Iniciação sexual e fatores associados: um estudo com adolescentes escolares

A iniciação sexual é um marco significativo na vida do indivíduo, ocorrendo geralmente na adolescência. Importantes transformações biopsicossociais ocorrem nesta fase, denotando vulnerabilidades à vida do adolescente, dentre elas, as decorrentes da iniciação sexual, sendo o risco de infecção pelo HIV/aids a mais grave. A infecção pelo HIV/aids constitui atualmente um importante problema de Saúde Pública, estando os jovens no centro da epidemia mundial. No Brasil, dados do último boletim epidemiológico, lançado em 2013, apontam para a tendência de aumento de sua prevalência na população jovem. Desta forma, o presente estudo teve por objetivo investigar a associação entre iniciação sexual e o perfil sociodemográfico, o indicador de conhecimento das formas de transmissão do HIV/aids e fatores biopsicossociais autoestima e habilidades sociais, em adolescentes de 16 a 19 anos, de ambos os sexos, estudantes do nível médio técnico integrado, do Instituto Federal de Educação, Ciências e Tecnologia do Rio Grande do Norte, Campus Natal. Trata-se de um estudo transversal, cuja amostra foi constituída aleatoriamente por 200 alunos que responderam de forma anônima a quatro instrumentos: perfil sociodemográfico, questionário da Pesquisa de Conhecimentos, Atitudes e Práticas na População Brasileira (PCAP), Escala de Autoestima de Rosenberg e o Inventário de Habilidades Sociais para Adolescentes de Del-Prette (IHSA). A análise estatística dos dados foi realizada através do teste qui-quadrado de Pearson e do exato de Fisher (α <5%). A média de idade para a primeira relação sexual foi de 15,96 anos, com o início mais cedo para o sexo masculino. Verificou-se associações estatisticamente significativas entre iniciação sexual e as seguintes variáveis: idade, sexo, situação conjugal, religião, renda familiar, autoestima e o repertório de habilidades sociais. Observou-se ainda que apenas 11% dos adolescentes possuíam conhecimento correto acerca das formas de transmissão do HIV/aids. Conclui-se que os esforços para a prevenção das DST/aids precisam ser direcionados a campanhas e programas mais eficazes, que considerem não somente o caráter informativo, mas também os fatores psicossociais já que estes mostraram-se associados ao início da vida sexual

Indicadores e fatores preditivos de uso abusivo de álcool em adultos jovens

The abusive use of alcohol is closely related to dependence and to social and work damages. The main focus of this thesis is to create an instrument about alcohol abuse, in order to differentiate the degree of commitment of the symptomatology, considering its psychosocial factors of prediction. As specific goals: I) characterize the state of the art about assessment related to the abuse and dependence to alcohol; II) investigate and systematize aspects related to the predictive psychosocial factors for alcohol dependence; III) build an instrument for the assessment of alcohol abuse and protection and risk factors for the development of an alcohol dependence; and IV) verify validity evidence of the instrument built for the Brazilian population. In Study I, it was possible to observe the prevalence of articles related to the use of alcohol in a problematic way, without a classification dependence, it is lower than the one of articles that investigate the disease when it is already manifested, not to mention a few systematic studies about the theme of alcohol abuse in the scientific environment. In Study II, focus groups (FGs) were conducted, the analysis about the discourses of the focus groups were made through the ALCESTE software and it was possible to observe a response pattern that existed among the participants in different groups, with the generation of five classes. In Study III, we developed an instrument that contemplated aspects of the Alcohol Dependence Syndrome of the Millon Clinical Multiaxial Inventory-III, in addition to the characteristics defined in Study I and in Study II. The final version of the instrument had 59 items assessed through the likert scale of five points. In Study IV, the administration of the instrument was performed in an online format with university students ranging from 18 to 24 years old, residents in Brazilian metropolitan cities. The results evidenced that the internal consistency of the instrument is considered satisfactory (α = 0,882) and in what it refers to classes, the most significant data was the one related to financial loss and criteria for the diagnosis of alcohol abuse. It is important to consider the evaluative potential of risk and protective factors for the development of alcohol dependence of the instrument as a whole. Once the indicators of abuse and the profile of the abusers has been modified, the patient may have his/her treatment/intervention focused on the trouble and/or specific syndrome, thus having a clear and fast improvement.

