The HIV epidemic in Colombia: spatial and temporal trends analysis.

BACKGROUND: Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. METHODS: Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS: While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0-14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45-64 group. The high-high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. CONCLUSION: Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0-14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the 'coffee belt' regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

Widening the spectrum of deletions and molecular mechanisms underlying alpha-thalassemia.

Inherited deletions of α-globin genes and/or their upstream regulatory elements (MCSs) give rise to α-thalassemia, an autosomal recessive microcytic hypochromic anemia. In this study, multiplex ligation-dependent probe amplification performed with commercial and synthetic engineered probes, Gap-PCR, and DNA sequencing were used to characterize lesions in the sub-telomeric region of the short arm of chromosome 16, possibly explaining the α-thalassemia/HbH disease phenotype in ten patients. We have found six different deletions, in heterozygosity, ranging from approximately 3.3 to 323 kb, two of them not previously described. The deletions fall into two categories: one includes deletions which totally remove the α-globin gene cluster, whereas the other includes deletions removing only the distal regulatory elements and keeping the α-globin genes structurally intact. An indel was observed in one patient involving the loss of the MCS-R2 and the insertion of 39 bp originated from a complex rearrangement spanning the deletion breakpoints. Finally, in another case, no α-globin gene cluster deletion was found and the patient revealed to be a very unusual case of acquired α-thalassemia-myelodysplastic syndrome. This study further illustrates the diversity of genomic lesions and underlying molecular mechanisms leading to α-thalassemia.

[Building the gerontological performance of nurses in Family Health Programs]. / Construindo o fazer gerontológico pelas enfermeiras das Unidades de Estratégia Saúde da Família.

The goal of this article is to analyze the development of gerontological nurses working in the Family Health Program in a municipal district in Belém, PA. Data have been collected through interviews with 14 nurses between 08/2009 and 02/2010 and have been analyzed using the content analysis method to generate topics. One such topic is the theme of this article: building gerontological work, and the sub-topics are the following: nursing consultation, home visits, family care, and seeking partnerships for integrated actions. According to the results, it may be inferred from nurses performing gerontological tasks that work is hampered primarily by urban violence, the inefficient functional structure of services and poor specific geriatric training. However, nurses have built a special "making of gerontology" by creating strategies of integrated actions according to each new situation that has been presented.

Incidence and Severity of Post-dural Puncture Headache in Non-obstetric Patients Undergoing Subarachnoid Block.

Background and goal of the study Post-dural puncture headache (PDPH) is a complication of central neuraxial block, either subarachnoid block (SAB) or epidural block. This clinical entity has a wide incidence and is affected by factors such as age, gender, needle gauge, needle shape/type, number of puncture attempts, and previous history of headache. Due to the lack of data in the non-obstetric population, this study assesses the incidence and severity of PDPH after SAB. Materials and methods A prospective observational study was carried out on patients undergoing SAB during the last trimester of 2020. Data were recorded on the day of surgery, 48 hours, and seven days after surgery. Data collected included demographic and medical clinic information, SAB procedure details, and clinical outcomes related to the presence of PDPH. Results and discussion Overall, 143 patients were included (median age: 62 years; 53.1% were women (n=76)). Most patients were aged >60 years (55.9%; n=80) and ASA 2 classification (65.0%; n=93). The incidence of PDPH was 21.7% (n=31), and most cases were from inpatient surgery (58.3%, n=21). The incidence of PDPH was 2.5 times higher with the use of 25 gauge compared to the use of the 27 gauge needle and was more prevalent with the use of the Quincke needles. Conclusion Over 20% of patients undergoing SAB experienced PDPH. Previous history of headache, larger gauge, and the Quincke needle use were associated with a higher incidence of PDPH.

AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis.

