Assessment of miscarriage factors among Latinas who live in the U.S.: a cross-sectional study.

Introduction: Latinas in the US are underrepresented in miscarriage research, yet face several risk factors for having a miscarriage, including intimate partner violence, and increasing maternal age. Increased acculturation is associated to increased risk of intimate partner violence and adverse pregnancy outcomes among Latinas yet is also understudied in the realm of miscarriage. Thus, this study aimed to analyze and compare sociodemographic characteristics, health-related factors, intimate partner violence, and acculturation among Latinas with and without a history of miscarriage. Methods: This study utilizes a cross-sectional design to analyze baseline data from a randomized clinical trial on the effectiveness of "Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/Self-care" (SEPA), a human immunodeficiency virus risk reduction intervention for Latinas. Survey interviews were conducted in a private room at the University of Miami Hospital. Survey data analyzed include demographics, a bi-dimensional acculturation scale, a health and sexual health survey, and the hurt, insult, threaten, and scream tool. This study's sample was 296 Latinas, 18 to 50 years old, with and without a history of miscarriage. Data analyses included descriptive statistics, t-tests for continuous variables, negative binomial for counts, and chi-square for dichotomous or categorical variables. Results: Most Latinas were Cuban (53%), lived in the U.S. an average of 8.4 years, had 13.7 years of education, and a monthly family income of $1,683.56. Latinas with history of miscarriage were significantly older, had more children, more pregnancies, and poorer self-rated health than Latinas without history of miscarriage. Although not significant, a high percentage of intimate partner violence (40%) and low levels of acculturation were reported. Discussion: This study contributes new data about different characteristics of Latinas who have and have not experienced a miscarriage. Results can help identify Latinas at risk for miscarriage or its adverse-related outcomes and help develop public health policies focusing on preventing and managing miscarriage among Latinas. Further research is warranted to determine the role of intimate partner violence, acculturation, and self-rated health perceptions among Latinas who experience miscarriage. Certified nurse midwives are encouraged to provide Latinas with culturally tailored education on the importance of early prenatal care for optimal pregnancy outcomes.

COVID-19 and Health Disparities: Structural Evil Unmasked.

Background: Incidence and mortality from COVID-19 are starkly elevated in poor, minority and marginalized communities. These differences reflect longstanding disparities in income, housing, air quality, preexisting health status, legal protections, and access to health care. The COVID-19 pandemic and its economic consequences have made these ancient disparities plainly visible. Methodology: As scholars in Catholic research universities committed to advancing both scientific knowledge and social justice, we examined these disparities through the lenses of both epidemiology and ethics. Findings: We see these widening disparities as not only as threats to human health, societal stability, and planetary health, but also as moral wrongs - outward manifestations of unrecognized privilege and greed. They are the concrete consequences of policies that promote structural violence and institutionalize racism. Recommendations: We encourage governments to take the following three scientific and ethical justified actions to reduce disparities, prevent future pandemics, and advance the common good: (1) Invest in public health systems; (2) Reduce economic inequities by making health care affordable to all; providing education, including early education, to all children; strengthening environmental and occupational safeguards; and creating more just tax structures; and (3) Preserve our Common Home, the small blue planet on which we all live.

Gender-Based Violence, Perspectives in Latin America and the Caribbean.

INTRODUCTION: To address the phenomenon of gender-based violence in Latin America and the Caribbean is an issue of epic proportion that reflects the unequal power dynamics created within the binary gender system and is often perpetrated by those with more physical, cultural, or social power and inflicted upon those without. METHOD: Each database was comprehensively searched for MeSH keyword combinations of gender violence (violence against women) or (gender-based violence) with the region of interest (Latin America and the Caribbean) in addition to a third word or phrase regarding health care (health care training, training, health care curricula, curricula, health care professionals). RESULTS: After completing this scope review, we have found a widespread call for more comprehensive preparation for health care professionals involved in identifying and addressing gender-based violence. CONCLUSIONS: Though some research has been conducted documenting the ways in which gender-based violence is managed or not managed by health care providers, Latin America and the Caribbean in particular represent a gap in research on health care tools and their effectiveness in these situations. There is a distinct need for the creation of context-specific protocols for vulnerable and underrepresented groups.

