Uma trajetória acadêmica nos estudos de gênero: entrevista com Ana Maria Colling

A entrevistada Ana Maria Colling é uma das pioneiras na àrea dos Estudos da Mulher e dos Estudos de Gênero no Rio Grande do Sul. Na entrevista procuramos traçar parte da sua trajetória acadêmica e de vida perspassada tanto pelas questões de gênero quanto pelo período da ditadura militar

Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil

<p>Abstract</p> <p>Background</p> <p>Proper knowledge of HIV transmission is not enough for people to adopt protective behaviors, but deficits in this information may increase HIV/AIDS vulnerability.</p> <p>Objective</p> <p>To assess drug users' knowledge of HIV/AIDS and the possible association between knowledge and HIV testing.</p> <p>Methods</p> <p>A Cross-sectional study conducted in 2006/7 with a convenience sample of 295 illicit drug users in Rio de Janeiro, assessing knowledge on AIDS/HIV transmission and its relationship with HIV testing. Information from 108 randomly selected drug users who received an educational intervention using cards illustrating situations potentially associated with HIV transmission were assessed using Multidimensional Scaling (MDS).</p> <p>Results</p> <p>Almost 40% of drug users reported having never used condoms and more than 60% reported not using condoms under the influence of substances. Most drug users (80.6%) correctly answered that condoms make sex safer, but incorrect beliefs are still common (e.g. nearly 44% believed HIV can be transmitted through saliva and 55% reported that HIV infection can be transmitted by sharing toothbrushes), with significant differences between drug users who had and who had not been tested for HIV. MDS showed queries on vaginal/anal sex and sharing syringes/needles were classified in the same set as effective modes of HIV transmission. The event that was further away from this core of properly perceived risks referred to blood donation, perceived as risky. Other items were found to be dispersed, suggesting inchoate beliefs on transmission modes.</p> <p>Conclusions</p> <p>Drug users have an increased HIV infection vulnerability compared to the general population, this specific population expressed relevant doubts about HIV transmission, as well as high levels of risky behavior. Moreover, the findings suggest that possessing inaccurate HIV/AIDS knowledge may be a barrier to timely HIV testing. Interventions should be tailored to such specific characteristics.</p

