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Abstract Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework II (2020/21-2024/25). Knowledge of factors that explain men’s uptake of VMMC and sexual health services at these facilities and preferences of where to get the services remain poorly understood. Using qualitative methodologies, we examined factors that determined facility choice for VMMC services and reasons for preferring the facility among men aged 25–39 years who previously underwent VMMC. The current study draws from focus group discussion interviews with circumcised men and their partners conducted as part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya. This involved 12 focus group discussions (FGD) with 6–10 participants each. Six FGDs were conducted with circumcised men, and 6 with their sex partners. Thematic issues relevant to a predetermined framework were identified. The themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25–39 years. Additionally, preferences were influenced by individual’s disposition, attitudes, knowledge of VMMC services and tacit balance between their own recognized health needs versus desire to conform to social-cultural norms. Facility choice and individual preference are intricate issues, simultaneously involving multiple but largely intra-personal and facility-level factors. The intrapersonal dimensions elicited may also reflect differential responses to strategic communications and demand creation messages with promotion and prevention frames.

Voluntary medical male circumcision (VMMC) reduces men's risk of acquiring Human immunodeficiency virus (HIV) through vaginal sex. However, VMMC uptake remains lowest among Kenyan men ages 25-39 years among whom the impact on reducing population-level HIV incidence was estimated to be greatest at the start of the study in 2014. We conducted a pre- and post-intervention survey as part of a cluster randomized controlled trial to determine the effect of two interventions (interpersonal communication (IPC) and dedicated service outlets (DSO), delivered individually or together) on improving VMMC uptake among men ages 25-39 years in western Kenya between 2014 and 2016. The study had three intervention arms and a control arm. In arm one, an IPC toolkit was used to address barriers to VMMC. In arm two, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO. The control arm had standard of care. At baseline, uncircumcised men ranked the top three reasons for remaining uncircumcised. An IPC demand creation toolkit was used to address the identified barriers and men were referred for VMMC at study-designated facilities. At follow-up, those who remained uncircumcised were again asked to rank the top three reasons for not getting circumcised. There was inconsistency in ranking of reported barriers at pre- and post- intervention: 'time/venue not convenient' was ranked third at baseline and seventh at follow-up; 'too busy to go for circumcision' was tenth at baseline but second at follow-up, and concern about 'what I/family will eat' was ranked first at both baseline and follow-up, but the proportion reduced from 62% to 28%. Men ages 25-39 years cited a variety of logistical and psychosocial barriers to receiving VMMC. After exposure to IPC, most of these barriers shifted while some remained the same. Additional innovative interventions to address on-going and shifting barriers may help improve VMMC uptake among older men.

IntroductionFemale and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre-exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention.MethodsFrom 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences.ResultsAmong 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past-month alcohol use and 91% of women and 82% of men reported past-month drug use. Violence was pervasive, with most women and men reporting past-year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non-stigmatizing PrEP delivery initiatives designed with input from sex workers.ConclusionsThrough a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.

AimsGlobally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services.MethodsIn a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use.ResultsAmong 32 women, median age was 28 (range: 18-37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender "morale" and "courage" to engage in sex work and "fight" potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks.ConclusionsDrawing on the concept of "paradoxical autonomy," we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.

IntroductionVoluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region.Materials and methodsWe conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome.ResultsAt baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67.DiscussionUsing these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years.Trial registrationclinicaltrials.gov identifier: NCT02497989.

OBJETIVOS: Descrever a técnica ultrassonográfica utilizada para verificar o posicionamento do tubo em trato gastrointestinal e verificar se ultrassonografia é um método confiável para confirmar o posicionamento do tubo enteral. MÉTODO: Trata-se de uma revisão integrativa de literatura. A busca foi realizada no mês de maio de 2022 na Biblioteca Virtual em Saúde. Os critérios de inclusão foram: artigos publicados entre os anos de 2017 a 2022, cuja população estudada fosse acima de 18 anos, independente do idioma e país que foi realizado. RESULTADOS: Foram selecionados 17 estudos, todos eles descreveram a técnica utilizada, sendo possível identificar os principais pontos de convergência. Quanto à confiança do método para visualização do tubo enteral, o valor preditivo positivo variou de 91 a 100%, já o valor preditivo negativo teve uma variação grande de 11,1% a 100%. CONCLUSÃO: Essa revisão aponta para muitas convergências quanto às técnicas de insonação para avaliação da localização do tubo enteral, sendo assim um ponto de partida para os profissionais que pretendem avançar no uso desta ferramenta. Os estudos também indicam que o ultrassom é uma ferramenta promissora para a confirmação do posicionamento do tubo enteral. No entanto, a taxa de sucesso de visualização do tubo enteral no trato gastrointestinal, assim como o valor preditivo positivo ainda são muito variáveis, além das limitações mencionadas para o seu uso. Assim, se faz necessário mais pesquisas, a fim de construir protocolos seguros de uso do ultrassom como tecnologia confiável de confirmação do tubo de alimentação enteral.

