Evaluating the implementation of STD/AIDS prevention activities in primary health care facilities: a case study in Greater Metropolitan São Paulo, Brazil

Desde os anos 1990, a incorporação da prevenção das DST/AIDS na atenção básica é internacionalmente recomendada. No Brasil, investimentos para essa incorporação vêm sendo feitos pelo Ministério da Saúde. Esta pesquisa realiza uma avaliação da implantação dessas atividades, mediante estudo de caso em profundidade, realizado numa unidade de saúde da família da Região Metropolitana de São Paulo. Analisam-se o conjunto das atividades da unidade e aquelas específicas de prevenção das DST/AIDS, por meio de observações diretas e entrevistas semi-estruturadas com profissionais do serviço. Verifica-se que o perfil tecnológico da unidade se assemelha ao dos tradicionais serviços da atenção básica brasileiros, apresentando limitado potencial de concretização do princípio da integralidade. Incorporam-se atividades de prevenção das DST/ AIDS, porém esvaziadas de importantes sentidos tecnológicos, como o diálogo e a atenção à singularidade dos usuários. Esta e outras características revelam um tensionamento entre as propostas tecnológicas do programa e o perfil tecnológico atual da atenção básica. Entretanto, a explicitação desse tensionamento pode favorecer a reflexão sobre novos valores no cotidiano da atenção básica, potencializando a concretização de arranjos tecnológicos mais integrais.Since the 1990s, international guidelines have recommended the incorporation of STD/AIDS prevention in primary care. In Brazil, the Ministry of Health has made investments to include such preventive activities. This in-depth case study is an evaluation of the implementation of these activities in a family health unit in Greater Metropolitan São Paulo. The study analyzed the unit's activities as a whole and the specific STD/ AIDS prevention activities by means of direct observations and semi-structured interviews with the unit's professional health staff. The unit's technological characteristics were similar to those of traditional Brazilian primary care services, with limited potential for achieving the principle of comprehensive care. STD/AIDS prevention activities had been incorporated, but were devoid of important technological meanings like dialogue and specific attention to users' uniqueness. This characteristic and others reveal a tension between the program's technological proposals and the current technological profile of primary care. However, the identification of this tension could favor reflection on new values in routine primary care, thereby favoring the achievement of more comprehensive technological arrangements

Young Women's Experiences of Health and Well-Being in a Postfeminist Social Media Culture: The MeStories Study Protocol

Introduction: To date, there is much controversy in the literature on the impacts of social media use on young women’s health and wellbeing. Alongside the massive popularity of platforms like Instagram and TikTok, the social media culture has become a key mediator of social discourses on health, femininities, bodies, and identities. In contemporary Western societies, the individual pursuit of health is highly valued, related to contemporary forms of governance that emphasize self-regulation, individual responsibility, and individual choice. Furthermore, postfeminist discourses strongly encourage women to engage in constant work on their body, health, and identity. In this context, it is imperative to understand how the contemporary social media culture relates to young women’s health, body, and sense of self. Aims: The overall aim of this study is to understand the role of a new social media culture on narrative constructions of a sense of self among young women in late adolescence, aged 18–20 years old, and, particularly the ways in which such narrative identities relate to experiences and practices involving health and wellbeing. Methods: In this 3-year research we adopt a social constructionist approach in critical health psychology focused on socio-culturally situated practices and meanings involved in the construction of human experience. We adopt a qualitative research approach - consisting of in-depth interviews, focus groups and photo elicitation techniques - with people self-identifying as women. Data analysis will employ both narrative and reflexive thematic analysis. Ethics and dissemination: The study protocol was approved by the Ethics Committee of the University of Lausanne. Findings will be published in scientific journals, presented at meetings, and will serve for public health and educational purposes. Content in form of flyers and posts will be designed to communicate findings to participants via current social media platforms. FNS grant number: 10001F_201142/1