Determinantes sociales como factores contextuales de la obesidad: construcción de significado y valoración del estado nutricional según nivel socioeconómico

RESUMEN El objetivo fue explorar la influencia del nivel socioeconómico (NSE), como determinante estructural de la salud, sobre la construcción de significados y valor atribuidos a la obesidad. Se realizaron entrevistas semiestructuradas a usuarios de programas de obesidad de dos centros de salud, procurando diferencias en el NSE del público objetivo. A partir del análisis de contenido temático, los resultados se organizaron en cuatro categorías construidas inductivamente: 1) significado atribuido de vivir con obesidad, 2) conciencia manifiesta del impacto de la obesidad sobre la propia salud, 3) búsqueda vivida de alternativas ante la obesidad y 4) origen atribuido de la obesidad. Se observó que la obesidad, entendida como categoría médica, varió según NSE tanto en significado como en la forma en que es problematizada, tomando sentidos incluso contradictorios. El salutismo se incorporó de manera heterogénea entre distintos grupos socioeconómicos, reproduciéndose como estilo de vida. Así, el NSE, entrelazado con otros determinantes sociales estructurales de la salud, pudo influir no sólo en los resultados de salud de manera 'causal', sino también -a través de mecanismos donde participaron contextualmente- en la definición del estado de salud y en el valor atribuido a la salud. Considerar este efecto diferencial de los determinantes sociales de la salud en la obesidad, sería importante para el logro de intervenciones efectivas en salud.

ABSTRACT The objective of the study was to explore the influence of socio-economic status (SES), as a structural social determinant of health, in the construction of the meaning and value attached to obesity. To do so, we conducted semi-structured interviews with obesity care users from two health centres, targeting socio-economic differences amongst participants. Using thematic content analysis, the findings were organised into four inductively constructed categories, labelled as: 1) the meaning attached to suffering from obesity; 2) awareness of the impact of obesity on one's health; 3) the search for alternatives while being obese; 4) attributed origin of obesity. Obesity was understood as a medical category, varied in meaning as well as in the way it was problematized depending on SES, acquiring contradictory meanings. Healthism is incorporated in a heterogeneous way among different socioeconomic groups, reproduced via specific lifestyles. Thus, SES, intertwined with other structural social determinants of health, was not only a 'cause' of the outcome but also contextually in the mechanisms through which health status and the value of health were defined. Considering this differential effect of social determinants of health would be important in designing appropriate health interventions.

Strengthening universal health: development of a nursing and midwifery education quality improvement toolkit.

OBJECTIVE: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. METHODS: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. RESULTS: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. CONCLUSIONS: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.

A scoping review of sexual minority women's health in Latin America and the Caribbean.

OBJECTIVES: Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women's health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities. DESIGN: A scoping review methodology was used. DATA SOURCES: We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included. REVIEW METHODS: A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles. RESULTS: More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC. CONCLUSIONS: Significant knowledge gaps regarding sexual minority women's health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.

HIV Testing Among Heterosexual Hispanic Women in South Florida.

PURPOSE: The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women. DESIGN: This study utilizes a cross-sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. The Social Cognitive Model (SCM) guided this study. METHODS: Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression. FINDINGS: The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it. CONCLUSIONS: Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women. CLINICAL RELEVANCE: Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.

Assessment of Technology Use and Technology Preferences for HIV Prevention Among Hispanic Women.

INTRODUCTION: HIV transmission presents an ongoing risk to Hispanic women, and prevention efforts remain a priority. The use of technology to prevent HIV transmission among Hispanic women and those of lower socioeconomic status underscore the need for effective implementation of technology. The purpose of this study is to describe technology preferences and predictors of the use of the internet for HIV prevention among low-income Hispanic women. METHOD: A secondary analysis was conducted using baseline data from an intervention to prevent HIV among 320 Hispanic women. The parent study was SEPA, Salud (health), Educación (education), Promoción (promotion), y [and] Autocuidado (self-care). RESULTS: Most participants reported using personal technology, such as smartphones (90.6%), the internet (78.1%), and personal email (67.5%), every day. Most (71.3%) participants were open to learning about HIV education via the internet. In the logistic regression analysis, education and time since the last visit to the health care provider were significant predictors of the use of the internet to learn about HIV prevention, after controlling for age, living with the partner, and years living in the United States. CONCLUSION: Hispanic women demonstrated high levels of comfort with different forms of technology. These results indicated the potential to expand future HIV intervention efforts by implementing electronic dissemination of bilingual and culturally appropriate information for Hispanic women of diverse ages.

Women's and Healthcare Workers' Beliefs and Experiences Surrounding Abortion: The Case of Haiti.

