RESUMO
Guatemala has a concentrated HIV epidemic disproportionately affecting men who have sex with men (MSM) and transgender women. We recruited 205 self-identified MSM, bisexuals, transvestites, and transgender women in western Guatemala using long-chain peer referral, wherein "seed" participants were asked to invite as many as three acquaintances to participate in the study. Self-reported sexual or gender identity was MSM, 46%; bisexual, 28%; transvestite, 21%, and transgender woman, 5%. Median age of the participants was 23 years, and 36% self-identified as being indigenous. Indigenous persons were more likely to self-identity as transvestite (32.9% vs 13.8%, P = 0.04), strongly perceive themselves at risk for HIV (87.7% vs 51.5%, P = 0.001), have had an HIV test in the last 12 months and know the result (97.3% vs 85.4%, P = 0.008), and experience barriers to testing and treatment (86.3% vs 67.7%, P = 0.004). HIV prevention services for indigenous MSM should especially target transvestites and how to overcome stigmatization and barriers to care.
Assuntos
Infecções por HIV/prevenção & controle , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Adulto , Estudos Transversais , Feminino , Guatemala/epidemiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Percepção , Assunção de Riscos , Adulto JovemRESUMO
Objective: To analyze the reliability, validity and operational equivalence of the nutritional screening method "Assessing The Nutritional Condition Of The Elderly". Method: This study was conducted with a subsample of 174 elderly persons from the Health, Welfare and Aging (SABE) study. The "Assessing The Nutritional Condition Of The Elderly" method consists of ten questions which classify individuals according to nutritional risk. Anthropometric and nutritional indicators were adopted as gold standard measures for comparison with the values of the method. Reliability was verified using the McNemar and Bland Altman tests, the validity of the discriminant type was assessed by the Mann-Whitney test and operational equivalence was identified through data relating to the time required to apply the method and the degree of understanding of the same using the Likert scale (1 to 5). Results: Of the 174 elderly persons interviewed, 63.8% were women and 52.3% were in the 60-74 years age group. It was found that 43.1% and 33.3% of the subjects had moderate to high nutritional risk, respectively, with a higher prevalence of high nutritional risk among women (33.3%) and those aged 60-74 years (43.4%). The method analyzed showed satisfactory results for reliability and discriminant validity. The average time required to apply this method was approximately seven minutes and the overall mean grade of understanding was 4.8. Conclusion: The method studied can be used by health professionals in epidemiological and clinical studies to identify the presence of nutritional risk in elderly persons living at home.
Objetivo: Analisar a confiablidade, a validade e a equivalência operacional do método de triagem nutricional "Verifique a condição nutricional do idoso". Método: Este estudo foi realizado com subamostra de 174 idosos do Estudo Saúde, Bem-estar e Envelhecimento (SABE). O método "Verifique a condição nutricional do idoso", consiste de 10 perguntas, que classifica os indivíduos, segundo risco nutricional. Adotou-se a antropometria e indicadores nutricionais, como medidas padrão-ouro para comparação com os valores desse método. A confiabilidade foi verificada pelo teste de McNemar e gráficos de Bland Altman, a validade do tipo discriminante foi avaliada por meio do teste Mann-Whitney e a equivalência operacional do método foi identificada pelos dados referentes à duração de realização do método e pelo grau de entendimento do mesmo pela escala Likert (entre 1 e 5). Resultados: Dos 174 idosos entrevistados, 63,8% eram mulheres e 52,3% eram do grupo etário de 60 a 74 anos. Constatou-se que 43,1% e 33,3% dos indivíduos apresentavam risco nutricional moderado e alto, respectivamente, sendo maior a prevalência de risco nutricional alto nas mulheres (33,3%) e naqueles do grupo de 60 a 74 anos (43,4%). O método analisado apresentou resultados satisfatórios para confiabilidade e validade discriminante. A duração média de realização do método foi de aproximadamente sete minutos e nota média geral de entendimento foi de 4,8. Conclusão: O método estudado pode ser utilizado em estudos epidemiológicos e clínicos, por profissionais de saúde, para identificar a presença de risco nutricional em idosos domiciliados.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Avaliação Nutricional , Reprodutibilidade dos Testes , Estudo de Validação , Nutrição do IdosoRESUMO
Resumo O objetivo deste artigo é descrever o processo de adaptação transcultural do método de triagem nutricional, Determine Your Nutritional Health® (DNH), para utilização na população idosa brasileira. O DNH consiste de 10 questões com enunciados afirmativos, às quais são atribuídas pontuações específicas e cuja soma corresponde ao escore final, que classifica os indivíduos de acordo com a presença ou a ausência de risco nutricional. O processo de adaptação transcultural do método DNH envolveu as seguintes etapas: tradução; retrotradução; equivalência semântica; avaliação dos especialistas; pré-teste e versão final do método. Foram realizadas adaptações de palavras e expressões do método DNH, para a realidade brasileira. A versão final do método foi definida para o Brasil como "Verifique a condição nutricional do idoso", apresentando as mesmas questões da versão original do DNH, contudo, em formato mais claro, por meio de perguntas, consideradas acessíveis e de fácil entendimento, segundo a avaliação de profissionais de saúde e de idosos. A versão brasileira do método de triagem nutricional, "Verifique a condição nutricional do idoso", encontra-se traduzida e adaptada para uso em idosos brasileiros domiciliados.
