Analysis of the implementation of an AIDS mortality committee through municipal health indicators / Análise da implantação de um comitê de mortalidade por AIDS mediante indicadores de saúde municipais / Análisis de la implantación de un comité de mortalidad por SIDA a través de indicadores municipales de salud

Background and objective: the acquired immunodeficiency syndrome (AIDS) has high rates of detection and death in the state of Rio Grande do Sul. In order to better understand such deaths, in December 2017, the Uruguaiana Municipal Department of Health implemented the AIDS Mortality Committee (CMaids). This study aimed to analyze the impact of an CMaids implementation in Uruguaiana through municipal health indicators. Methods: an ecological time-series study that used secondary data from the official platforms of the Ministry of Health from 2008 to 2020. Results: a reduction in the indicators number of deaths (from 28 in 2008 to 9 in 2020), mortality rate (from 22.0 in 2008 to 7.1 deaths/100,000 inhabitants in 2020), and fatality rate (from 46.74 in 2008 to 9.61 deaths/1,000 inhabitants in 2020) was observed. Moreover, trend lines were verified between 2017-2020 through the logarithmic regression model with join points. A relevant Annual Percent Change in mortality and fatality indicators was verified, with a reduction of 59.1% and 73.4%, respectively, in 2020, when comparing the observed and expected values. Conclusion: the findings enable us to conjecture that CMaids contributed to health indicator improvement, evidencing this as a relevant strategy to handle HIV/AIDS endemic at the local level.(AU)

Justificativa e objetivo: a síndrome da imunodeficiência adquirida (aids) apresenta elevadas taxas de detecção e óbito no estado do Rio Grande do Sul. A fim de compreender melhor tais óbitos, em dezembro de 2017, a Secretaria Municipal de Saúde de Uruguaiana implementou o Comitê de Mortalidade por aids (CMaids). O objetivo deste estudo é analisar o impacto da implantação do CMaids de Uruguaiana por meio de indicadores de saúde municipais. Métodos: estudo ecológico de série temporal, utilizando dados secundários das plataformas oficiais do Ministério da Saúde entre o período de 2008 a 2020. Resultados: observou-se redução dos indicadores número de óbitos (de 28 em 2008 para 9 em 2020), taxa de mortalidade (de 22,0 em 2008 para 7,1 óbitos/100.000 habitantes em 2020) e taxa de letalidade (de 46,74 em 2008 para 9,61 óbitos/1.000 habitantes em 2020). Ainda, verificaram-se linhas de tendência entre 2017-2020 por meio do modelo de regressão logarítmica com pontos de junção. Averiguou-se relevante mudança percentual anual nos indicadores de mortalidade e letalidade, com redução de 59,1% e 73,4%, respectivamente, em 2020, ao comparar-se o valor observado e o esperado. Conclusão: os achados permitem conjecturar que o CMaids contribuiu para melhorias dos indicadores de saúde, evidenciando essa como uma estratégia relevante para o enfrentamento do HIV/aids em nível local.(AU)

Justificación y objetivo: el síndrome de inmunodeficiencia adquirida (sida) presenta altas tasas de detección y muerte en el estado de Rio Grande do Sul. Para entender mejor esas muertes, en diciembre de 2017, la Secretaría Municipal de Salud de Uruguaiana implementó el Comité de Mortalidad por SIDA (CMaids). El objetivo de este estudio es analizar el impacto de la implementación del CMaids de Uruguaiana a través de los indicadores de salud municipales. Métodos: estudio ecológico de series temporales, utilizando datos secundarios de las plataformas oficiales del Ministerio de Salud desde 2008 hasta 2020. Resultados: se observó la reducción de los indicadores de número de óbitos (de 28 en 2008 a 9 en 2020), tasa de mortalidad (de 22,0 en 2008 a 7,1 muertes/100.000 habitantes en 2020) y tasa de letalidad (de 46,74 en 2008 a 9,61 muertes/1.000 habitantes en 2020). Además, se verificaron líneas de tendencia entre 2017-2020 a través del modelo de regresión logarítmica con puntos de unión. Se verificó un cambio porcentual anual relevante en los indicadores de mortalidad y letalidad, con una reducción de 59,1% y 73,4%, respectivamente, en 2020, al comparar los valores observados y esperados. Conclusión: los resultados permiten conjeturar que el CMaids contribuye a mejorar los indicadores de salud, evidenciando que es una estrategia relevante para la lucha contra el VIH/SIDA a nivel local.(AU)

Structural validity of the Brazilian version of the Sense of Coherence scale (SOC-13) in oral health research: exploratory and confirmatory factor analysis.

BACKGROUND: The Sense of Coherence (SOC) construct has been used worldwide in oral health research, but rigorous factor analyses of the scale are scarce. We aim to test the dimensional structure of the Brazilian short version of the SOC scale with 13 items. METHODS: This study is a secondary analysis of four independent cross-sectional Brazilian studies on oral health, using the 13-items SOC scale. Sample 1 was conducted on 1760 mothers and 1771 adolescents. Sample 2 comprised 1100 adults. Sample 3 had 720 adults and older individuals. Sample 4 comprised 664 adolescent students. Confirmatory Factor Analysis (CFA) was conducted on sample 1 to compare two models: 3-factor versus 1-factor. Because they were refuted, Exploratory Factor Analysis was implemented in samples 2 and 3. Modified models were tested in sample 4 using CFA. All analyses were conducted with MPlus version 7.11. RESULTS: CFA of sample 1 resulted in an unacceptable fit (RMSEA = 0.12;CFI = 0.78; TLI = 0.73; and WRMR = 3.28) for 1-factor model and 3-factor (RMSEA = 0.10; CFI = 0.87; TLI = 0.84; and WRMR = 2.50). The EFA on samples 2 and 3 showed, respectively, two eigenvalues greater than 1 (4.11 and 1.56) and (4.32 and 1.42), but the scale items soc1, soc2 and soc3 formed an uninterpretable second factor. Another CFA, using sample 4, showed acceptable model fit after removing those three items and also soc11 (RMSEA = 0.05; CFI = 0.98; TLI = 0.99; and WRMR = 0.71). CONCLUSION: The results indicate that the SOC-13 scale needs further adjustments. The one-factor model with nine items showed a good statistical fit, but the implications of excluding items should be further investigated, considering the scale's content validity, cross-cultural adaptation and theoretical background.