PURPOSE: Women in developing countries usually encounter serious inequities in terms of women's health. To date, there is limited understanding of abortion from the perspective of Haitian women. As a limited-resource country, Haiti faces complex social issues and healthcare challenges. With abortion being illegal, many adult and teenage women seek clandestine abortions. The aim of this study was to explore and gain a greater understanding of women's and healthcare workers' beliefs and experiences about abortion in Haiti. METHODS: Descriptive qualitative design was used to elicit information for the study. Eight focus groups were conducted with Haitian women and healthcare workers in five communities in the south of Haiti: Les Cayes, Aquin, St. Louis du Sud, Cavaillon, Maniche, and Ile a Vache. Participants were purposively selected and consented to participate and to be tape recorded. Content analysis followed using the verbatim transcripts, with triangulation of four researchers; saturation was reached with this number of focus groups. FINDINGS: The transcripts revealed six main themes regarding beliefs and experiences about abortion in Haiti: cultural aspects, consumers, perils of care, and legal concerns. Both women and healthcare workers discussed the repercussions of illegal abortion and the role of the government and hospitals. Participants identified similar perils and complications of unsafe abortions, such as postpartum hemorrhage and infection. CONCLUSIONS: Results showed an urgent need to create a public health response that addresses different dimensions of abortion by engaging women and healthcare providers in rapid and concrete actions that promote access and safe care of women. It is imperative to conduct more research related to abortion in order to examine other associated factors to better understand the links between abortion and sexual health disparities among Haitian women. These results highlight the need for a rapid response to the need of this vulnerable group, who are experiencing high rates of mortality. This can also serve as a directive to approach this issue in other developing countries in the Caribbean region, particularly from its clinical relevance. CLINICAL RELEVANCE: Unsafe abortions are prevalent in developing countries; yet limited research exists on the topic. It is paramount to gain an understanding of the women's and healthcare workers' beliefs and experiences surrounding abortion, in order to develop interventions that prevent abortion complications in Haitian women.

Mujeres que Consumen Sustancias y su Vulnerabilidad frente al VIH en Santiago de Chile (Women Who Consume Substances and Their Vulnerability to HIV in Santiago of Chile).

INTRODUCTION: Women represent 15% of the people living with HIV in Chile. Risk behaviors for HIV are: multiple partners, unsafe sex, and exchange of sex for drugs/money. METHODOLOGY: A correlational design was used. A sample of 203 women who were sexually active and consumed substances within the last 3-months were selected for this study. RESULTS: The average age of the participants was 32.4 years (SD = 9.2) and 68.1% were housewives. The substance most commonly used was alcohol (95.1%) and marijuana (49.8%); 23.7% of the women were drunk or drugged before having sex; 74.4% had multiple sexual partners and 95.6% had unprotected sex. There is a significant correlation (p < 0.05) between substance abuse and HIV risk behaviors. CONCLUSION: It is necessary to develop more research to understand in depth the relationship between substance use and HIV risk among Chilean women. It is important to consider the use of substances to develop and implement HIV prevention programs in the Chilean community.

Exploring the Masculine Identity in the Context of HIV Prevention in Chile.

PURPOSE: This study aims to describe human immunodeficiency virus (HIV)-related knowledge and beliefs, as well as understanding attitudes towards masculinity in the context of HIV prevention, held among Chilean men. DESIGN: This study reports the qualitative findings of a sequential qualitative-quantitative mixed methodology study: Bringing men into HIV Prevention in Chile, NIH R01 TW007674-03. METHODS: Twenty in-depth interviews using a qualitative, descriptive approach to elicit information for the study were conducted among men residing in two communities of low socio-economic status in Santiago, Chile. FINDINGS: Content analysis of interviews revealed three main themes regarding machismo and how it relates to HIV: sexuality and machismo, the changing nature of machismo, and violence against women. CONCLUSIONS: Addressing HIV and intimate partner violence through developing education programs tailored to meet the needs of Chilean men are needed to include men in HIV prevention efforts. CLINICAL RELEVANCE: Specifically, incorporating ideas of what men consider healthy masculinity and working to destigmatize men who have sex with men are important steps in addressing the negative aspects of machismo.

Predictors of HIV enacted stigma among Chilean women.