Abstract Background As countries make progress towards HIV epidemic control, there is increasing need to identify finer geographic areas to target HIV interventions. We mapped geographic clusters of new HIV diagnoses, and described factors associated with HIV-positive diagnosis, in order to inform targeting of HIV interventions to finer geographic areas and sub-populations. Methods We analyzed data for clients aged > 15 years who received home-based HIV testing as part of a routine public health program between May 2016 and July 2017 in Siaya County, western Kenya. Geospatial analysis using Kulldorff’s spatial scan statistic was used to detect geographic clusters (radius 35 years (aRR 2.44, 95% CI 1.99–3.00); those in polygamous marriage (aRR 1.84, 95% CI 1.55–2.16), or separated/divorced (aRR 3.36, 95% CI 2.72–4.08); and clients who reported having never been tested for HIV (aRR 2.35, 95% CI 2.02–2.72), or having been tested > 12 months ago (aRR 1.53, 95% CI 1.41–1.66). Conclusion Our study used routine public health program data to identify granular geographic clusters of higher new HIV diagnoses, and sub-populations with higher HIV-positive yield in the setting of a generalized HIV epidemic. In order to target HIV testing and prevention interventions to finer granular geographic areas for maximal epidemiologic impact, integrating geospatial analysis into routine public health programs can be useful.

BackgroundIllegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use.MethodsOur exploratory study of injection drug use was conducted in Kisumu from 2013 to 2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein.ResultsInjectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya.ConclusionsWe suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa.

BackgroundInjection drug use is increasingly contributing to the HIV epidemic across sub-Saharan Africa. This paper provides the first descriptive analysis of injection drug use in western Kenya, where HIV prevalence is already highest in the nation at 15.1%.MethodsWe draw on quantitative data from a study of injection drug use in Kisumu, Kenya. We generated descriptive statistics on socio-demographics, sexual characteristics, and drug-related behaviors. Logistic regression models were adjusted for sex to identify correlates of self-reported HIV positive status.ResultsOf 151 participants, mean age was 28.8 years, 84% (n = 127) were male, and overall self-reported HIV prevalence reached 19.4%. Women had greater than four times the odds of being HIV positive relative to men (Odds Ratio [OR] 4.5, CI: 1.7, 11.8, p = .003). Controlling for sex, ever experiencing STI symptoms (Adjusted Odds ratio [AOR] 4.6, 95% CI 1.7, 12.0, p = .002) and sharing needles or syringes due to lack of access (AOR 3.6, 95% CI 1.2, 10.5, p = .02) were significantly associated with HIV positive status. Lower education (AOR 2.3, 95% CI 0.9, 5.6, p=.08), trading sex for drugs (AOR 2.8, 95% CI 0.9, 8.8, p = .08), being injected by a peddler (AOR 2.9, 95% CI 1.0, 8.5, p = .05), and injecting heroin (AOR 2.3, 95% CI 1.0, 5.7, p = .06), were marginally associated with HIV.ConclusionsThis exploratory study identified patterns of unsafe drug injection and concurrent sexual risk in western Kenya, yet few resources are currently available to address addiction or injection-related harm. Expanded research, surveillance, and gender sensitive programming are needed.