HIV/AIDS epidemic in a western border municipality of Rio Grande do Sul, Brazil: evolution, HIV cascade of care and lethality.

OBJECTIVE: To analyze the characteristics and trends of HIV/AIDS epidemic in Uruguaiana, Rio Grande do Sul, between 2005 and 2015 through indicators related to infection and the cascade of care of people living with HIV/AIDS (PLWHA). METHODS: Descriptive study performed with data from the Health Information Systems of the Ministry of Health. Historical sets of indicators related to detection of HIV/AIDS cases and deaths were developed, comparing with national and state data from 2005 to 2015. Also, the cascades of care for PLWHA were elaborated for the municipality between 2013 and 2015. RESULTS: AIDS detection rates of Uruguaiana were higher in comparison to the country and state, the same happened with the mortality and lethality indicators, which varied between 35.1 and 17.7 deaths/100,000 inhabitants and 6.5 and 2.7 deaths/100 inhabitants, respectively. The cascades of care for PLWHA showed an increase in individuals diagnosed with HIV in the period (from 1,125 to 1,527). The main gap occurred between the "diagnosed" and "connected" categories, expanding over time (78, 48 and 43.4%, respectively). There was a low proportion of individuals in the "undetectable viral load" category in the three years, ranging from 32 to 22.9%. CONCLUSION: Indicators of detection, mortality, and lethality due to HIV/AIDS are high in Uruguaiana, with an increase in the number of people diagnosed with HIV and decrease in their link with health services, suggesting the need for advances in strategies to attract and link PLWHA to the health care network.

HIV/AIDS EPIDEMIC IN A WESTERN BORDER MUNICIPALITY OF RIO GRANDE DO SUL, BRAZIL: EVOLUTION, HIV CASCADE OF CARE AND LETHALITY / EPIDEMIA DE HIV/AIDS EM MUNICÍPIO DA FRONTEIRA OESTE DO RIO GRANDE DO SUL, BRASIL: EVOLUÇÃO, CASCATA DE CUIDADOS E LETALIDADE

Objective: To analyze the characteristics and trends of HIV/AIDS epidemic in Uruguaiana/RS between 2005 and 2015 through indicators related to infection and the HIV cascade of care. Methods: Descriptive study performed with secondary data from Health Information Systems of the Ministry of Health. Historical sets of indicators related to detection of HIV/AIDS cases and deaths were developed, comparing with national and state data from 2005 to 2015. Also, the HIV cascades of care were elaborated for the municipality between 2013 and 2015. Results: AIDS detection rates of Uruguaiana were higher in comparison with the country and state, the same happened with the mortality and lethality indicators, which varied among 35.1 and 17.7 deaths/100 thousands of inhabitants and 6.5 and 2.7 deaths/100 inhabitants, respectively. The HIV cascades of care showed an increase in individuals diagnosed with HIV in the period (from 1,125 to 1,527). The main gap occurred between the "diagnosed" and "linked" categories, expanding over time (78%, 48% and 43.4% respectively). There was a low proportion of individuals in the "undetectable viral load" category in the three years, ranging from 32% to 22.9%. Conclusion: Indicators of detection, mortality and lethality due to HIV/AIDS are high in Uruguaiana, with an increase in the number of people diagnosed with HIV and decrease in their link with health services, suggesting the need for advances in strategies to attract and link people living with HIV/AIDS to the health care network.  

Objetivo: Analisar características e tendência da epidemia de HIV/aids em Uruguaiana/RS entre 2005 e 2015 por meio de indicadores básicos relacionados à infecção e da cascata de cuidado de pessoas vivendo com HIV/aids (PVHA). Métodos: Estudo descritivo realizado com dados dos Sistemas de Informação em Saúde do Ministério da Saúde. Foram elaboradas séries históricas de indicadores relacionados à detecção de casos e óbitos por HIV/aids, comparando com dados nacionais e estaduais de 2005 a 2015. Também foram desenvolvidas as cascatas de cuidado das PVHA para o município entre 2013 e 2015. Resultados: As taxas de detecção de aids de Uruguaiana apresentaram valores mais altos quando comparados ao país e estado, o mesmo acontecendo com os indicadores de mortalidade e letalidade, que variaram entre 35,1 e 17,7 óbitos/100 mil habitantes e 6,5 e 2,7 óbitos/100 habitantes, respectivamente. A cascata de PVHA demonstrou um aumento dos indivíduos diagnosticados com HIV no período (de 1.125 para 1.527). O principal gap ocorreu entre as categorias "diagnosticados" e "vinculados", ampliando-se no decorrer do tempo (78%, 48% e 43,4% respectivamente). Verificou-se baixa proporção de indivíduos na categoria "com carga viral indetectável" nos três anos, variando entre 32% e 22,9%. Conclusões: Os indicadores de detecção, mortalidade e letalidade por HIV/aids são elevados em Uruguaiana, observando-se aumento do número de pessoas diagnosticadas com HIV e diminuição do vínculo destas com os serviços de saúde, sugerindo a necessidade de avanços em estratégias de captação e vinculação das PVHA à rede de atenção.

Sense of coherence and impact of oral health on quality of life in adults and elderly in Southern Brazil.

This cross-sectional study aimed to investigate the association between the Sense of Coherence and impact of oral health on the quality of life. Was conducted with a sample of 720 individuals of both sexes, between the ages of 50 and 74 years, selected through multistage proportional random sampling. The data collection instruments used were: short version of the Sense of Coherence Scale (SOC-13), Oral Impacts on Daily Performances (OIDP) questionnaire, oral clinical examination and questionnaire containing socio demographic and use of dental services information. Bivariate and multivariate analyses were performed through Poisson regression adjusted for robust variance, with level of significance p < 0.05. Oral impacts were reported by 416 participants (57.8%). In the adjusted model, those with strong SOC were more likely of not having any impact when compared with individuals with weak SOC (PR=1.30). Need for dental prosthesis was also associated with the outcome, individuals who did not require prosthesis had less impact (PR=1.50). The findings showed that SOC is associated with OIDP, supporting the hypothesis that individuals with strong SOC present a lower impact of oral health on the quality of life, suggesting that SOC is a determinant that can provide protection against that impact.