AIMS AND OBJECTIVES: To investigate if socio-demographic factors, religiosity, HIV-related knowledge, Marianismo, history of having been tested for HIV, knowing someone who died of AIDS and HIV risk perception were predictive factors to HIV enacted stigma predictors among Chilean women. BACKGROUND: HIV infection is the number one cause of death among women during their reproductive years. In Chile, studies with people living with HIV demonstrate the existence of HIV-related stigma. However, limited evidence is available about the underlying causes of HIV enacted stigma that results in stigmatisation and discrimination. DESIGN: The current cross-sectional study is a secondary analysis of data collected to assess the impact of an HIV prevention intervention (Mano a Mano-Mujer) designed for Chilean women. A quasi-experimental design was used in the original study. METHODS: This study was conducted in two communities in Santiago, Chile. The sample for this study consisted of 496 Chileans between ages 18-49. Descriptive statistics and multiple regression were used for the analysis. RESULTS: Participants in the study reported high levels (77·8%) of HIV enacted stigma. Higher levels of HIV-related knowledge were associated with lower levels of HIV enacted stigma. Women with higher education had lower levels of HIV enacted stigma than women with elementary education. In addition, greater levels of marianismo (cultural belief that women should be passive, faithful, and devoted to family) were associated with higher HIV enacted stigma scores. CONCLUSIONS: The findings reflected the presence of HIV enacted stigma among Chilean women. Identifying the significant predictors of HIV enacted stigma can help the nursing community to design HIV prevention interventions that include the reduction in HIV enacted stigma. HIV evidence-based prevention interventions should incorporate contents related to stigma to contribute to prevent HIV enacted stigma at individual and community levels in accordance with the bioecological model. RELEVANCE TO CLINICAL PRACTICE: The results of this study could serve to develop HIV prevention interventions that target the reduction in HIV enacted stigma.

Pilot testing an internet-based STI and HIV prevention intervention with Chilean women.

PURPOSE: The incidence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is high among young Chilean women, and there are no STI or HIV prevention interventions available to them that incorporate technology. The purpose of this study was to investigate the preliminary efficacy of an Internet-based STI and HIV prevention intervention (I-STIPI) for Chilean young women on measures of STI- and HIV-related information, motivation, behavioral skills, and preventive behaviors. DESIGN: This is a pretest-posttest study. Forty young Chilean women between 18 and 24 years of age participated in an investigation of the I-STIPI's preliminary efficacy on STI and HIV prevention-related outcomes between baseline and a postintervention assessment. The intervention consisted of four online modules. Data collection was conducted in Santiago, Chile. Paired-samples t test analysis was used to determine whether there were significant differences in each of the outcome variables. FINDINGS: After receiving I-STIPI, women reported a significant increase in levels of STI- and HIV-related knowledge, attitudes toward the use of condoms and perceived self-efficacy, and a reduction of risky sexual behaviors with uncommitted partners. CONCLUSIONS: The I-STIPI showed promise as an Internet-based intervention that can reduce barriers to accessing preventive interventions and increase STI and HIV preventive behaviors in young Chilean women. CLINICAL RELEVANCE: The study provided important information about the ability of an Internet-based intervention to reduce young women's risk factors and to provide positive preliminary efficacy on STI- and HIV-related outcomes. Internet-based interventions can eliminate many barriers to receiving prevention interventions and may prove to be cost effective.

Oral rapid test: an alternative to traditional HIV screening in Chile.

OBJECTIVE: To compare the sensitivity and specificity of an Oral Rapid Test (ORT) to that of the Enzyme-Linked Immunosorbent Assay (ELISA) for HIV testing in Santiago, Chile; to track the number of study participants returning for ELISA testing results; and to analyze the participants' perceptions of the ORT compared to the ELISA. METHODS: A total of 497 people were recruited in Santiago, Chile: 153 had previously tested positive for HIV, and 344 were of unknown status. Participants were tested for HIV using both the ELISA and the ORT to examine and compare specificity and sensitivity. Qualitative data were collected from 22 participants to compare perceptions of the testing experience with ORT versus ELISA. RESULTS: The ELISA reported 184 (37%) of the 497 participants as being "positive" for HIV antibodies; the ORT showed 181 (36.4%) as being "reactive" for HIV. The ORT showed a sensitivity of 98.4% (95.7%-99.9%, 95% Confidence Interval) and specificity of 100%. The Kappa test produced K = 0.983 (P < 0.0001). Of the 344 participants whose HIV status was unknown at the start of the study, 55 failed to return for their ELISA results. Participants positively perceived ORT as having reduced both waiting time and anxiety over obtaining their test results. ORT oral swabbing appeared more practical and less invasive than drawing blood for the ELISA. CONCLUSIONS: The ORT and ELISA were statistically equal in specificity and sensitivity. ORT provides quicker results, potentially ensuring that more people receive them, and does not require handling of or exposure to potentially hazardous blood products.

Unique factors that place older Hispanic women at risk for HIV: intimate partner violence, machismo, and marianismo.

Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal-postmenopausal-related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention.