Despite considerable therapeutic advances in the care of people living with human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) and an overall reduction of 47% in the AIDS mortality rate in the last decade, the AIDS-mortality rates remains high. The social determinants of health (SDH) have a direct influence on the dynamics of this phenomenon. However, changes in SDH caused by the implemented policies against HIV have been poorly investigated. Moreover, the Brazilian rainforest has had the highest and continuously increasing AIDS mortality rate in Brazil since the 1980s. In this study, AIDS mortality in a province of the Brazilian rainforest was examined by using temporal and spatial analyses. METHODS: In this ecological study, data from 2007 to 2018 were extracted from the Mortality Information System provided by the State Department of Public Health of Pará. For the temporal analysis, the integrated autoregressive model of moving average (ARIMA) and locally weighted polynomial regression (STLF) were used to forecast AIDS mortality from 2019 to 2022. For the spatial analysis, spatial autocorrelation and geographically weighted regression (GWR) analyses were employed. RESULTS: The samples consisted of 6,498 notifications for AIDS-related deaths. From 2007 to 2013, the AIDS mortality rates showed an upward trend, followed by a stabilization until 2018 and an upward forecasted trend from 2019 to 2022. High mortality rates and high-high clusters were found in economic pole municipalities. Furthermore, AIDS mortality risk was directly associated with per capita income and demographic density, except in the southwestern region of Pará, which exhibited an inverse association with population density. CONCLUSION: Although the policies against HIV may have contributed to the stabilization of AIDS mortality rates from 2013 in Pará, the upward forecasted trend until 2022 raises an alert and concern to health authorities to provide reinforcement of the policies. The geographic variability of AIDS mortality promoted by SDH provides subsidies to health authorities to implement SDH-focused strategies for AIDS mortality reduction.

Fall-Related Hospitalizations in Elderly People: Temporal Trend and Spatial Distribution in Brazil.

This study aims to identify the temporal variation and the spatial dependence structure of the hospitalization rate for falls in the elderly residing in Brazil in the period between 2010 and 2021. This ecological study employs secondary data from the Brazilian Ministry of Health about the fall-related hospitalization of people aged 60 years old and over. A time-series analysis was carried out, employing the joinpoint model. For the spatial analysis, the Moran autocorrelation technique was employed. In Brazil, between 2010 and 2021, there were 1,270,341 hospitalizations for falls recorded among the elderly in the Brazilian Hospitalization System. There was a continuous upward trend between 2010 and 2019 for all age groups, female and male, and all Brazilian regions. The trend stabilized between 2019 to 2021. The North and Northeast regions had faster upward trends among all Brazilian regions, and there was also a faster upward trend among women compared to men. A high-high pattern in hospitalization incidence was noticed from 2011 to 2019 in the states of São Paulo, Minhas Gerais, Paraná, and Mato Grosso do Sul. The results of this study provide subsidies for Brazilian health authorities to implement more efficient public policies to improve the quality of life of elderly people.

[Nurse's assessment of oral health of elderly people: OHAT validity and reliability]. / Avaliaçãcao da saúde bucal de idosos por enfermeiros: validade e confiabilidade do instrumento asbto.

The aim of the study was to apply the Oral Health Assessment Tool (OHAT)for determination of the reliability and validity indexes, when utilized by nursing staff The OHAT was administered to 50 elderly individuals. The exams were performed in different periods of times by a Nurse and a Dental Surgeon (DS). The determination of internal consistency was verified through Cronbach's Alpha Coeficient and ANOVA. For the determination of stability and reliability, the percentage agreement and Kappa test were considered. There was no statistical difference among the final averages obtained by the DS and the nurse (p=0.41). There was a higher internal consistency in the exams performed by the DS. The Kappa value of the instrument reached 0.46, being considered moderate. The OHAT instrument can be used by nurses as a screening tool however, previous training is needed for criteria standardization.

A differential diagnosis for a postpartum headache.

Headache is a common finding in the postpartum period. A wide variety of factors can contribute for its appearance and the causes include primary as well as secondary headache disorders. The postdural puncture is one of the most common headache causes in this context, but not the only one, which is why a differential diagnosis of postpartum headache is essential. We describe a patient with a headache in the immediate postpartum period. It was initially diagnosed as a common postdural puncture headache, but was later discovered to be a cervical hematoma.

Nursing process for elderly women susceptible to falls from the perspective of the Pender's Model.