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale : a literature review

A existência de diferentes métodos preventivos que oferecem elevado grau de proteção contra o HIV tem trazido à luz um desafio: como países que proporcionaram ampla cobertura de prevenção e tratamento poderão utilizar novos métodos preventivos para reverter taxas de incidência que permanecem elevadas, até mesmo crescentes, em grupos sociais específicos? Realizamos uma revisão narrativa da literatura com a finalidade de examinar os métodos preventivos e as intervenções estruturais que, no contexto de epidemias concentradas populacional e geograficamente, podem ter maior impacto nas taxas de incidência. Com isso, analisamos o conhecimento acerca do grau de proteção dos diferentes métodos, seus limites e suas potencialidades. O alcance e a efetividade dos métodos têm sido minimizados, notadamente, por barreiras estruturais e psicossociais, como falhas de adesão, uso inconsistente ao longo do tempo ou apenas em situações em que as pessoas se percebem em maior risco. Indivíduos e grupos sociais mais atingidos pela epidemia têm limitado o uso e o não uso de métodos de acordo com seus valores, necessidades identificadas de prevenção e condições de vida. Isso impede que um método isoladamente venha a promover um forte impacto de redução na epidemia. Políticas baseadas na oferta conjunta e na complementaridade entre os métodos, na atenção aos aspectos psicossociais que interferem no seu uso e na redução das barreiras estruturais de acesso poderão ter maior impacto na incidência, especialmente se forem planejadas e implantadas com participação e mobilização social.A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation

A CONVIVÊNCIA FAMILIAR DO PORTADOR DO HIV E DO DOENTE COM AIDS

The present study has the goal to understand how is the family living of people with HIV and AIDS. It is an ethnographic case study in which participant observation and interviews were used. The data collected is organized in cultural domains which were: family living before and after the diagnosis; communicaton process of the pesons with HIV and AIDS and their families; expression of family support after developing aids; family coping with homossexuality. The central focus of the study enphazises feelings of solitude and isolation of these people, and the importance of the support in the adaptation in the new life style. This study demontrates the need of nursing intervention with other health professionals with the families and clients for them to find new ways of life and to make possible humanization of care.O número de pessoas infectadas com o HIV continua em franca ascensão, e a AIDS vem afetando a vida das pessoas e a qualidade das relações humanas, impondo a necessidade de revisão de valores, crenças e até mesmo mudanças de estilo de vida. Preocupa-nos, no presente estudo, compreender a convivência familiar do portador do HIV ou doente com AIDS. Apresentamos um estudo de caso etnográfico, utilizando fases da observação participante e entrevista. Destes extraímos alguns domínios culturais que são: sentimentos em relação à família e à vida antes e depois do diagnóstico; processo de comunicação do portador do HIV/ AIDS com os familiares; expressões de apoio familiar após as manifestações clínicas da AIDS; resistência na aceitação da homossexualidade pela família. O foco central do estudo aponta para os sentimentos de solidão e isolamento do portador do HIV/AIDS e a relevância do suporte familiar no processo de adaptação a uma nova condição de vida. Foram evidenciadas dificuldades no relacionamento entre o portador do HIV/AIDS e seus familiares. Este estudo aponta para a necessidade de atuação da enfermagem, juntamente com outros profissionais da saúde, para que possam oferecer aos familiares, elementos que possibilitem o encontro de caminhos para a humanização da convivência familiar, quando um dos membros é portador do HIV ou doente com AIDS. Tal contexto demanda a adoção de estratégias de intervenção fundamentada em abordagem integral e humanizada, juntamente com outros profissionais,que contemple também o cuidado da família das pessoas que vivem com HIV/AIDS, além delas próprias

Have we improved pain control in cancer patients? A multicenter study of ambulatory and hospitalized cancer patients

