Interventions for families affected by HIV

Family-based interventions are efficacious for human immunodeficiency virus (HIV) detection, prevention, and care, but they are not broadly diffused. Understanding intervention adaptation and translation processes can support evidence-based intervention (EBI) diffusion processes. This paper provides a narrative review of a series of EBI for families affected by HIV (FAH) that were adapted across five randomized controlled trials in the US, Thailand, and South Africa over 15 years. The FAH interventions targeted parents living with HIV and their children or caregiver supports. Parents with HIV were primarily mothers infected through sexual transmission. The EBIs for FAH are reviewed with attention to commonalities and variations in risk environments and intervention features. Frameworks for common and robust intervention functions, principles, practice elements, and delivery processes are utilized to highlight commonalities and adaptations for each location, time period, and intervention delivery settings. Health care, housing, food, and financial security vary dramatically in each risk environment. Yet, all FAH face common health, mental health, transmission, and relationship challenges. The EBIs efficaciously addressed these common challenges and were adapted across contexts with fidelity to robust intervention principles, processes, factors, and practices. Intervention adaptation teams have a series of structural decision points: mainstreaming HIV with other local health priorities or not; selecting an optimal delivery site (clinics, homes, community centers); and how to translate intervention protocols to local contexts and cultures. Replication of interventions with fidelity must occur at the level of standardized functions and robust principles, processes, and practices, not manualized protocols. Adopting a continuous quality improvement paradigm will enhance rapid and global diffusion of EBI for FAH

Analysis of the ethical aspects of professional confidentiality in dental practice

From the point of view of deontological ethics, privacy is a moral right that patients are entitled to and it is bound to professional confidentiality. Otherwise, the information given by patients to health professionals would not be reliable and a trustable relationship could not be established. The aim of the present study was to assess, by means of questionnaires with open and closed questions, the awareness and attitudes of 100 dentists working in the city of Andradina, São Paulo State, Brazil, with respect to professional confidentiality in dental practice. Most dentists (91.43%) reported to have instructed their assistants on professional confidentiality. However, 44.29% of the interviewees showed to act contradictorily as reported talking about the clinical cases of their patients to their friends or spouses. The great majority of professionals (98.57%) believed that it is important to have classes on Ethics and Bioethics during graduation and, when asked about their knowledge of the penalties imposed for breach of professional confidentiality, only 48.57% of them declared to be aware of it. Only 28.57% of the interviewees affirmed to have exclusive access to the files; 67.14% reported that that files were also accessed by their secretary; 1.43% answered that their spouses also had access, and 2.86% did not answer. From the results of the present survey, it could be observed that, although dentists affirmed to be aware of professional confidentiality, their attitudes did not adhere to ethical and legal requirements. This stand of health professionals has contributed to violate professional ethics and the law itself, bringing problems both to the professional and to the patient

Avaliação de campanhas de saúde com ênfase na sífilis congênita: uma revisão sistemática Evaluation of health campaigns with emphasis on congenital syphilis: a systematic review

Campanhas têm sido instrumentos de políticas públicas de saúde, freqüentemente utilizadas no Brasil para esclarecer, motivar ou conseguir o apoio da população e/ou dos profissionais de saúde, em ações relevantes para a saúde pública. Esta revisão procurou levantar subsídios para a avaliação de campanhas de saúde, particularizando-se as metodologias utilizadas, tendo em vista a avaliação de campanhas dirigidas ao controle da sífilis congênita. Os conjuntos de palavras-chave utilizados foram "sífilis congênita + avaliação"; "campanhas de saúde + avaliação" e, "campanha + saúde + avaliação". As bases de dados pesquisadas foram a Medline (Medical Literature Analysis and Retrieval System Online) da National Library of Medicine (EUA), a LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e da PAHO (Pan-American Health Organization), no período de 1980 e 2003. Foram incluídos 37 artigos nessa revisão, sendo 15 referentes à sífilis congênita e avaliação e 22 à campanha de saúde e avaliação. A revisão realizada mostrou que existe um espaço a ser preenchido neste campo, principalmente no que se refere à construção metodológica. Apesar da palavra avaliação constar nesses vários artigos, a fundamentação teórica encontrada não foi totalmente condizente com as propostas apresentadas.<br>Campaigns are healthcare public policies means frequently used in Brazil, to educate, motivate or achieve population and/or healthcare professionals in relevant public health actions. This review pursued the gathering of input to assess health campaigns, specifically the methodologies used, focusing on congenital syphilis control campaigns. Keywords used were "congenital syphilis + assessment", "health campaigns + assessment" and, "campaign + health + assessment". Databases surveyed were Medline (Medical Literature Analysis and Retrieval System Online) of National Library of Medicine, LILACS (Latin American and Caribbean Health Sciences) and PAHO (Pan-American Health Organization), from 1980 to 2003. Thirty seven articles in this review, 15 related to congenital syphilis and assessment and 22 to healthcare campaigns and assessment. Review accomplished indicated a gap to be filled in this field specially related to methodology design. Notwithstanding the word "assessment" inclusion in these articles, the theoretical rationale determined was not consistent with the submitted proposals