Oral health in the family health strategy: a change of practices or semantics diversionism

OBJECTIVE:To evaluate public health dentistry practices of two different family health models. METHODS: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

Public health and the knowledge industry

Knowledge plays an important role in health care. The production and diffusion of health-related knowledge are increasingly under the control of private commercial interests, which are characterized by conflicts of interests that result in abuses of power. Considerable research has been done on the medical-industrial complex and its role in the production of power imbalances and the consequent abuses, but little attention has been dedicated to the role played by the publishing industry, which can be subject to the same problems. The widely diffused idea that "frequent and major changes" occur in medicine, albeit unsupported by clearcut evidence, is an effective marketing tool for both the pharmaceutical and publishing industries, who feed and thrive on physicians' insecurities. The production and distribution of knowledge should be addressed as a strategic component of public health.

Locus of control and contraceptive knowledge, attitude and practice among university students

OBJECTIVE: To assess the relationship between locus of control and knowledge, attitude and practice regarding pill and condom use among university students. METHODS: The inquiry was developed in Campinas, a city in Southeastern Brazil, in 2006. A total of 295 adolescent newcomers to a public university answered a structured questionnaire and Levenson's multidimensional locus of control scale. The scores of the dimensions of locus of control were calculated and Spearman's correlation coefficient was used to assess their correlation with knowledge and practice concerning pill and condom use. In order to assess the relationship between the dimensions of locus of control and sociodemographic variables and variables related to the individuals' sex life, Kruskal-Wallis and Mann-Whitney tests were used. RESULTS: Male adolescents had higher scores of powerful others externality when compared to female adolescents (p=0.01). Students living alone had lower internality (p=0.01). When locus of control was compared to condom use in the first intercourse, considering only the 102 students who informed the age of the beginning of sexual activity, greater internality was found among male adolescents who did not use condoms (p<0.05). When the locus of control scores were correlated with contraceptive knowledge and practice, it was found that the higher the powerful others externality locus, the lower the adequate use of contraceptive methods (r = -0.22, p=0.03). CONCLUSIONS: The powerful others externality locus influences the practice of contraceptive use in this group of adolescents.

Risk perception about zoonoses in immigrants and Italian workers in Northwestern Italy

OBJETIVO: To assess factors associated with a low risk perception of zoonoses and to identify the gaps in knowledge about transmission and prevention of zoonoses in immigrant and Italian workers. MÉTODOS: A cross-sectional study with 175 workers in the agro-livestock and agro-food industry in Piemonte, Italy, was carried out. Data were collected with a semi-structured questionnaire based on knowledge, attitudes and practices (KAP) survey. We calculated proportions and used chi-square tests and odds ratios to assess associations. Eight individual interviews with key informants on immigration and public health in Piemonte were carried out. RESULTADOS: Participants were 82 (47%) Italians and 93 (53%) immigrants. Immigrants were from Romania, Morocco, Albania, India, China, Argentina, Peru, Macedonia, Ivory Coast, Ukraine and Colombia. The study revealed significant differences in risk perception at work (p = 0.001). We found associations between "not having correct knowledge about zoonoses" and the following variables: i. "being immigrant" OR = 4.1 (95%CI 1.7;9.8 p ≤ 0.01); ii. "working in the livestock industry" OR = 2.9 (95%CI 1.2;15.4 p = 0.01); and iii. "being an unqualified worker" OR = 4.4 (95%CI 2.9;15.4 p ≤ 0.01). Another strong association was found between being immigrant and having a low job qualification OR = 6.7 (IC95% 2.9 - 15.4 p ≤ 0.01). Asian immigrants were the group with the highest frequency of risky behaviours and the lowest level of knowledge about zoonoses. CONCLUSÕES: Our results indicate that there were differences in risk perception of zoonoses between the groups participating in our study. These results suggest that immigrant status can be considered a risk factor for having lower risk perception and lower level of knowledge of zoonoses at work. There is a relationship between this specific knowledge of zoonoses and lack of training and instruction among migrant populations. Our results stress the need for developing education programs on zoonoses prevention among the immigrant population in Piemonte, Italy.