Background: Pain in cancer patients is recognized as a major health problem, yet few studies of both inpatient and outpatient populations have been carried out. Objective: The study objective was to assess the frequency, type, and characteristics of pain in adult cancer patients, including both inpatients and outpatients. Methods: This cross-sectional study involved 1064 adult cancer patients (437 outpatients and 627 inpatients) from 44 hospitals and/or long-term-care centers in Catalonia, Spain. Cancer patients suffering from pain of any etiology for >_2 weeks and/or under analgesic treatment >_2 weeks were enrolled. Demographic and pain data were collected. The Spanish version of the Brief Pain Inventory was used to assess pain. Results: Pain frequency was 55.3%. Pain was less frequent in outpatients than inpatients (41.6% versus 64.7%; p<0.001), although median pain duration was longer in outpatients (20 versus 6 weeks; p<0.001). Pain was assessable in 333 patients, and intensity was similar in both out- and inpatients; however, outpatients reported less improvement, less pain interference with daily life, and less pain related to the cancer per se. In both groups, patients with multiple myeloma (73%), breast (65%), and lung cancer (61%) were most likely to report pain. Conclusions: Pain in cancer patients, both ambulatory and hospitalized, remains a challenge for health care professionals, health administrators, and stakeholders. Our study reveals the high level of pain and distress that cancer patients continue to suffer, a problem that is particularly notable in outpatients due to the intensity and duration of the pain

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

O olhar dos e pelos cuidadores : os impactos de cuidar e a importância do apoio ao cuidador

Dissertação de mestrado em Intervenção Social, Inovação e Empreendedorismo, apresentada à Faculdade de Psicologia e Ciências da Educação e à Faculdade de Economia da Universidade de Coimbra, sob a orientação de Cristina Albuquerque.No âmbito do Mestrado em Intervenção Social, Inovação e Empreendedorismo, construiu-se esta tese de dissertação designada “O olhar dos e pelos cuidadores: os impactos de cuidar e a importância do apoio ao cuidador”. Numa ênfase teórica, diversos estudos referem que “burnout”, “burnot”, “sobrecarga”, condição geralmente associada a meios profissionais de “risco” ligados à saúde e à segurança, pode aplicar-se à exaustão física e mental que atinge uma parte significativa de cuidadores informais, tornando pertinente e prioritário reflectir sobre o cuidar e sobre os apoios, de acordo com o seu próprio olhar crítico. Nesse sentido, este trabalho partiu da questão: em que medida o apoio prestado aos cuidadores informais corresponde às suas reais expectativas e está de acordo com o que perspectivam como ideal na prestação de cuidados a dependentes? Começa por contextualizar a problemática da dependência, da prestação de cuidados em geral e seus impactos, recorrendo a fontes de informação diversas. Entretanto descreve o estudo empírico realizado no contexto geográfico do Concelho de Tondela, centrado no cuidador informal principal, primeiro descritivo e orientado para a obtenção de perfis de cuidadores informais que se salientam pela singularidade da sua situação, através de questionário; depois compreensivo, recorrendo à entrevista desse grupo mais restrito de cuidadores e à análise das narrativas individuais. A título de conclusão, pelo olhar dos cuidadores há distinção entre as respostas existentes e as desejáveis. E ao olhar pelos cuidadores, verifica-se que os apoios têm falhas na adequação aos seus contextos e circunstâncias de cuidar, dificultando o personalizar desses apoios e consequentemente dos cuidados

Sex, human rights and AIDS: an analysis of new technologies for HIV prevention in the Brazilian context

ABSTRACTWorldwide, HIV prevention is challenged to change because clinical trials show the protective effect of technologies such as circumcision, preexposure prophylaxis, and the suppression of viral load through antiretroviral treatment. In the face of demands for their implementation on population levels, the fear of stimulating risk compensation processes and of increasing riskier sexual practices has retarded their integration into prevention programs. In this article, following a narrative review of the literature on risk compensation using the PubMed database, we offer a critical reflection on the theme using a constructionist approach of social psychology integrated to the theoretical framework of vulnerability and human rights. The use of biomedical technologies for prevention does not consistently induce its users to the increase of riskier practices, and variations on the specificity of each method need to be carefully considered. Alternatives to the theories of sociocognitive studies, such as social constructionist approaches developed in the social sciences and humanities fields, indicate more comprehensive interpretations, valuing the notions of agency and rights. The critical analysis suggests priority actions to be taken in the implementation process: development of comprehensive programs, monitoring and fostering dialog on sexuality, and technical information. We highlight the need to implement a human rights-based approach and to prioritize dialog, stressing how complementary these technologies can be to meet different population needs. We conclude by stressing the need to prioritize sociopolitical changes to restore participation, dialog about sexuality, and emphasis on human rights such as core elements of the Brazilian AIDS policy