OBJECTIVES: to describe the strategy of applying the nursing process guided by Pender's Health Promotion Model to elderly women susceptible to falls with a view to promoting a self-efficacy behavior for fall prevention. METHODS: application of the nursing process to eleven elderly women who had already experienced falls, living in a neighborhood in the outskirts of Belem, state of Pará, which involved interviews to obtain their nursing history and group meetings using the focus group technique to develop the other phases of the nursing process: nursing diagnosis, nursing interventions, and nursing assessment. RESULTS: despite the risk factors for falls, the intervention model adopted in this study allowed elderly women to enhance their self-efficacy. FINAL CONSIDERATIONS: the model proved to be suitable for the participation of elderly women in actions to build fall prevention behaviors, with a view to healthier lifestyles.

The Family Health Strategy Influence on the Human Papillomavirus Vaccine Acceptance in a Peripheral Community of the Brazilian Amazon Region.

Introduction: The coverage of the human papillomavirus (HPV) vaccine remains low worldwide. The Family Health Strategy (FHS) in Brazil has an important role in health promotion in communities. Given the FHS's close contact with assisted communities, the coverage of the HPV vaccine should be high in children. This study aims to investigate the acceptance of the HPV vaccine of parents or guardians of a peripheral community of the Brazilian Amazon region assisted by the FHS and influencing factors. Methods: A cross-sectional community-based study recruiting the residents of a subnormal agglomerate of Belém (Pará-Brazil) and covered by the FHS was conducted. Data were collected from September 30 to November 5, 2019. The questionnaire "Knowledge and Acceptability of HPV and Its Vaccine" was used. Data were analyzed through binary and multiple regression analyses. Results: A total of 247 participants were included in this study, and 85 of which (34.4%) declared that they did not vaccinate their children. Hesitation to vaccinate was related to few years of schooling (odds ratio [OR]: 0.79, p=0.008), having sons (OR: 3.14, p=0.000), inadequate knowledge about doses of the HPV (OR: 2.44, p=0.015), and knowledge of anyone who received the HPV vaccine (OR: 7.07, p=0.000). Conclusion: Results suggested the low efficiency of FHS in increasing the HPV vaccination coverage in the assisted communities. A strategy involving a dialog with assisted families and continuous health education to health professionals should be implemented to combat fake news and increase HPV vaccination coverage.

[Long-term care institutions for the elderly and their structural coupling with the surrounding social systems]. / Acoplamento estrutural das instituições de longa permanência para idosos com sistemas societais do entorno.

This study was performed in six Long-Term Care Institutions for the Elderly (LTCIEs) that helped low-income senior citizens in three regions of the country. Its aim is to examine how LTCIEs' internal organizational system maintained structural coupling with surrounding systems. The data were collected through interviews and observation. The analysis was based on concepts of Luhmann's Social Systems Theory. As a result, the rules of belonging did not encourage aid proposals that stimulated independent life and the individuality of residents. The structural couplings with the external environment generated negative resonance within LTCIEs, such as the lack of links to programmatic actions of public primary health care, inability to maintain a multiprofessional staff, inability to fully adapt the infrastructure, and inability to bring reçatives closer to the institution's daily routine. As a positive aspect, the staff was empowered by the presence of students and their professors.

Factors associated with low knowledge about sexually transmitted infections in subnormal agglomerate, in the Brazilian Amazon.