HIV/AIDS knowledge among men who have sex with men: applying the item response theory

OBJECTIVE To evaluate the level of HIV/AIDS knowledge among men who have sex with men in Brazil using the latent trait model estimated by Item Response Theory. METHODS Multicenter, cross-sectional study, carried out in ten Brazilian cities between 2008 and 2009. Adult men who have sex with men were recruited (n = 3,746) through Respondent Driven Sampling. HIV/AIDS knowledge was ascertained through ten statements by face-to-face interview and latent scores were obtained through two-parameter logistic modeling (difficulty and discrimination) using Item Response Theory. Differential item functioning was used to examine each item characteristic curve by age and schooling. RESULTS Overall, the HIV/AIDS knowledge scores using Item Response Theory did not exceed 6.0 (scale 0-10), with mean and median values of 5.0 (SD = 0.9) and 5.3, respectively, with 40.7% of the sample with knowledge levels below the average. Some beliefs still exist in this population regarding the transmission of the virus by insect bites, by using public restrooms, and by sharing utensils during meals. With regard to the difficulty and discrimination parameters, eight items were located below the mean of the scale and were considered very easy, and four items presented very low discrimination parameter (< 0.34). The absence of difficult items contributed to the inaccuracy of the measurement of knowledge among those with median level and above. CONCLUSIONS Item Response Theory analysis, which focuses on the individual properties of each item, allows measures to be obtained that do not vary or depend on the questionnaire, which provides better ascertainment and accuracy of knowledge scores. Valid and reliable scales are essential for monitoring HIV/AIDS knowledge among the men who have sex with men population over time and in different geographic regions, and this psychometric model brings this advantage.

Body image in Brazil: recent advances in the state of knowledge and methodological issues

OBJECTIVE To analyze Brazilian literature on body image and the theoretical and methodological advances that have been made. METHODS A detailed review was undertaken of the Brazilian literature on body image, selecting published articles, dissertations and theses from the SciELO, SCOPUS, LILACS and PubMed databases and the CAPES thesis database. Google Scholar was also used. There was no start date for the search, which used the following search terms: “body image” AND “Brazil” AND “scale(s)”; “body image” AND “Brazil” AND “questionnaire(s)”; “body image” AND “Brazil” AND “instrument(s)”; “body image” limited to Brazil and “body image”. RESULTS The majority of measures available were intended to be used in college students, with half of them evaluating satisfaction/dissatisfaction with the body. Females and adolescents of both sexes were the most studied population. There has been a significant increase in the number of available instruments. Nevertheless, numerous published studies have used non-validated instruments, with much confusion in the use of the appropriate terms (e.g., perception, dissatisfaction, distortion). CONCLUSIONS Much more is needed to understand body image within the Brazilian population, especially in terms of evaluating different age groups and diversifying the components/dimensions assessed. However, interest in this theme is increasing, and important steps have been taken in a short space of time.

HIV risk practices by female sex workers according to workplace

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues.

TOXOPLASMOSIS-RELATED KNOWLEDGE AMONG PREGNANT AND POSTPARTUM WOMEN ATTENDED IN PUBLIC HEALTH UNITS IN NITERÓI, RIO DE JANEIRO, BRAZIL

The present study conducted a toxoplasmosis-related knowledge level survey with 400 pregnant and puerperal women attended in public health units in the municipality of Niterói, Rio de Janeiro. Only 111 (27.8%) women claimed to know about the disease. Most of them (n = 289; 72.2%) had never heard about toxoplasmosis nor knew how to prevent the infection by Toxoplasma gondii. A significant difference (p = 0.013) regarding the presence of anti-T. gondii IgG was observed between women who claimed to know about the disease and those who had never heard about it. These results highlight the importance of a systematic serological screening process for toxoplasmosis, as well as the importance of primary prevention by accurate information during prenatal care, an important Public Health action to be implemented.

Tityus stigmurus (Thorell, 1876) (Scorpiones; Buthidae): response to chemical control and understanding of scorpionism among the population

In this study, the events following application of the insecticideDemand 2.5 concentrated solution (CS) in the field, to control Tityus stigmurus, were investigated. Data on attitudes and practices relating to scorpionism were collected using a questionnaire. During the months of May to July 2005, 69 premises were monitored on different days following insecticide treatment, focusing on scorpion frequency and mortality. According to the results, 42% of the premises showed scorpion incidence, with an average of three specimens per house. The highest incidence was recorded during the first week following the treatment. Only 7% of the specimens were found dead. Most (72%) of the population showed knowledge about prevention and control measures. Despite this, 100% of the premises presented breeding sites, mainly in debris (79.7%). These results indicate that the scorpion control method used by health agents during this investigation was not efficient, and the results suggest that the method may have had a dispersive effect on these animals.

Level of behavior and knowledge concerning human papillomavirus among university students of a nursing college

INTRODUCTION: Human pappilomavirus is one of the most common sexually transmitted diseases, and persistent HPV infection is considered the most important cause of cervical cancer. It is detected in more than 98% of this type of cancer. This study aimed to determine the level of knowledge concerning human papillomavirus among nursing college students of a private educational institution located in the City of Bauru, SP, and correlate their knowledge according to the course year. METHODS: A descriptive study with a quantitative approach, performed with a questionnaire that permitted the quantification of data and opinions, thus guaranteeing the precision of the results without distortions in analysis or interpretation. The survey was applied to randomly selected 1st, 2nd, 3rd, and 4th-year nursing college students. Twenty students from each level were selected during August 2009, totaling 80 students of both genders. RESULTS: Observation revealed that 4th-year students had greater knowledge than 1st-year students, reflecting the greater period of study, the lack of knowledge of 1st-year students was due to the low level of information acquired before entering college. CONCLUSIONS: The need for complementary studies which determine the profile and knowledge of a larger number of teenagers in relation to HPV was established. The need for educational programs that can overcome this lack of information is undeniable, especially those aimed at making adolescents less susceptible to HPV and other STDs.

Toxoplasmosis: an examination of knowledge among health professionals and pregnant women in a municipality of the State of Paraná

Introduction The aim of this study was to investigate the knowledge of toxoplasmosis among professionals and pregnant women in the public health services in Paraná, Brazil. Methods A cross-sectional observational and transversal study of 80 health professionals (44 nurses and 36 physicians) and 330 pregnant women [111 immunoglobulin M (IgM)- and IgG-non-reactive and 219 IgG-reactive] was conducted in 2010. An epidemiological data questionnaire was administered to the professionals and to the pregnant women, and a questionnaire about the clinical aspects and laboratory diagnosis of toxoplasmosis was administered to the professionals. Results The participants frequently provided correct responses about prophylactic measures. Regarding the clinical and laboratory aspects, the physicians provided more correct responses and discussed toxoplasmosis with the pregnant women. The professionals had difficulty interpreting the avidity test results, and the physicians stated that they referred pregnant women with high-risk pregnancies to a county reference center. Of the professionals, 53 (91.4%) reported that they instructed women during prenatal care, but only 54 (48.6%) at-risk pregnant women and 99 (45.2%) women who were not at risk reported receiving information about preventive measures. The physicians provided verbal instructions to 120 (78.4%) women, although instructional materials were available in the county. The pregnant women generally lacked knowledge about preventive measures for congenital toxoplasmosis, but the at-risk pregnant women tended to respond correctly. Conclusions This study provides data to direct public health policies regarding the importance of updating the knowledge of primary care professionals. Mechanisms should be developed to increase public knowledge because prophylactic strategies are important for preventing congenital toxoplasmosis.

Awareness of visceral leishmaniasis and its relationship to canine infection in riverside endemic areas in Northeastern Brazil

IntroductionAn awareness of visceral leishmaniasis (VL) is necessary to encourage the population to participate in prevention and control in collaboration with more efficient, centrally organized health programs. The aim of this study was to evaluate the awareness of the riverside population regarding VL and the association between awareness and the prevalence of canine visceral leishmaniasis (CVL).MethodsIn total, 71 people living in riverside areas in the City of Mossoró in State of Rio Grande do Norte participated of the study, and 71 dogs were tested for CVL by polymerase chain reaction (PCR). Association analysis of several variables related to knowledge of the riverside population regarding CVL positivity was performed, yielding odds ratios (OR) and 95% confidence intervals (CI), and significance was determined using chi-square (χ2) and Fisher's exact tests.ResultsAmong individuals whose dogs tested positive for CVL, 60% did not know the cure for CVL, and these subjects were three times more likely to have a dog test positive for CVL than those who were aware the cure for CVL. Knowledge of CVL cure was the only variable that remained in the logistic model after the successive removal of variables, with an adjusted OR of 3.11 (95%CI: 1.1-8,799; p=0.032).ConclusionsInsufficient awareness regarding VL in riverside areas with CVL-positive dogs was associated with increased rates of canine infection, which suggests that changes in habits and the adoption of attitudes and preventive practices may contribute to the control and prevention of this disease. This study reinforces the need to invest in better health education programs regarding VL.

Current and previous eating practices among women recovered from anorexia nervosa: a qualitative approach

OBJECTIVE: The aim of this study was to analyze qualitatively how women, who have recovered from anorexia nervosa, perceive and describe their current eating practices, as well as the ones developed during the eating disorder period. METHODS: Seven women were interviewed individually with the objective of investigating their eating practices, transition phases and all relevant aspects that somewhat contributed to the habit-forming; experiences, feelings and perceptions related to mealtime and the influence that food has had over the present subjects' life. The interviews were analyzed by the discourse of the collective subject method. RESULTS: The results brought up the following topics: a) control; b) concerns and feelings; c) deprivation d) beauty dictatorship; e) eating competence; f) importance of food; g) food cacophony. CONCLUSIONS: What stands out is a multiplicity of eating practices, which during the eating disorder were similar to and characterized by restriction; however, after recovery, part of the subjects seem to have developed a higher eating competence, whereas others show a practice similar to the one acquired during the anorexia nervosa, such as the difficulty in realizing when they are satisfied and a feeling of discomfort when facing social interactions.