Sense of coherence and impact of oral health on quality of life in adults and elderly in Southern Brazil / Senso de coerência e impacto da saúde bucal na qualidade de vida em adultos e idosos do sul do Brasil

Abstract This cross-sectional study aimed to investigate the association between the Sense of Coherence and impact of oral health on the quality of life. Was conducted with a sample of 720 individuals of both sexes, between the ages of 50 and 74 years, selected through multistage proportional random sampling. The data collection instruments used were: short version of the Sense of Coherence Scale (SOC-13), Oral Impacts on Daily Performances (OIDP) questionnaire, oral clinical examination and questionnaire containing socio demographic and use of dental services information. Bivariate and multivariate analyses were performed through Poisson regression adjusted for robust variance, with level of significance p < 0.05. Oral impacts were reported by 416 participants (57.8%). In the adjusted model, those with strong SOC were more likely of not having any impact when compared with individuals with weak SOC (PR=1.30). Need for dental prosthesis was also associated with the outcome, individuals who did not require prosthesis had less impact (PR=1.50). The findings showed that SOC is associated with OIDP, supporting the hypothesis that individuals with strong SOC present a lower impact of oral health on the quality of life, suggesting that SOC is a determinant that can provide protection against that impact.

Resumo Este estudo transversal objetivou investigar a associação entre Senso de Coerência (SOC) e o impacto da saúde bucal na qualidade de vida. Foi realizado com uma amostra de 720 indivíduos de ambos os sexos, com idade entre 50 e 74 anos, selecionados por amostragem aleatória proporcional em múltiplos estágios. Os instrumentos de coleta de dados foram: versão curta da Sense of Coherence Scale, questionário Oral Impact on Daily Performance (OIDP), exame clínico bucal e questionário sociodemográfico e de uso de serviços odontológicos. As análises bivariadas e multivariadas foram realizadas por regressão de Poisson ajustada para variância robusta, com nível de significância p < 0,05. O impacto da saúde bucal foi relatado por 416 participantes (57,8%). No modelo ajustado, aqueles com SOC forte foram mais propensos a não ter nenhum impacto, comparados aos indivíduos com SOC fraco (PR=1,30). A necessidade de prótese dentária também foi associada ao desfecho e os indivíduos que não necessitavam prótese tiveram menor impacto (PR=1,50). Os resultados mostraram que o SOC está associado ao OIDP, apoiando a hipótese de que os indivíduos com SOC forte apresentam menor impacto da saúde bucal na qualidade de vida, sugerindo que o SOC é um determinante que pode proporcionar proteção contra esse impacto.

Vulnerabilidade a infecções sexualmente transmissíveis em idosos usuários de um centro de testagem e aconselhamento / Vulnerability to sexually transmissible infections in elderly users of a trial and counseling center

O processo de envelhecimento populacional e o aumento do número de casos de Infecções Sexualmente Transmissíveis (IST) em idosos evidenciam a necessidade de ações voltadas para a terceira idade. Trata-se um estudo analítico observacional transversal, exploratório, com o objetivo de investigar situações de vulnerabilidade relacionadas à IST em idosos usuários de um Centro de Testagem e Aconselhamento para DTS/Aids de um município de médio porte do estado da Bahia, Brasil, no período de 2006 a 2012. Foram utilizados dados secundários de 233 usuários, com 60 anos ou mais, coletados dos Formulários de Entrada do Sistema de Informação do Centro de Testagem e Aconselhamento, prontuários clínicos e folha de descrição do atendimento. Houve predomínio de usuários do sexo masculino (60,94%), faixa etária de 60 a 70 anos (75,97%), cor parda (26,61%), casados (61,80%), aposentados (57,08%) e com escolaridade de 4 a 7 anos de estudo (35,19%). A maioria relatou a relação sexual como tipo de exposição (76,39%), preferência heterossexual (92,27%) e parceria fixa (72,96%). A frequência de uso do preservativo foi baixa com o parceiro não fixo (32,73%) e com o parceiro fixo (5,58%). A prevalência de IST foi 25,32%, com maior percentual entre os homens. A IST mais prevalente foi a hepatite C (10,73%), seguida da hepatite B (8,58%), sífilis (7,73%) e HIV (3,43). A faixa etária menor que 70 anos mostrou associação estatisticamente significativa com a presença de IST. Os resultados evidenciaram práticas sexuais inseguras e elevada vulnerabilidade dos idosos às IST, havendo necessidade de ações preventivas direcionadas a esse grupo populacional, considerando suas necessidades e especificidades.

The population aging process and the increase in the number of cases of Sexually Transmitted Infections (STI) in the elderly shows the need of actions aimed at that population. This is an exploratory, observational, cross-sectional study to investigate vulnerability situations related to Sexually Transmitted Infections in elderly users of an STD/AIDS Counseling Center of a medium-sized city in the state of Bahia, Brazil, from 2006 to 2012. The study used secondary data from 233 users aged 60 or older, collected from the Counseling Center Information System Admission Forms, clinical records and service description sheet. There was a predominance of male users (60.94%), 60 to 70 years old (75.97%), brown (26.61%), married (61.80%), retired (57,8%) and with 4 to 7 years of schooling (35,19%). Most reported sexual intercourse as the exposure type (76.39%), heterosexual preference (92.27%) and stable partnership (72.96%). The frequency of condom use was low with non-stable partners (32.73%) and with stable partners (5.58%). The prevalence of STI was 25.32%, with greater percentage among men. The most prevalent STI was hepatitis C (10.73%), followed by hepatitis B (8.58%), syphilis (7.73%) and HIV (3.43). The age group younger than 70 years showed a statistically significant association with the presence of STI. The results evidenced unsafe sexual practices and high vulnerability of the elderly to STIs, requiring preventive actions aimed at that population group, considering their needs and specificities.

Vulnerability of adolescents to sexually transmitted infections / Vulnerabilidade a infecções sexualmente transmissíveis em adolescentes

Introduction: Adolescents are especially susceptible to sexually transmitted infections, with approximately 1/7 of all new cases of human immunodeficiency virus infection in this group. Objective: To investigate the vulnerability to sexually transmitted infections among adolescents of the Centers for Testing and Counseling for Sexually Transmitted Diseases / Aids, CTAs, in the city of Juazeiro, state of Bahia, Brazil, from 2006 to 2012. Methods: This was an exploratory cross-sectional study that used secondary data from 1,173 adolescents. Data analysis was processed in Stata 9.0 software by descriptive statistics and Pearson's χ2 test. Results: There was predominance of female adolescents (56.86%), brown (22.85%), single (80.22%), with 8­11 years of education (44.76%) and stable partner (56.78%). The prevalence of sexually transmitted infections was of 5.88%, and there was statistically significant association with sex (more prevalent among girls; p=0.014), education (more common among the less educated; p=0.031) and marital status (more frequent among married/common-law; p=0.036). Conclusion: Safer sex practices and later start of sexual activity combined with empowering actions, especially girls', are important steps to reduce sexually transmitted diseases among adolescents

Introduction: Adolescents are especially susceptible to sexually transmitted infections, with approximately 1/7 of all new cases of human immunodeficiency virus infection in this group. Objective: To investigate the vulnerability to sexually transmitted infections among adolescents of the Centers for Testing and Counseling for Sexually Transmitted Diseases / Aids, CTAs, in the city of Juazeiro, state of Bahia, Brazil, from 2006 to 2012. Methods: This was an exploratory cross-sectional study that used secondary data from 1,173 adolescents. Data analysis was processed in Stata 9.0 software by descriptive statistics and Pearson's χ2 test. Results: There was predominance of female adolescents (56.86%), brown (22.85%), single (80.22%), with 8­11 years of education (44.76%) and stable partner (56.78%). The prevalence of sexually transmitted infections was of 5.88%, and there was statistically significant association with sex (more prevalent among girls; p=0.014), education (more common among the less educated; p=0.031) and marital status (more frequent among married/common-law; p=0.036). Conclusion: Safer sex practices and later start of sexual activity combined with empowering actions, especially girls', are important steps to reduce sexually transmitted diseases among adolescents

FATORES ASSOCIADOS ÀS INFECÇÕES SEXUALMENTE TRANSMISSÍVEIS EM USUÁRIOS DE CENTRO DE TESTAGEM E ACONSELHAMENTO DA BAHIA / FACTORS ASSOCIATED WITH SEXUALLY TRANSMITTED INFECTIONS IN USERS OF A TESTING AND COUNSELING CENTER IN BAHIA / FACTORES ASOCIADOS CON INFECCIONES DE TRANSMISIÓN SEXUAL EN UN CENTRO DE PRUEBAS Y CONSEJERÍA DE BAHIA

As Infecções Sexualmente Transmissíveis constituem importante determinante da carga de doenças na população, principalmente em países subdesenvolvidos e em desenvolvimento. O objetivo deste estudo foi investigar a prevalência e fatores associados a Infecções Sexualmente Transmissíveis em usuários de um Centro de Testagem e Aconselhamento da Bahia. Estudo analítico observacional transversal com 880 participantes, desenvolvido em 2011. Os dados foram coletados dos Formulários de Entrada do Sistema de Informações do Centro de Testagem e Aconselhamento, folha de descrição de atendimentos do usuário e prontuário clínico. Foram realizadas análises univariada e multivariada por Regressão de Poisson. Os resultados mostraram uma prevalência de Infecções Sexualmente Transmissíveis de 11,1%. O HIV foi o agravo mais prevalente (4,2%), seguido da sífilis (4%) e hepatites B (2,1%) e C (2,1%). O uso consistente de preservativo foi baixo, com parceiros fixos (9,5%) e não fixos (16,2%). Na análise ajustada, associaram-se estatisticamente ao desfecho: idade acima de 35 anos, escolaridade entre 8 e 11 anos, origem da clientela de serviços/profissionais de saúde e indicação de amigos/usuários, e preferência por relações homossexuais. Concluiu-se que foi elevada a prevalência de Infecções Sexualmente Transmissíveis em usuários do Centro de Testagem e Aconselhamento estudado, e associaram-se às variáveis sociodemográficas e comportamentais.

Sexually Transmitted Infections are an important determinant of the disease burden in the population, especially in underdeveloped and developing countries. The objective of this study was to investigate the prevalence and associated factors with Sexually Transmitted Infections (STI) among users of a STD Center for Counseling and Testing in Bahia. This is a cross sectional study with 880 participants, developed in 2011. Data were collected from healthcare and clinical records forms. Univariate and multivariate analyses were performed by Poisson Regression. The results showed that the prevalence of Sexually Transmitted Infections corresponded to 11.1%. HIV is the most prevalent injury (4.2%), followed by syphilis (4%) and hepatitis B (2.1%) and C (2.1%). Consistent condom use was low, both with steady partners (9.5%) and non-fixed (16.2%). In the adjusted analysis they were statistically associated with the outcome: age above 35 years, schooling from 8 to 11 years, the origin of the customer from healthcare service/ providers and the indication of friends / users, and preference for homosexual relations. In conclusion, the prevalence of Sexually Transmitted Infections to users of the Testing and Counseling Center studied was high, and they were associated with sociodemographic and behavioral variables..

Las infecciones de transmisión sexual son un importante determinante de la carga de enfermedad en la población, especialmente en los países subdesarrollados y en desarrollo. Investigar la prevalencia y los factores asociados con enfermedades de transmisión sexual entre los usuarios de un Centro de Asesoramiento y Pruebas de infecciones de transmissión sexual del estado de Bahía. Estudio analítico de corte transversal con 880 participantes, desarrollado en 2011. Se recogieron datos de formularios del servicio de salud y registro de salud. Se realizó el análisis univariado y multivariado, por Regresión de Poisson. Los resultados mostraron prevalencia de ITS de 11,1%. La infección más frecuente fue VIH (4,2%), seguido de la sífilis (4%), hepatitis B (2,1%) y hepatitis C (2,1%). El uso sistemático de preservativos fue bajo, con parejas estables (9,5%) y no estables (16,2%). En el análisis ajustado se asociaron estadísticamente con infecciones de transmissión sexual: edad superior a 35 años, escolaridad entre 8 y 11 años, origen de la clientela de servicios/ profesionales de salud e indicación de amigos / usuarios, y preferencia por relaciones homosexuales. Se concluyó que la prevalencia de Enfermedades de Transmisión Sexual en los usuarios del Centro de Exámenes y Asesoramiento estudiados fue alta y se asociaron con variables sociodemograficas y comportamentales.