Physical activity in pregnant women receiving care in primary health care units

OBJETIVO Analisar o padrão de atividade física de gestantes de baixo risco e os fatores associados. MÉTODOS Estudo transversal com 256 gestantes adultas no segundo trimestre gestacional, sorteadas dentre as assistidas pelas unidades de atenção primária à saúde do município de Botucatu, SP, em 2010. As atividades físicas foram investigadas por meio do “pregnancy physical activity questionnaire”, verificando-se tempo e intensidade de atividades ocupacionais, de deslocamento, domésticas e de lazer, expressos em equivalentes metabólicos dia. As gestantes foram classificadas segundo nível de atividade e em relação a atingir 150 min/semana de atividades físicas de lazer, variáveis dependentes do estudo. A associação entre essas variáveis e as socioeconômicas, características maternas, fatores comportamentais e modelo de atenção da unidade de saúde foi avaliada mediante modelos de regressão de Poisson com variância robusta, adotando-se modelo hierárquico. RESULTADOS A maior parte das gestantes era insuficientemente ativa (77,7%), 12,5% moderadamente ativa e 9,8% vigorosamente ativa. Os maiores gastos diários de energia foram com atividades domésticas, seguidas pelas atividades de locomoção; 10,2% atingiram a recomendação de 150 min semanais de atividades físicas de lazer. Trabalho fora de casa reduziu a chance de atingir essa recomendação (RP = 0,39, IC95% 0,16;0,93). Ter tido pelo menos um parto anterior (RP = 0,87, IC95% 0,77;0,99) e excesso ponderal pré-gestacional (RP = 0,85, IC95% 0,731;0,99) reduziram a chance de ser insuficientemente ativa, enquanto consumir menos alimentos saudáveis teve aumento discreto (RP = 1,18, IC95% 1,02;1,36). CONCLUSÕES Gestantes assistidas na atenção primária à saúde são insuficientemente ativas. Ter tido pelo menos um parto e apresentar sobrepeso pré-gestacional foram identificados como fatores protetores contra tal situação, enquanto consumo menos frequente de alimentos saudáveis foi fator de risco, sugerindo aglomeração de fatores de risco à saúde.OBJETIVO Analizar el patrón de actividad física de gestantes de bajo riesgo y los factores asociados. MÉTODOS Estudio transversal con 256 gestantes adultas en el segundo trimestre de gestación, sorteadas entre las atendidas por las unidades de asistencia primaria de la salud del municipio de Botucatu, SP, Brasil, en 2010. Las actividades físicas fueron investigadas por medio del “pregnancy physical activity questionnaire”, verificándose tiempo e intensidad de actividades ocupacionales, de traslado, domésticas y de disfrute, expresados en equivalentes metabólicos por día. Las gestantes fueron clasificadas según nivel de actividad y si alcanzaron 150 min/semana de actividades físicas de disfrute, variables dependientes del estudio. La asociación entre las variables y las socioeconómicas, características maternas, factores conductuales y modelo de atención de la unidad de salud fue evaluada mediante modelos de regresión de Poisson con varianza robusta, adoptándose modelo jerárquico. RESULTADOS La mayor parte de las gestantes era insuficientemente activa (77,7%); 12,5% moderadamente activa y 9,8% vigorosamente activa. Los mayores gastos diarios de energía fueron con actividades domésticas, seguidas por las actividades de locomoción; 10,2% alcanzaron la recomendación de 150 min semanales de actividades físicas de disfrute. Trabajo fuera de casa redujo el chance de alcanzar esa recomendación (RP= 0,39, IC95% 0,16;0,93). Haber tenido por lo menos un parto anterior (RP= 0,87, IC95% 0,77;0,99) y exceso ponderado pre-gestacional (RP= 0,85, IC95% 0,731;0,99) redujeron el chance de ser insuficientemente activa, mientras que consumir menos alimentos saludables tubo un aumento discreto (RP=1,18, IC95% 1,02;1,36). CONCLUSIONES Gestantes atendidas en la asistencia primaria de la salud son insuficientemente activas. Haber tenido por lo menos un parto y presentar sobrepeso pre-gestacional fueron identificados como factores protectores contra tal situación, mientras que el consumo menos frecuente de alimentos saludables fue factor de riesgo, sugiriendo aglomeración de factores de riesgo para la salud.OBJECTIVE To describe physical-activity patterns of low-risk pregnant women and investigate associated factors. METHODS This is a cross-sectional study based on a sample (n = 256) of adult pregnant women in their 2ndtrimester. The participants were randomly selected among those attending primary health care units in Botucatu in Sao Paulo State in 2010. Physical activities were investigated by using the pregnancy physical activity questionnaire and by analyzing the time and intensity of the following activities: occupational, commuting, household and leisure, expressed in metabolic equivalents/day. The pregnant women were classified according to their level of physical activity and to achieving 150 minutes/week of leisure physical activities, which were the dependent variables in the study. The association between such variables and socioeconomic variables, maternal characteristics, behavioral factors and the care model in the health care unit was evaluated by Poisson regression models with robust variance and by adopting the hierarchical model. RESULTS Most pregnant women were insufficiently active (77.7%); 12.5% were moderately active and 9.8% were vigorously active. The highest daily energy expenditure was in carrying out household activities, followed by commuting activities. Only 10.2% of them followed the recommendation, successfully achieving 150 minutes of leisure physical activities per week. Having a job outside of the home reduced the chance of achieving such recommendation (OR = 0.39, 95%CI 0.16;0.93). Having at least one previous delivery (OR = 0.87, 95%CI 0.77;0.99) and being overweight pre-pregnancy (OR = 0.85, 95%CI 0.731;0.99) reduced the chance of being insufficiently active whereas consuming healthy foods less frequently slightly increased it: OR = 1.18, 95%CI 1.02;1.36. CONCLUSIONS Pregnant women who were cared for in primary health care units were insufficiently active. Having at least one previous delivery and being overweight pre-pregnancy were identified as protective factors against such condition. Less frequent intake of healthy foods was found to be a risk factor, therefore suggesting a cluster of health risk factors

Iniciativa STROBE: subsídios para a comunicação de estudos observacionais

Freqüentemente, a descrição de pesquisas de natureza observacional é inadequada, dificultando a avaliação de seus pontos fracos e fortes e, em conseqüência, a generalização de seus resultados. A iniciativa denominada Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), formulou uma lista de verificação que contém 22 itens, denominada STROBE Statement ("Declaração STROBE"), com recomendações sobre o que deveria ser incluído em uma descrição mais precisa e completa de estudos observacionais. Entre junho e dezembro de 2008, um grupo de pesquisadores brasileiros dedicou-se à tradução e adaptação da "Declaração STROBE" para o português. O objetivo do estudo foi apresentar a tradução para o português, bem como introduzir a discussão sobre o contexto de utilização, as potencialidades e limitações da Iniciativa STROBE.El objetivo del artículo fue estimar la prevalencia de extremos antropométricos indicativos del estado nutricional de niños. Se realizó estudio transversal con muestra probabilística de 1.386 niños menores de cinco años del estado de Alagoas. Las prevalencias de déficit (z< -2; patrón de la Organización Mundial de Salud - 2006) para los índices peso-para-edad (bajo peso), peso-para-altura (flacura) y altura-para-edad (déficit estatural) fueron, respectivamente, 2,9% (n=40), 1,2% (n=17) y 10,3% (n=144). El exceso de peso-para-altura (sobrepeso) acometió 135 niños (9,7%). Se concluyó que las prevalencias de bajo peso y flacura son epidemiológicamente irrelevantes y que el déficit estatural y el sobrepeso prevalecen con idéntica magnitud.Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative

Risco frente ao HIV/Aids entre mulheres trabalhadoras do sexo que usam crack no sul do Brasil

OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.OBJETIVO: Comprender el contexto social en el cual están insertadas trabajadoras del sexo que usan crack y su impacto en la adopción de comportamientos de riesgo frente al HIV/Sida. MÉTODOS: Se realizó estudio cualitativo en Foz de Iguacu (Sur de Brasil), en 2003. Se realizaron 26 encuestas con profundidad y dos grupos focales con trabajadoras del sexo que utilizan crack frecuentemente. También se realizaron encuestas con profundidad con profesionales de la salud, líderes comunitarios y gerentes de políticas públicas, además de observaciones de campo. Los datos transcritos fueron codificados con ayuda del software Atlas.ti y el método grounded theory (teoría fundamentada en datos) fue utilizada para analizar los datos y desarrollar un modelo conceptual como resultado de estudio. ANÁLISIS DE LOS RESULTADOS: Las trabajadoras del sexo que utilizan crack presentaron baja autopercepción del riesgo frente al HIV, a pesar de estar relacionadas con comportamientos de riesgo, como sexo desprotegido con múltiples parejas. Experiencias de violencia física y sexual con clientes, parejas ocasionales y estables fueron bastante frecuentes entre estas mujeres, perjudicando la negociación y el uso consistente de preservativos. Según los profesionales de la salud, los líderes comunitarios y los gerentes de políticas públicas, diversas trabajadoras del sexo usuarias de crack, viven en las calles o en barrios, raramente tienen acceso a los servicios de salud, de consejos y exámenes anónimos, de apoyo social y de salud reproductiva y pre-natal. CONCLUSIONES: Las profesionales del sexo que utilizan crack experimentaron varios problemas sociales y de salud que parecen influenciar sobre el riesgo a la infección por el HIV. Intervenciones de bajo umbral, amigables y dirigidas para cuestiones de género deben ser implementadas buscando facilitar el acceso a servicios de salud y de apoyo social en esa población. Tales iniciativas podrán también facilitar el acceso de ese grupo a servicios dirigidos a la salud reproductiva en general y estrategias específicamente dirigidas a la prevención del HIV/Sida y otras infecciones sexualmente transmisibles.OBJETIVO: Compreender o contexto social no qual estão inseridas trabalhadoras do sexo que usam crack e seu impacto na adoção de comportamentos de risco frente ao HIV/Aids. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo realizado em Foz do Iguaçu (PR), em 2003. Foram realizadas 26 entrevistas em profundidade e dois grupos focais com trabalhadoras do sexo que utilizam crack freqüentemente. Também foram realizadas entrevistas em profundidade com profissionais de saúde, líderes comunitários e gerentes de políticas públicas, além de observações de campo. Os dados transcritos foram codificados com auxílio do software Atlas.ti e a metodologia grounded theory (teoria fundamentada em dados) foi utilizada para analisar os dados e desenvolver um modelo conceitual como resultado do estudo. ANÁLISE DOS RESULTADOS: As trabalhadoras do sexo que utilizam crack apresentaram baixa autopercepção de risco frente ao HIV, apesar de estarem envolvidas em comportamentos de risco, como sexo desprotegido com múltiplos parceiros. Experiências de violência física e sexual com clientes, parceiros ocasionais e estáveis foram bastante freqüentes entre estas mulheres, prejudicando a negociação e o uso consistente de preservativos. Segundo profissionais de saúde, líderes comunitários e gerentes de políticas públicas, diversas trabalhadoras do sexo usuárias de crack, são moradoras de rua ou favelas, raramente acessam serviços de saúde, de aconselhamento e testagem anônimos, de apoio social e de saúde reprodutiva e pré-natal. CONCLUSÕES: As profissionais do sexo que utilizam crack vivenciam vários problemas sociais e de saúde que parecem influenciar o risco à infecção pelo HIV. Intervenções de limiar baixo, amigáveis e voltadas para questões de gênero devem ser implementadas objetivando facilitar o acesso a serviços de saúde e de apoio social nessa população. Tais iniciativas poderão também facilitar o acesso deste grupo a serviços voltados para saúde reprodutiva em geral e estratégias especificamente voltadas para prevenção do HIV/Aids e demais infecções sexualmente transmissíveis

[anthropometric Measures For The Introduction Of The Nasogastric Tube For Enteral Nutrition Employing The Esophagogastroduodenoscopy].