BACKGROUND: Populations living in subnormal agglomerates in urban areas are more vulnerable to infections, including sexually transmitted infections (STIs). In these groups, inadequate knowledge about sexually transmitted infections can further increase the risk of contracting STIs. AIM: We investigated the factors associated with low knowledge about STIs in a peripheral population in the Brazilian Amazon. METHODS: This cross-sectional study was conducted in Belém, in the Amazon region that has a high percentage of subnormal agglomerates in an urban area and a high incidence of STIs. Random sampling was adopted which resulted in a sample of 320 participants. To assess knowledge about STIs, the self-administered Sexually Transmitted Disease Knowledge Questionnaire was used. To assess aspects of vulnerability, a questionnaire was constructed which is linked to individual, social, and programmatic factors. The chi-square test, G test, and ordinal regression analyses were all performed. FINDINGS: The sample of this study was composed of 320 participants. The mean age of the participants was 46.09 years. 37.5% (120), 50.6% (162), and 11.9% (38) showed low, medium, and high knowledge, respectively. Multiple analysis revealed that the factors associated with higher chance of having smaller knowledge about sexually transmitted infections were single/separated/divorced/widow(er) marital status (AOR: 1.80, CI: 1.15-2.84, P = 0.01); income equal to or less than one minimum wage (1.98, CI: 1.21-3.17, P = 0.00); equal to or over than 52 years old (AOR: 1.99, CI: 1.25-3.17, P = 0.00); lack of guidance by a health professional (AOR: 1.59, CI: 1.01-2.51, P = 0.04). Our results show that this community suffer from suboptimal levels of knowledge on STIs, which are linked to individual, social, and programmatic factors. Characterising the risk and vulnerabilities factors allows for carrying out appropriate interventions for populations living in subnormal agglomerates in urban area.

HIV epidemic in a province of the Brazilian Amazon region: Temporal trend analysis.

BACKGROUND: Although considerable progress has been made over the last decades, human immunodeficiency virus (HIV) incidence and acquired immunodeficiency syndrome (AIDS) mortality rates have remarkably increased in the Brazilian Amazon region. Here, we employed temporal analysis to determine the impact of public policies on the HIV epidemic in the state of Pará, Brazil, which has the second highest HIV incidence rate in the Amazon region. DESIGN AND METHODS: This is an ecological study conducted in the state of Pará, employing secondary data of HIV/AIDS cases notified to the Information System for Notifiable Diseases, 2007-2018. The following epidemiological variables were collected: year of notification, municipality of residence, age, sex, education, exposure category, and HIV/AIDS diagnostic criteria. The study population was composed of 21,504 HIV/AIDS cases. The HIV/AIDS incidence rates were analyzed employing the temporal trend analysis (TTA) followed by the chi-square test and residue analysis to determine the association between the epidemiological variables and time series periods. RESULTS: A total of 50% of the notifications were composed of AIDS cases. TTA identified two periods in HIV/AIDS incidence, with stabilization of cases in the first period (G1, 2007-2012) and an upward trend in the second period (G2, 2012-2018). The most prevalent epidemiological characteristics in G2 (versus G1) were as follows: young people, brown skin color, higher schooling, and homosexuals. CONCLUSIONS: Public policy to control HIV infection in the Brazilian Amazon region has been partially effective. HIV screening tests and treatment should be made widely available to eradicate HIV infection in the Amazon region by 2030.

Vitamin D-related polymorphisms and vitamin D levels as risk biomarkers of COVID-19 disease severity.

Vitamin D is a fundamental regulator of host defences by activating genes related to innate and adaptive immunity. Previous research shows a correlation between the levels of vitamin D in patients infected with SARS-CoV-2 and the degree of disease severity. This work investigates the impact of the genetic background related to vitamin D pathways on COVID-19 severity. For the first time, the Portuguese population was characterized regarding the prevalence of high impact variants in genes associated with the vitamin D pathways. This study enrolled 517 patients admitted to two tertiary Portuguese hospitals. The serum concentration of 25 (OH)D, was measured in the hospital at the time of patient admission. Genetic variants, 18 variants, in the genes AMDHD1, CYP2R1, CYP24A1, DHCR7, GC, SEC23A, and VDR were analysed. The results show that polymorphisms in the vitamin D binding protein encoded by the GC gene are related to the infection severity (p = 0.005). There is an association between vitamin D polygenic risk score and the serum concentration of 25 (OH)D (p = 0.04). There is an association between 25 (OH)D levels and the survival and fatal outcomes (p = 1.5e-4). The Portuguese population has a higher prevalence of the DHCR7 RS12785878 variant when compared with its prevalence in the European population (19% versus 10%). This study shows a genetic susceptibility for vitamin D deficiency that might explain higher severity degrees in COVID-19 patients. These results reinforce the relevance of personalized strategies in the context of viral diseases.Trial registration: NCT04370808.