Abstract This article aims to describe the process of cross-cultural adaptation of the Determine Your Nutritional Health® (DNH) screening method for the elderly Brazilian population. The DNH consists of 10 questions with affirmative statements, to which specific scores are assigned and when added up correspond to the final score, which classifies individuals according to the presence or absence of nutritional risk. The process of cross-cultural adaptation of the DNH method involved the following stages: translation; back translation; semantic equivalence; evaluation by the experts; pre-test and final version of the method. Adjustments were made in words and expressions of the DNH method for the Brazilian reality. The final version of the method has been defined for Brazil as "Verify the nutritional conditions of the elderly," presenting the same questions as in the original version of the DNH. It was in a clearer format, through questions, considered accessible and easy to understand, according to the assessment of health professionals and the elderly. The Brazilian version of the nutritional screening method, "Verify nutritional conditions of the elderly," was translated and adapted, for use in Brazilian elderly in assisted living accommodation.
RESUMO
BACKGROUND: Kleptomania is characterized by repetitive stealing and has severe consequences for patients. Stigma, a lack of standardized therapy and a limited number of assessment tools hinder advances in treatment. This study provides preliminary data on the Portuguese-language version of the Kleptomania Symptom Assessment Scale (P-K-SAS) and preliminary data on an outpatient program. METHODS: Experts in the field analyzed an initial P-K-SAS version, produced through translation/back-translation, in order to arrive at a final version. Eight patients currently on cognitive-behavioral therapy (CBT) and 10 patients under maintenance CBT were initially assessed, then re-assessed 6months later. RESULTS: The mean P-K-SAS score was higher among patients initiating CBT than among those under maintenance CBT (21.1±8.0 vs. 11.3±7.5; Mann-Whitney U=15.0, P=.024). The final version of the P-K-SAS presented excellent reliability (Cronbach's alpha=0.980; inter-item correlation, 0.638-0.907). CONCLUSIONS: The P-K-SAS presented solid psychometrics and seems ready for use in assessing the effectiveness of treatments for kleptomania. The findings suggest that kleptomania patients need follow-up treatment that goes beyond the traditional 12-session structure.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/terapia , Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Adulto , Brasil/etnologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Reprodutibilidade dos Testes , Avaliação de Sintomas , Resultado do TratamentoRESUMO
HIV and sexually transmitted infection (STI) are of concern in Mayan districts of Guatemala in which labor migration is common. This study assessed whether the migration status of men is associated with reported STI symptoms among their female primary partners. In a multivariate analysis of survey data taken from a larger Mayan sexual health study, the odds of reporting STI symptoms were twofold higher among women who reported that their partner migrated (OR 2.08, 95 % CI, 1.16-3.71), compared to women whose partners did not. Women from the Mam and Kaqchikel ethnolinguistic groups reported higher rates of STI symptoms after adjustment for their partners' migration status.
Assuntos
População Rural , Comportamento Sexual/etnologia , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/etnologia , Migrantes/estatística & dados numéricos , Populações Vulneráveis/etnologia , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Cultura , Feminino , Guatemala/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Infecções Sexualmente Transmissíveis/psicologia , Infecções Sexualmente Transmissíveis/transmissão , Fatores Socioeconômicos , Populações Vulneráveis/psicologia , Adulto JovemRESUMO
Resource-limited settings have made slow progress in integrating TB and HIV care for co-infected patients. We examined the impact of integrated TB/HIV care on clinical and survival outcomes in rural western Guatemala. Prospective data from 254 newly diagnosed TB/HIV patients (99 enrolled in the pre-integrated program from August 2005 to July 2006, and 155 enrolled in the integrated program from February 2008 to January 2009) showed no significant baseline differences between clients in the two periods. They were principally male (65.5 %), Mayan (71 %), median age 33 years, and CD4 count averaged 111 cells/mm³. TB/HIV co-infected patients were more likely to receive antiretroviral therapy in the integrated program than in the pre-integrated program (72 vs. 22 %, respectively) and had lower mortality (HR 0.22, 95 % CI 0.140.33). This study shows how using a TB setting as the entry point for integrated TB/HIV care can improve health outcomes for HIV-positive patients in rural Guatemala.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Avaliação de Programas e Projetos de Saúde , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coinfecção/epidemiologia , Prestação Integrada de Cuidados de Saúde/métodos , Feminino , Guatemala/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Desenvolvimento de Programas/métodos , Estudos Prospectivos , Serviços de Saúde Rural/organização & administração , População Rural , Análise de Sobrevida , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/mortalidade , Adulto JovemRESUMO
This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.
Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/diagnóstico , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.
Analisaram-se dados de duas coortes retrospectivas consecutivas (1983-1998, 1999-2002) de crianças brasileiras com AIDS (n = 1.758), expostas ao HIV por transmissão vertical. Ocorrência de diagnóstico tardio (categoria C-CDC) foi verificada para: ano de nascimento, ano de diagnóstico da infecção e períodos relacionados a mudanças das diretrizes terapêuticas governamentais. Encontramos 731 (41,6%) crianças com diagnóstico em estágio tardio, especialmente com < 1 ano de idade. No segundo período o desempenho do diagnóstico melhorou (36 vs. 48% de atraso diagnóstico no primeiro período). Verificou-se melhoria da proporção de crianças com diagnóstico tardio e do tempo entre o diagnóstico da infecção e a introdução da terapia antirretroviral. Ano de nascimento (OR = 0,62; p = 0,009) e ano de diagnóstico da infecção (OR = 0,72; p = 0,002/OR = 0,62; p < 0,001) mais recentes estiveram significativamente associados a diagnóstico oportuno. Crianças com idade < 1 ano tiveram maior risco para diagnóstico tardio do que as mais velhas (OR = 1,70; p = 0,004). Apesar dos avanços, há necessidade de potencializar diagnóstico e manejo oportunos.
Se analizaron datos de dos cohortes retrospectivas consecutivas (1983-1998, 1999-2002) de niños brasileños con SIDA (N = 1.758), expuestos al VIH por transmisión vertical. La ocurrencia de diagnóstico tardío (categoría C-CDC) fue verificada para: año de nacimiento, año de diagnóstico de la infección y períodos relacionados con cambios de las directrices terapéuticas gubernamentales. Hubo 731 (41,6%) niños con diagnóstico en estadio tardío, especialmente con < 1 año de edad. En el segundo período el desempeño del diagnóstico mejoró (36 versus 48% de atraso diagnóstico). Se verificó una mejoría de la proporción de niños con diagnóstico tardío y del tiempo entre diagnóstico de la infección e introducción de la terapia antirretroviral. Los años de nacimiento (OR = 0,62; p = 0,009) y años de diagnóstico de la infección (OR = 0,72; p = 0,002/OR = 0,62; p < 0,001) más recientes estuvieron significativamente asociados a un diagnóstico oportuno. Los niños con edad < 1 año tuvieron mayor riesgo para un diagnóstico tardío que los más viejos (OR = 1,70; p = 0,004). A pesar de los avances, existe una necesidad de potenciar el diagnóstico y tratamientos oportunos.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/diagnóstico , Brasil/epidemiologia , Estudos de Coortes , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Estudos RetrospectivosRESUMO
This study aimed to describe the translation into Brazilian Portuguese and the analysis of conceptual, semantic, and instrumental equivalences and assessment of internal consistency of the Male Body Dissatisfaction Scale (MBDS). The study included the steps of (1) translation; (2) synthesis of translation; (3) back-translation; (4) review by experts - judges - analysis of the semantic and instrumental equivalences; (5) pre-test - assessment of verbal understanding of the instrument by specialists and male students; (6) analysis of the internal consistency by Cronbach's α coefficient. The MBDS was translated and adapted into Brazilian Portuguese maintaining its original 25 items, showed good verbal comprehension, and had an internal consistency coefficient of 0.92. The scale was translated and adapted with satisfactory results, thus confirming its initial psychometric qualities. The instrument requires further analysis of internal and external validity, and reproducibility.
Assuntos
Imagem Corporal , Semântica , Inquéritos e Questionários , Tradução , Brasil , Comparação Transcultural , Humanos , Masculino , TraduçõesRESUMO
With the increase in research on the components of Body Image, validated instruments are needed to evaluate its dimensions. The Body Change Inventory (BCI) assesses strategies used to alter body size among adolescents. The scope of this study was to describe the translation and evaluation for semantic equivalence of the BCI in the Portuguese language. The process involved the steps of (1) translation of the questionnaire to the Portuguese language; (2) back-translation to English; (3) evaluation of semantic equivalence; and (4) assessment of comprehension by professional experts and the target population. The six subscales of the instrument were translated into the Portuguese language. Language adaptations were made to render the instrument suitable for the Brazilian reality. The questions were interpreted as easily understandable by both experts and young people. The Body Change Inventory has been translated and adapted into Portuguese. Evaluation of the operational, measurement and functional equivalence are still needed.