Consumo privado de ansiolíticos benzodiazepínicos e sua correlação com indicadores sociodemográficos nas capitais brasileiras

This work aims to analyze the distribution of anxiolytics and their frequency of consumption in the period of 2010 to 2012, on the Federal District and at other Brazilian cities, as well as evaluating the correlation between such consumption and its demographic, epidemiological, economic and social characteristics for each region of this study. Into the analysis, it was observed that social, economic and cultural factors seem to influence the over-consumption of these drugs in many countries. Based on this, the benzodiazepines (BDZs) have achieved great popularity among members of the medical community and among the general population, mainly because of its safety and effectiveness in controlling symptoms of anxiety, insomnia and convulsions. Concerning the methodology of this work, an ecological study was performed having as sampling Brazilian capitals and as data source the 2010 Population Census, as well as information from IBGE, DATASUS and ANVISA. Still in the case of the methodological procedure, a multiple linear regression was used. Through descriptive analysis, it was demonstrated that the Northern region has the lowest average on consumption of these drugs (being 0.24 DHD in Manaus); meanwhile in the capitals of the Southeast, higher means were identified (reaching 7.29 DHD in Belo Horizonte), with a national average of 3.04 DHD. Among the drugs analyzed, it was found that Alprazolam is the most dispensed by pharmacies and private drugstores, averaging 2.00 DHD for Brazilian capitals. A análise de regressão linear múltipla mostrou que 76% da variação no consumo foi explicada pela variação da densidade populacional (β = 0,310 p = 0,045) e pela percentagem de médicos (β = 0,507 p = 0,016). Therefore, it was concluded that the consumption of anxiolytics of short half-life has been increasing over the years, mainly in the cities of greater population density and with the highest concentration of doctors

Interações físicas e psicossociais em mulheres com fibromialgia

Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome of unknown etiology, with symptoms of diffuse musculoskeletal pain and presence of specific anatomic sites called tender points. The symptoms are often associated with fatigue, sleep disturbances, morning stiffness, alterations in pain perception, anxiety and depression. Fibromyalgia exhibits a correlation between physical and behavioral symptoms, which have a negative influence on the quality of life of patients. Emotional skills are important factors since they are related to subjective well-being, personal productivity, social interaction and interpersonal relationships. We aim to describe the physical and psychosocial interactions in women with FM, showing the association between perceived social support and affect with symptoms of pain, functionality and mood. We will also describe a body representation of pain in women with FM. Data were collected over 3 years and the sample size ranged between studies. This is an exploratory cross-sectional study conducted with a convenience sample of 63 women with FM and 42 healthy women as a control group (CT), aged 20-76 years, recruited through spontaneous demand at Onofre Lopes University Hospital (HUOL) and the Clinical School of Physiotherapy of Universidade Potiguar (UNP). The Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Social Support Scale (MOS), Hamilton Anxiety Scale and Scale of Positive and Negative Affect Schedule (PANAS), in addition to pressure algometry were used. For data analysis, we used parametric and non-parametric tests and a general linear model with adjustment variables and analysis of variance. A significant difference was found between pain threshold and tolerance, functionality, depression, anxiety, social support, and positive and negative affect between the groups. Affective states and social support were associated with anxiety, depression and functionality. A body was drawn representing pain with higher incidences in trapeze, supraspinatus and second ribs. The reason for studying sensory aspects, affective behavior and social support in FM patients opens perspectives for scientific and clinical research of this syndrome. Women with chronic pain such as FM appear to have altered mood states, less social support and affective dysfunctions, influencing the other symptoms of the syndrome

Prevalência de incontinência urinária e fatores associados em idosos institucionalizados

Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher‟s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding

Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.