The correct placement of a nasogastric tube for enteral nutrition is subject of several investigations, demonstrating the controversy of the procedure. To establish an external measure that can correspond to the internal measurement which determines the insertion length of nasogastric feeding tube up to the stomach. External measures were obtained between points: nose tip vs earlobe vs xiphoid appendix vs umbilicus and height correlated with the standard measures obtained from patients undergoing diagnostic esophagogastroduodenoscopy. It was found a significative statistical correlation between esophagogastric junction, identified during the esophagogastroduodenoscopy, with the distance measured between the anatomic points of the earlobe and xiphoid appendix (r= 0.75) and from this line with the orthostatic height (r=0.72). The distance between the earlobe to the xiphoid appendix (0.75) and the distance between the earlobe to the xiphoid appendix to the midpoint of the umbilicus, subtracting the distance from tip of nose to earlobe, were safe anatomical parameters to reach the esophagogastric junction. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach.26107-1

HIV, HCV, HBV, and syphilis among transgender women from Brazil: Assessing different methods to adjust infection rates of a hard-to-reach, sparse population.

Different sampling strategies, analytic alternatives, and estimators have been proposed to better assess the characteristics of different hard-to-reach populations and their respective infection rates (as well as their sociodemographic characteristics, associated harms, and needs) in the context of studies based on respondent-driven sampling (RDS). Despite several methodological advances and hundreds of empirical studies implemented worldwide, some inchoate findings and methodological challenges remain. The in-depth assessment of the local structure of networks and the performance of the available estimators are particularly relevant when the target populations are sparse and highly stigmatized. In such populations, bottlenecks as well as other sources of biases (for instance, due to homophily and/or too sparse or fragmented groups of individuals) may be frequent, affecting the estimates.In the present study, data were derived from a cross-sectional, multicity RDS study, carried out in 12 Brazilian cities with transgender women (TGW). Overall, infection rates for HIV and syphilis were very high, with some variation between different cities. Notwithstanding, findings are of great concern, considering the fact that female TGW are not only very hard-to-reach but also face deeply-entrenched prejudice and have been out of the reach of most therapeutic and preventive programs and projects.We cross-compared findings adjusted using 2 estimators (the classic estimator usually known as estimator II, originally proposed by Volz and Heckathorn) and a brand new strategy to adjust data generated by RDS, partially based on Bayesian statistics, called for the sake of this paper, the RDS-B estimator. Adjusted prevalence was cross-compared with estimates generated by non-weighted analyses, using what has been called by us a naïve estimator or rough estimates

Knowledge, perceived stigma, and care-seeking experiences for sexually transmitted infections: a qualitative study from the perspective of public clinic attendees in Rio de Janeiro, Brazil

BACKGROUND: An estimated 12 million sexually transmitted infections (STIs) are documented in Brazil per year. Given the scope of this public health challenge and the importance of prompt treatment and follow-up counseling to reduce future STI/HIV-related risk behavior, we sought to qualitatively explore STI clinic experiences among individuals diagnosed with STIs via public clinics in Rio de Janeiro, Brazil. The study focused on eliciting the perspective of clinic users with regard to those factors influencing their STI care-seeking decisions and the health education and counseling which they received during their clinic visit. METHODS: Thirty semi-structured interviews were conducted with heterosexual men and women and men who have sex with men presenting with STIs at two public clinics. Content analysis was conducted by coding transcripts of audio-taped interviews for key domains of interest and comparing and synthesizing code output across participants and sub-groups. Thematic narratives were then developed per each of the study sub-groups. RESULTS: Salient themes that emerged from participant narratives included the importance of low STI-related knowledge and high perceived stigma, both STI-related and other types of social stigma, on STI care-seeking delays. However, there are indications in the data that the level of STI-related knowledge and the amount and types of stigma experienced vary across the study sub-groups suggesting the need for further research on the significance and program relevance of these potential differences. Interview findings also suggest that such barriers to care seeking are not adequately addressed through ongoing health education and counseling efforts at public STI clinics and in turn critical opportunities for STI/HIV prevention are currently being missed. CONCLUSION: Information, communication and education regarding early recognition and prompt care-seeking for STIs should be developed, with consideration given to the possibility of tailoring messages tailored to specific sub-groups. To promote prompt treatment-seeking, interventions must also address both STI-specific and other forms of social stigma which may limit access to care. Efforts to further assess and respond to barriers related to the delivery of quality health education and counseling within the context of public STI clinics are also needed