Constant-random practice and the adaptive process in motor learning with varying amounts of constant practice.

The adaptive process in motor learning was examined in terms of effects of varying amounts of constant practice performed before random practice. Participants pressed five response keys sequentially, the last one coincident with the lighting of a final visual stimulus provided by a complex coincident timing apparatus. Different visual stimulus speeds were used during the random practice. 33 children (M age=11.6 yr.) were randomly assigned to one of three experimental groups: constant-random, constant-random 33%, and constant-random 66%. The constant-random group practiced constantly until they reached a criterion of performance stabilization--three consecutive trials within 50 msec. of error. The other two groups had additional constant practice of 33 and 66%, respectively, of the number of trials needed to achieve the stabilization criterion. All three groups performed 36 trials under random practice; in the adaptation phase, they practiced at a different visual stimulus speed adopted in the stabilization phase. Global performance measures were absolute, constant, and variable errors, and movement pattern was analyzed by relative timing and overall movement time. There was no group difference in relation to global performance measures and overall movement time. However, differences between the groups were observed on movement pattern, since constant-random 66% group changed its relative timing performance in the adaptation phase.

Sensibility in the relations and interactions of teaching and learning to be and do nursing.

This qualitative study focused on proxemic feelings and feelings of detachment and ambiguity among professors-nurses concerning their experiences. This study aimed to reveal the meanings of sensibility held by being-professor-nurse in teaching and learning to be and do nursing. The theoretical-philosophical support is based on Merleau-Ponty's existential phenomenological approach and the hermeneutics phenomenology of Paul Ricoeur was used. Nineteen professors-nurses from a Higher Education institution in the South of Brazil were interviewed between November and December 2006. Sensibility was revealed as the capacity to observe details in order to intervene in a situation the best way possible, and also as a way to break with exclusive models of the cognitive-instrumental rationality of science and technique, since sensibility is the basis for developing other ways of teaching and learning to be and do Nursing.

[Analytics of ambiguity: methodological strategy to the phenomenological research in health]. / Analítica da ambiguidade: estratégia metódica para a pesquisa fenomenológica em saúde.

The strategy presented in this paper, called Analytics of ambiguity, is connected to the necessity of understanding findings in researches based on Merleau-Ponty's phenomenology. It was developed through a study of descriptions of life experiences from ten family members, members of a Mutual Help Group for caregivers of Alzheimer's patients, conducted at a university in Florianopolis, Santa Catarina, Brazil. Such descriptions were shown through interviews based on intercorporeal experience, during the writing of a Doctoral Dissertation in Nursing. The application of the Analytics of ambiguity to this study is consistent with other similar studies and opens up possibilities for the understanding of findings in phenomenological researches, specifically those based on the experiential ontology of Merleau-Ponty, for it enables us to recognize consciousness as something non-perceptible and perception as an always ambiguous process.

[Systematized care for elders with dementia living in a long-stay institution]. / Cuidado sistematizado a idosos com afeccão demencial residentes em instituição de longa permanência.

This study aimed to systematize a basic model of nursing care based on the taxonomy from the North American Nursing Diagnosis Association (NANDA), tested in elderly patients with dementia affection, living in a Long-Stay Institution (ILPIs) in the countryside of Bahia, Brazil. Nine elder residents were selected at the Institution by the application of the Mini Test on Mental State in two stages, with an interval of six months, which confirmed dementia affection. Data were collected through multidimensional assessment tools for the elder provided by the Ministry of Health. In order to elaborate a caring plan, in accordance with the steps of the nursing process, nursing diagnoses were grouped into four categories: motor behavior cognition and memory, communication and other health physical problems. The caring plans have been implemented and evaluated. Testing and systematization of the basic model from nursing care based on NANDA has been possible among institutionalized demented elder inferring its applicability to other ILPIs.

Deep neck space infection and Lemierre's syndrome caused by Streptococcus anginosus: A case report.

INTRODUCTION: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre's syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. CASE PRESENTATION: A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. CONCLUSION: As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan.