prevalência de co-infecção foi 4,4 por cento (IC95 por cento 2,95 por cento-5,85 por cento). Os fatores identificados como sendo associados com a infecção pela CT foram ser jovem (15-24) [OR=1,4 (IC95 por cento 1,01-1,91)], apresentar corrimento uretral ao exame [OR=4.8 (IC95 por cento 1,52-15,05)], verrugas genitais [OR=3,0 (IC95 por cento 1,49-5,92)] e história prévia de corrimento uretral [OR=2,4 (IC95 por cento 1,11-5,18)]. As variáveis associadas com a gonorréia foram ser jovem (15 to 24) [OR=1,5 (IC95 por cento 1,09-2,05)], apresentar corrimento uretral [OR=9,9 (IC95 por cento 5,53-17,79)], verrugas genitais [OR=18,3 (IC95 por cento 8,03-41,60)] e úlcera ao exame clínico [OR=4,9 (IC95 por cento 1,06-22,73)]. CONCLUSÕES: Estes resultados têm implicações importantes para medidas de educação e prevenção direcionadas aos homens com risco acrescido de HIV/DST. A abordagem no serviço para oferecer testes de rotina para homens jovens atendidos em clínica de DST deve ser estimulada.

[Use of medicines in a Guaraní Indian village on the coast of Santa Catarina State, Brazil]. / Uso de medicamentos em uma aldeia Guaraní do litoral de Santa Catarina, Brasil.

This article analyzes the use of medicines and related perceptions among Guaraní Indians on the coast of Santa Catarina State, Brazil. The ethnographic research included participant observation, open and semi-structured interviews, and household surveys. Analyzing six months of prescriptions from 2008, 458 medicines were prescribed in 236 medical consultations, featuring cough and cold preparations, analgesics, and anti-helminthics, among drugs. In the three household surveys, analgesics and cough and cold preparations were the most frequently found in 2006 and 2007, while drugs for anemia were the most common in 2008. The Guaraní mainly used the primary healthcare services for colds, coughs, and diarrhea, and their practices also included turning to the shaman and self-care with medicines and herbal remedies, recognizing the efficacy of medicines and evaluating the treatment according to their experiences and their conceptions of the health-disease-care process. The study indicates the need for dialogue between professionals and users, linking the various forms of health knowledge.