PERFIL EPIDEMIOLÓGICO DOS USUÁRIOS DE UM CENTRO DE TESTAGEM E ACONSELHAMENTO DA BAHIA / EPIDEMIOLOGICAL PROFILE OF THE USERS OF A TESTING AND COUNSELING CENTER OF BAHIA / PERFIL EPIDEMIOLÓGICO DE LOS USUARIOS DE UN CENTRO DE PRUEBAS Y ASESORAMIENTO DE BAHIA

Os Centros de Testagem e Aconselhamento realizam diagnóstico e ações preventivas para doenças sexualmente transmissíveis, oferecendo testagem sorológica para HIV, sífilis e hepatites virais B e C. O objetivo da pesquisa foi traçar o perfil epidemiológico dos usuários de um Centro de Testagem e Aconselhamento da Bahia no período de 2006 a 2012, em relação a características sociodemográficas, situações de vulnerabilidade individual e prevalência de infecções sexualmente transmissíveis. Para tanto, foi realizado um estudo descritivo do tipo levantamento epidemiológico, utilizando dados secundários de serviços de saúde de 7.048 usuários, coletados dos formulários de entrada do sistema de informação dos Centros de Testagem e Aconselhamento, folha de descrição do atendimento e prontuários clínicos. A análise dos dados foi realizada por estatística descritiva, no Stata 9.0. Os resultados mostraram predomínio de mulheres (52,87%), faixa etária entre 20 a 30 anos (40,32%), casados/união estável (48,69%) e escolaridade de 8 a 11 anos (38,14%). A prevalência de infecções sexualmente transmissíveis foi 12,25%, mais frequente entre os homens, e o agravo mais prevalente foi sífilis (4,52%), seguido de infecção por HIV (3,33%), hepatites B (2,62%) e hepatite C (1,78%). O uso consistente do preservativo com parceiro fixo (17,19%) e parceiro não fixo (34,37%) foi baixo, com maior exposição do sexo feminino. Concluiu-se que a elevada prevalência de infecções sexualmente transmissíveis evidencia a situação de exposição e vulnerabilidade desta população, necessitando ações que contribuam para o empoderamento individual e coletivo na adoção de comportamentos sexuais mais seguros.

The Testing and Counseling Centers perform diagnostic and preventive actions for Sexually Transmitted Diseases, offering testing for HIV, syphilis and hepatitis B and C. The objective of the research was to trace the epidemiological profile of the users of a Testing and Counseling Center of Bahia from 2006 to 2012, in relation to sociodemographic characteristics, situations of individual vulnerability and prevalence of sexually transmitted infections. For that purpose, it was realized a descriptive study of epidemiological survey, using secondary data of health services of 7048 users, collected from input forms from the information system of Testing and Counseling Centers, service description sheet and clinical chart. The analysis was performed using descriptive statistics in Stata 9.0. There was a predominance of women (52.87%), aged 20-30 years (40.32%), married /stable union (48.69%), education between 8 to 11 years (38.14%). The Sexually Transmitted Infections prevalence was 12.25%, more frequent among men, and the most problem was syphilis (4.52%), followed by HIV (3.33%) and hepatitis B (2.62%) and hepatitis C (1.78%). Consistent condom uses with a fixed partner (17, 19%) and non-fixed partner (34.37%) was low, females were more exposed. In conclusion, the high prevalence of sexually transmitted infections shows the situation of exposure and vulnerability of this population, requiring actions that contribute to individual and collective empowerment in the adoption of safer sexual behaviors.

Los Centros de Asesoramiento y Pruebas realizan diagnóstico y prevención de enfermedades de transmisión sexual y ofrecen prueba de VIH, sífilis y hepatitis B y C. La investigación tuvo por objetivo trazar el perfil epidemiológico de los usuarios de un Centro de Asesoramiento y Pruebas de la Bahía no período de 2006 a 2012, en relación a características sociodemográficas, situaciones de vulnerabilidad individual y prevalencia de infecciones sexualmente transmisibles. Para ello fue utilizado un estudio descriptivo de tipo de levantamiento epidemiológico, utilizando datos secundarios de 7048 usuarios, recogidos de formularios de entrada del Sistema de Información del Centro de Asesoramiento y Pruebas, hoja de descripción de la atención y registros médicos. El análisis se realizó mediante estadística descriptiva en el Stata 9.0. Hubo predominio de mujeres (52,87%), edad 20-30 años (40,32%), casadas/unión estable (48.69%), educación entre 8-11 años (38,14%). La prevalencia de infecciones de transmisión sexual fue 12,25%, más frecuente entre los hombres, y la infección más prevalente fue sífilis (4,52%), seguida por VIH (3,33%) y hepatitis B (2,62%) y hepatitis C (1,78%). El uso consistente de preservativos con pareja fija (17,19%) y no fija (34,37%) fue bajo, con mayor exposición femenina. Se ha concluido que la elevada prevalencia de infecciones sexualmente transmisibles evidencia una situación de exposición y vulnerabilidad de la población, que exige acciones que contribuyan para el empoderamiento individual y colectivo en la adopción de comportamientos sexuales más seguros.

Hipertensão materna e baixo peso ao nascer: estudo caso-controle em dois municípios do semiárido nordestino / Maternal hypertension and low birth weight: case-control study of two brazilian northeastern semiarid cities / Hipertensión materna y bajo peso al nascer: estudio caso-control en dos ciudades del nordeste de Brasil

A hipertensão arterial materna pode ocasionar insuficiência placentária, interferir na nutrição fetal e, ainda, resultar no nascimento de um bebê com baixo peso. O objetivo deste estudo foi investigar a relação entre hipertensão materna e baixo peso ao nascer em puérperas usuárias do Sistema Único de Saúde, em dois municípios da região semiárida do Nordeste brasileiro. Trata-se de estudo do tipo caso-controle. Foram investigadas 1.567 puérperas, sendo 388 casos e 1.179 controles, utilizando- -se um questionário estruturado e o exame clínico para coleta de dados de saúde bucal. A análise de associação foi realizada pela estimativa da medida de associação Odds Ratio, considerando-se um intervalo de confiança de 95%. O efeito da associação principal foi estimado adotando-se um modelo de regressão logística não condicional. Os resultados mostraram associação entre hipertensão materna e baixo peso ao nascer, após ajuste para índice de massa corporal pré-gestacional, escolaridade materna, idade materna e número de consultas pré-natal (OR 2,51; IC 1,61-3,91; p 0,000). Concluiu-se que há relação entre hipertensão materna e baixo peso ao nascer em gestantes da região semiárida, o que reforça a necessidade de ações de prevenção e controle, visando a melhora dos indicadores de saúde materno-infantil.

Maternal hypertension may cause placental insufficiency, interfere to fetal nutrition and, yet, cause low birth weight to the baby. The objective of this study was to investigate the relation between maternal hypertension and low birth weight to puerperal women assisted by the Unified Health System from two municipalities of semi-arid Brazilian Northeast. It was a case-control study. 1567 puerperal women were investigated, from which 388 cases and 1179 controls, using a structured questionnaire and clinical exam to collect oral health data. Odds Ratio association measure was used to association analysis, considering a 95% confidence interval. The main effect of association was estimated by the adoption of a unconditional logistic regression model. Results present association between maternal hypertension and low birth weight, after the adjust to pregestational body mass index, maternal formation, maternal age and the amount of prenatal consultations (OR 2,51; IC 1,61-3,91; p 0,000). In conclusion, there is a relation between maternal hypertension and low birth weight to semi-arid pregnant women, which reinforces the need of preventive actions and control, towards the improvement of maternal-infant health indicators.

Hipertensión materna puede ocasionar insuficiencia placentaria, interferir en la nutrición fetal y aún resultar en el nacimiento de un bebé con bajo peso. El objetivo de este estudio fue investigar la relación entre hipertensión materna y bajo peso al nacer en mujeres que han dado la luz que utilizan el Sistema Único de Salud, en dos municipalidades del semiárido del nordeste brasileño. Este es un estudio caso-control. Fueron investigadas 1567 mujeres que han dado a luz, siendo 388 casos y 1179 controles, utilizando un cuestionario estructurado y el examen clínico para la recolección de datos de salud bucal. El análisis de asociación fue realizado por la estimativa de la medida de asociación Odds Ratio, considerando el intervalo de confianza de 95%l El efecto de la asociación principal fue estimado con la adopción de un modelo de regresión logística no condicional. Los resultados mostraron la asociación entre hipertensión materna y baso peso al nacer. Después del ajuste para el el ínice del masa corporal pre-gestacional, escolaridad materna, edad materna, y el número de consultas prenatal (OR 2,51; IC 1,61-3,91; p 0,000). Concluyese que hay relación entre la hipertensión meterna y el baso peso al necer en embarazadas de la región semiárida, lo que refuerza la necesidad de las acciones de prevención y control, para la mejora de los indicadores de salud materno-infantil.

Agentes Comunitários de Saúde: perfil sociodemográfico, emprego e satisfação com o trabalho em um município do semiárido baiano / Community Health Agents: sociodemographic profile, employment and satisfaction with work in a city of Bahia's semiarid

Resumo Introdução O Agente Comunitário de Saúde (ACS) é elo entre o serviço de saúde e a comunidade, sendo imprescindível para a implementação de ações de Atenção Primária à Saúde (APS). As condições de emprego e de insatisfação com o trabalho podem ter reflexos sobre a saúde deste trabalhador. O objetivo do estudo foi conhecer o perfil sociodemográfico, as características do emprego e a satisfação com o trabalho de ACS de Juazeiro, na Bahia. Método Foi realizado um inquérito epidemiológico com dados de 145 ACS, coletados por meio de questionário estruturado, aplicado por entrevistador. Resultados A maioria era do sexo feminino (81,38%), com até 40 anos de idade (51,72%), cor parda (60,69%), casada/união estável (66,21%), do quadro permanente do município (95,77%) e com 6-12 anos na mesma unidade (55,86%). A maioria mostrou-se segura em querer candidatar-se novamente ao emprego (52,08%) e satisfeita/muito satisfeita com a capacidade para o trabalho (77,93%). Quanto à satisfação com o trabalho, 28,28% declaram-se insatisfeitos/muito insatisfeitos, 60%, indiferentes, e 11,72%, satisfeitos/muito satisfeitos. Conclusão A consolidação de políticas de organização e de gestão dos processos do trabalho do ACS e a valorização deste profissional são fundamentais para modificar o quadro de insatisfação existente, contribuindo para o fortalecimento da APS.

Abstract Introduction The Community Health Agent (CHA) is a link between health service and community, being an indispensable professional to implement Primary Health Care actions. Employment conditions and dissatisfaction with the job can affect the worker's health. The aim of this study was to identify the sociodemographic profile, employment characteristics and job satisfaction in CHA work of Juazeiro, Bahia. Method An epidemiological survey was performed to collect data of 145 CHA, using a structured questionnaire, applied by interviewer. Results Most participants were women (81.38%), up to 40 years old (51.72%), brown skin color (60.69%), married/common-law marriage (66.21%), city staff (95.77%), and working six to twelve years in the same unit (55.86%). Just over half proved showed interest in reapplying for the job (52.,08%) and most reported as satisfied/very satisfied with the work capacity (77.93%). As for work capacity, 28.28% declared themselves dissatisfied/very dissatisfied, 60.00% indifferent and 11.72% satisfied/very satisfied. Conclusion The consolidation of organizational policies and management of CHA work processes and appreciation of these professionals is fundamental to modify the existing dissatisfaction frame, contributing to the strengthening of Primary Health Care.

Dental pain, use of dental services and oral health-related quality of life in southern Brazil.

This study aimed at assessing the relationship between dental pain and the reason for using dental services and oral health quality of life in people aged 50 to 74 years in southern Brazil. A cross-sectional population-based study was conducted with 720 individuals aged 50 to 74 years, living in three health districts in the city of Porto Alegre. Dental impacts on daily life and sociodemographic data were assessed using structured interviews. The Oral Impacts on Daily Performance - OIDP instrument was used to measure oral impacts. The information was analyzed by Poisson regression with robust variance adjustment, taking into account cluster sampling. Dental pain was present in 32.5% of those reporting an oral impact on their daily activities. Dental pain most frequently affected talking (37.6%), cleaning teeth and gums (37.0%) and enjoying the companionship of people (36.5%). After adjustments to the multivariate analysis, the reason for dental visits due to dental pain was found to have a high impact on daily activities [RP 1.68 (1.11 - 2.54].

Relationship between Sense of Coherence and oral health in adults and elderly Brazilians.

The purpose of this study was to investigate the relationship between Sense of Coherence (SOC) and oral health clinical variables (number of teeth present and absence of need for dental prostheses). The sample consisted of 720 adults and elderly Brazilians. The data were collected at home using the SOC-13 scale - a form of clinical examination for the evaluation of oral conditions - and a questionnaire evaluating socioeconomic aspects and the use of dental services. Statistical analysis, both univariate and multivariate, was performed by Poisson regression with robust variance adjustment. The average age of the participants was 60.2 years, and they were predominantly female (57.8%). Among the participants who had a strong SOC, the absence of the need for dental prostheses was 34% higher than among those with a weak SOC, demonstrating a significant difference between the groups (PR = 1.34, 95%CI = 1.06-1.70; p = 0.015). Individuals who had a strong SOC had a 5% higher prevalence of 14 or more existing teeth than those with a weak SOC, which was statistically significant after adjustment for co-factors (PR = 1.05, 95%CI = 1.01-1.11, p = 0.033). A strong personal Sense of Coherence has a beneficial influence on the oral health of adults and older people in Brazil.

Relationship between Sense of Coherence and oral health in adults and elderly Brazilians

Abstract The purpose of this study was to investigate the relationship between Sense of Coherence (SOC) and oral health clinical variables (number of teeth present and absence of need for dental prostheses). The sample consisted of 720 adults and elderly Brazilians. The data were collected at home using the SOC-13 scale - a form of clinical examination for the evaluation of oral conditions - and a questionnaire evaluating socioeconomic aspects and the use of dental services. Statistical analysis, both univariate and multivariate, was performed by Poisson regression with robust variance adjustment. The average age of the participants was 60.2 years, and they were predominantly female (57.8%). Among the participants who had a strong SOC, the absence of the need for dental prostheses was 34% higher than among those with a weak SOC, demonstrating a significant difference between the groups (PR = 1.34, 95%CI = 1.06-1.70; p = 0.015). Individuals who had a strong SOC had a 5% higher prevalence of 14 or more existing teeth than those with a weak SOC, which was statistically significant after adjustment for co-factors (PR = 1.05, 95%CI = 1.01-1.11, p = 0.033). A strong personal Sense of Coherence has a beneficial influence on the oral health of adults and older people in Brazil.

Dental pain, use of dental services and oral health-related quality of life in southern Brazil

Abstract This study aimed at assessing the relationship between dental pain and the reason for using dental services and oral health quality of life in people aged 50 to 74 years in southern Brazil. A cross-sectional population-based study was conducted with 720 individuals aged 50 to 74 years, living in three health districts in the city of Porto Alegre. Dental impacts on daily life and sociodemographic data were assessed using structured interviews. The Oral Impacts on Daily Performance - OIDP instrument was used to measure oral impacts. The information was analyzed by Poisson regression with robust variance adjustment, taking into account cluster sampling. Dental pain was present in 32.5% of those reporting an oral impact on their daily activities. Dental pain most frequently affected talking (37.6%), cleaning teeth and gums (37.0%) and enjoying the companionship of people (36.5%). After adjustments to the multivariate analysis, the reason for dental visits due to dental pain was found to have a high impact on daily activities [RP 1.68 (1.11 - 2.54].

Adapting and testing the oral impacts on daily performances among adults and elderly in Brazil.

OBJECTIVES: To cross-culturally adapt and evaluate the psychometric properties of the oral impact on daily performance (OIDP) in Brazilians aged 50-74 years; to test the impact of oral health on 'work' and 'vigorous physical activity'. BACKGROUND: Clinical oral health indicators do not assess the perceived impact of oral health on people's lives. METHODS: The study was performed through small group interviews, pilot studies and a main study with 200 people aged 50 and over. Data were collected through interviews in health centres. RESULTS: For content validity, 'eating' (1.00, p < 0.001) and 'speaking' (0.96, p < 0.001) obtained the highest level of agreement among experts. For criterion and construct validity, there was an inverse correlation between self-rated oral health, perceived oral treatment needs and satisfaction with oral health and OIDP score. Cronbach's alpha coefficient varied from 0.69 to 0.67 when 'work' and 'vigorous physical activities' were deleted. Test-retest reliability was 0.69 (ICC). CONCLUSION: The validation process showed that the Brazilian OIDP has the necessary basic psychometric properties to be used in the 50-74 years age group in Brazil. 'Work' and 'vigorous physical activities' had low impact on oral health. The activity 'vigorous physical activities' was not maintained in the instrument because of its low impact, while 'work' was maintained due of the increase in the 50-59 years age group in the Brazilian population.

Factors Associated With Condom Use in Women of a Testing and Advice Center for STD/AIDS of Bahia, Brazil / Fatores Associados ao Uso de Preservativo em Mulheres Usuárias de um Centro de Testagem e Aconselhamento para DST/AIDS da Bahia, Brasi

The feminization process of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection in Brazil is evidenced by the expressive increase in the number of infected women and by mortality rates, which is increasing in females, contrary to what occurs among men. Despite the diffusion of condoms, consistent use is still considered low, even in relations with non-regular partners. Objective: To investigate factors associated with the use of condoms with non-regular partners, in women users of a Testing and Counseling Center for sexually transmitted disease (STD)/AIDS of Bahia, from 2006 to 2012. Methods: This is a transversal observational analytical study. Secondary data of 790 women users of a Testing and Counseling Center, obtained from forms and clinical records, were used. Statistical analysis, crude and adjusted, used the prevalence ratio as the measure of association and a 95% confidence interval. Results: The consistent use of condom in relations with non-regular partners was low (27.97%). The main reasons appointed to justify the absence of use were not liking it (35.71%) and difficulty in negotiating with the partner (21.22%). The outcome was associated statistically to the absence of use of condom in the last relation with a regular partner and to the age of first sexual relation lower than 16 years. Conclusion: The findings contribute to the understanding of the behavior of women in relationships with non-regular partners and provide a base in planning coping actions against the diseases resulting from unprotected sex, both in specialized care and in the primary health care network.

O processo de feminização da infecção por HIV/AIDS, no Brasil, é evidenciado pela elevação expressiva no número de mulheres infectadas e também pelas taxas de mortalidade, que vem aumentando no sexo feminino, ao contrário do que ocorre entre os homens. Apesar da difusão do preservativo, o uso consistente ainda é considerado baixo, mesmo em relações com parceiros não fixos. Objetivo: Investigar fatores associados ao uso de preservativo com parceiros não fixos, em mulheres usuárias de um Centro de Testagem e Aconselhamento (CTA) para DST/AIDS da Bahia, de 2006 a 2012. Métodos: Trata-se de um estudo analítico observacional transversal. Foram utilizados dados secundários de 790 mulheres usuárias de um CTA, obtidos de formulários e prontuário clínicos. A análise estatística, bruta e ajustada, adotou a medida de associação razão de prevalência com intervalo de confiança de 95%. Resultados: O uso consistente de preservativo nas relações com parceiro não fixo foi baixo (27,97%). Os principais motivos apontados para justificar a ausência de uso foram não gostar (35,71%) e dificuldade de negociação com o parceiro (21,22%). O desfecho associou-se estatisticamente com ausência de uso de preservativo na última relação com parceiro fixo e idade da primeira relação sexual menor que 16 anos. Conclusão: Os achados contribuem para a compreensão do comportamento de mulheres em relações eventuais e trazem subsídios para o planejamento de ações de enfrentamento dos agravos decorrentes de relações sexuais desprotegidas, tanto na atenção especializada quanto na Atenção Primária à Saúde.

Factors related to the use of dental services among adolescents from Gravataí, RS, Brazil, in 2005.

INTRODUCTION: Access to health services, including those for oral health, depends upon socioeconomic, environmental and individual factors. Moreover, cultural and lifestyle differences also influence the degree to which services are sought. OBJECTIVE: This study aimed to assess factors associated with the use of dental services among adolescents in the 7th grade of public primary schools from the city of Gravataí, RS, Brazil, in 2005. METHODS: A cross-sectional survey was carried out. Data were collected in schools through self-administered questionnaires evaluating demographic, socioeconomic and psychosocial factors, lifestyle, oral health habits and behaviors of 1,170 adolescents, using the Global School-Based Student Health Survey, International Physical Activity Questionnaire and Body Shape Questionnaire. Data analysis was carried out by means of Cox regression modified for cross-sectional studies, using the STATA 6.0 software. Univariate and multivariate analyses were performed from a hierarchical conceptual model supported by the literature on hierarchical models. RESULTS: The use of dental services was less frequent among those who reported concern with body image and involvement in fights; those whose parents did not know where they were in their leisure time, those who brushed their teeth less than twice a day, those who did not use dental floss daily, those who reported seeking dental services for curative treatment and those with a lower socioeconomic status. CONCLUSIONS: The results suggest that the use of dental services by adolescents depends upon the interaction of psychosocial and individual factors as well as the family context.

Uso do preservativo com parceiros não fixos por usuários do centro de testagem e aconselhamento em DST /AIDS / Condom use with random partners by users of testing and counseling center in STD/AIDS

Dentre as principais situações de vulnerabilidade ao HIV e outras doenças sexualmente transmissíveis (DST), destaca-se a ausência de uso de preservativo com parceiros não fixos, cujo uso rotineiro é pouco frequente em ambos os sexos, independente da faixa etária ou situação conjugal.Objetivo: Caracterizar os usuários do Centro de Testagem e Aconselhamento em DST/AIDS de Juazeiro, Bahia, que possuem parceiros não fixos e verificar a prevalência de uso de preservativo, no ano de 2011. Métodos: Foi realizado um estudo descritivo com dados secundários do serviço de saúde,utilizando o Formulário de Entrada do Sistema de Informação do Centro de Testagem e Aconselhamento, totalizando 408 usuários. Na análise dos dados,foi avaliada a distribuição das variáveis por meio de frequência absoluta e relativa. Resultados: A maioria dos participantes era do sexo masculino, na faixa etária entre 21 e 35 anos, com escolaridade de 8 anos ou mais e cerca de um terço tinha parceiro estável. A prevalência de uso de preservativo com parceiro não fixo foi 35,29%, elevando-se conforme aumentavam os anos de estudo. O uso rotineiro foi mais frequente entre os homossexuais e bissexuais.Daqueles que relataram ter tido algum tipo de DST no último ano, cerca de 70% referiram usar preservativos somente às vezes ou nunca. Conclusão: Ouso de preservativos com parceiros não fixos entre esses usuários é pouco frequente, sendo observadas práticas sexuais inseguras que os expõem, e a seus parceiros, a um maior risco de contaminação por DST.

Among the main situations of vulnerability to HIV and other sexually transmitted diseases (STD), the lack of condom use with non-fixedpartners is a major problem, which affects men and women, regardless of age or marital status. Objective: To characterize the users of the Center for Counseling and Testing STD/AIDS in Juazeiro, Bahia, Brazil, whose have non-fixed partners; and to determine the prevalence of condom use in the year 2011. Methods: We developed a descriptive study using secondary data from the health service, using the Entry Form Information System of the Center for Counseling and Testing, with a global number of 408 users. In data analysis, we evaluated the distribution of variables by means of absolute and relativefrequency. Results: The majority of participants were male, aged between 21-35 years with 8 years or more of schooling and about a third of them had astable partner. The prevalence of condom use with a non-fixed partner was low (35.29%), increasing according to the schooling years. The customary use was more common among gays and bisexuals. Of those who reported having any type of STD in the past year, about 70% reported using condoms onlysometimes or never. Conclusion: The use of condoms with non-fixed partners among these users is not common, being observed unsafe sexual practices that expose them and their partners at a greater risk of contamination by DST.