Oral rapid test: an alternative to traditional HIV screening in Chile / Prueba oral rápida: una alternativa al tamizaje tradicional del VIH en Chile

OBJECTIVE: To compare the sensitivity and specificity of an Oral Rapid Test (ORT) to that of the Enzyme-Linked Immunosorbent Assay (ELISA) for HIV testing in Santiago, Chile; to track the number of study participants returning for ELISA testing results; and to analyze the participants' perceptions of the ORT compared to the ELISA. METHODS: A total of 497 people were recruited in Santiago, Chile: 153 had previously tested positive for HIV, and 344 were of unknown status. Participants were tested for HIV using both the ELISA and the ORT to examine and compare specificity and sensitivity. Qualitative data were collected from 22 participants to compare perceptions of the testing experience with ORT versus ELISA. RESULTS: The ELISA reported 184 (37%) of the 497 participants as being "positive" for HIV antibodies; the ORT showed 181 (36.4%) as being "reactive" for HIV. The ORT showed a sensitivity of 98.4% (95.7%-99.9%, 95% Confidence Interval) and specificity of 100%. The Kappa test produced K = 0.983 (P < 0.0001). Of the 344 participants whose HIV status was unknown at the start of the study, 55 failed to return for their ELISA results. Participants positively perceived ORT as having reduced both waiting time and anxiety over obtaining their test results. ORT oral swabbing appeared more practical and less invasive than drawing blood for the ELISA. CONCLUSIONS: The ORT and ELISA were statistically equal in specificity and sensitivity. ORT provides quicker results, potentially ensuring that more people receive them, and does not require handling of or exposure to potentially hazardous blood products. Trial number: ClinicalTrials.gov identifier: NCT01733927.

OBJETIVO: Comparar la sensibilidad y la especificidad de una prueba oral rápida con las del análisis de inmunoadsorción enzimática (ELISA) para la detección del VIH en Santiago de Chile, Chile; hacer un seguimiento del número de participantes en el estudio que regresan para saber los resultados del ELISA; y analizar las percepciones de los participantes con relación a la prueba oral rápida en comparación con el ELISA. MÉTODOS: Se incluyeron 497 personas en Santiago de Chile: 153 tenían resultados positivos para el VIH, y la situación de las restantes 344 era desconocida. Se sometió a los participantes a pruebas de detección del VIH tanto mediante el ELISA como mediante la prueba oral rápida, con objeto de analizar y comparar la especificidad y la sensibilidad. Se recopilaron datos cualitativos de 22 participantes para comparar sus impresiones con relación a la experiencia de someterse a la prueba oral rápida en comparación con el ELISA. RESULTADOS: Mediante el ELISA se notificó que 184 de los 497 participantes (37%) obtuvieron un resultado "positivo" en las pruebas de detección de anticuerpos contra el VIH; mediante la prueba oral rápida 181 participantes (36,4%) fueron "reactivos" para el VIH. Esta prueba demostró una sensibilidad de 98,4% (intervalo de confianza de 95%: 95,7-99,9%) y una especificidad de 100%. El coeficiente kappa (K) fue de 0,983 (P < 0,0001). De los 344 participantes cuyo estado con respecto a la infección por el VIH era desconocido al comienzo del estudio, 55 no regresaron para conocer los resultados del ELISA. Los participantes percibieron positivamente la prueba oral rápida debido al período de espera más breve y la reducción de la ansiedad por conocer los resultados de la prueba. La obtención de una muestra oral mediante hisopo resultó más práctica y menos invasora que la extracción de sangre necesaria para llevar a cabo un ELISA. CONCLUSIONES: La prueba oral rápida y el ELISA se mostraron estadísticamente equivalentes en cuanto a especificidad y sensibilidad. La primera proporciona resultados más rápidos, garantiza que más personas puedan conocerlos, y no requiere el manejo o la exposición a hemoderivados potencialmente peligrosos. Número de ensayo: Identificador de ClinicalTrials.gov, NCT01733927.

Effect of emotionally complex roles on HIV-related simulated patients.

Simulated patients (SPs) have participated successfully in nursing and medical education. The SPs portraying stressful situations may have psychological or physiological effects for several days after their performance; however, long-term effects have not been well documented in the literature. The purpose of this study is to investigate the impact of interpreting roles related to HIV among SPs. A qualitative descriptive approach was used for this study. Questionnaires with open-ended questions were conducted immediately after the interpretation of HIV-related roles and a year later by 10 SPs. In addition, a focus group was run a year later using a preestablished interview guide. As a result of direct content analysis, 2 major themes emerged: effects of interpreting roles relating to HIV and complexity of the roles. The findings of this study stress that interpreting an HIV-related role produces emotional, behavioral, and physical effects in SPs, at any stage during the training or performance, and has a long-term impact on their perception of their personal health and risk.