Resumo Objetivo: Analisar a associação das condições climático-ambientais e a ocorrência das doenças e agravos de notificação compulsória no estado do Espírito Santo, Brasil. Métodos: Estudo ecológico dos agregados municipais calculados a partir de casos confirmados no Sistema de Informação de Agravos de Notificação (Sinan) para o período 2011-2015. Resultados: As notificações foram mais frequentes no sexo feminino (51,1%), raça/cor da pele parda (31,7%), faixa etária de 20-49 anos (48,1%) e região metropolitana de saúde (60,3%). Os fatores associados aos agravos foram as condições sensíveis à Atenção Básica (p-valor

Este artigo tem por objetivo discutir as relações entre os componentes curriculares e as estratégias didático-pedagógicas, na formação em serviço dos professores, visando os processos de alfabetização. Busca-se referências em estudos histórico-culturais e utiliza-se como metodologia uma investigação de base teórico-conceitual. Os resultados indicam que tal relação, na formação do professor, não precisa ser direcionada à eleição de um método de trabalho, mas sim de um conjunto de pressupostos e princípios que possam sustentar práticas contextuais, autorais, investigativas e diversificadas. Conclui-se que as questões didáticas precisam ser incorporadas à formação dos alfabetizadores como estratégias pedagógicas para o diálogo entre as diferentes culturas que se entrecruzam nas escolas.

Este estudo aborda a limpeza e desinfecção dos principais dispositivos não-críticos de monitoração, considerando sua participação na transmissão das infecções relativas aos cuidados médicos. O objetivo deste estudo é descrever o desenvolvimento de um protocolo de limpeza e desinfecção dos principais dispositivos não-críticos utilizados na monitorização, baseado em melhores práticas, evidenciadas na literatura. É um estudo descritivo e exploratório, guiado pela pesquisa baseada em evidência, conduzida de Março de 2012 à Julho de 2014, explorando as seguintes fases: uma revisão integrativa de literatura; preparação de protocolo de desinfecção e limpeza de dispositivos nãocríticos de monitoramento e avaliação por experts. Entre as boas práticas encontradas na literatura sobre limpeza e desinfecção destes dispositivos destaca-se o uso do álcool etílico à 70% como desinfetante principal da escolha da necessidade, utilizado em intervalos regulares. O protocolo foi avaliado por um painel de peritos, incluindo nesta avaliação a possibilidade de aplicação no contexto dos cuidados médicos nas instituições de saúde. Acredita-se que este protocolo possa contribuir como guia das práticas profi ssionais de saúde, minimizando os riscos de infecções no cotidiano do serviço de saúde. Palavras-chave: Termômetros; Esfi gnomômetros; Eletrocardiografi a; Oximetria; Infecção Hospitalar. ABsTRAcT This study approaches the cleaning and disinfection of the main non-critical monitoring devices, considering their participation in the transmission of infections related to health care and the goal this study is describe the development of a cleaning protocol and disinfection of the main non-critical monitoring devices based on best practices and evidence from the literature. It is a descriptive and exploratory study, guided by evidence-based research, conducted from March 2012 to July 2014 in the following stages: an integrative literature review, preparation of non-critical cleaning protocol and disinfection monitoring devices and evaluation expertise. Among the good practices identifi ed in the literature on cleaning and disinfection of these devices include the use of ethanol to 70% as the main disinfectant of choice and the need for cleaning and disinfection of these devices at regular intervals, set the protocol that was assessed by the experts as appropriate panel with application possibility in the healthcare context of health institutions. We believe that this protocol may contribute to guide health professional’s practices minimize the risk of infection associated with their use in everyday health services. Keywords: Thermometers; Sphygmomanometers; Electrocardiography; Oximetry; Hospital Infection.

A história do Brasil é inteiramente ligada a espécies nativas que moveram a economia do país por décadas, entre essas espécies está o jacarandá-da-bahia (Dalbergia nigra Vell. Fr. All. Ex Benth), cuja madeira possui alto valor comercial. Sua exploração aliada à falta de manejo levou essa espécie a figurar na lista das espécies ameaçadas de extinção da flora brasileira. Diante do exposto, o objetivo do presente trabalho foi avaliar as condições mais favoráveis à germinação e estabelecimento in vitro de jacarandá-da-bahia, a fim de possibilitar posteriormente a micropropagação e produção de plântulas viáveis. As sementes foram submetidas a dois tratamentos para desinfestação, uma com hipoclorito de sódio outro com peróxido de hidrogênio. Foi realizado um teste de germinação com três meios de cultivo (MS, WPM e B5) sendo o delineamento inteiramente casualizado. O tratamento com peróxido de hidrogênio apresentou maior porcentagem de germinação (72%). Os resultados de Parte Aérea (PA), Comprimento da Raiz (CR), e Massa Fresca (MF) não diferiram estatisticamente. Quanto ao número de folhas, o Meio WPM apresentou maior número de folhas, não distinguindo estatisticamente do Meio B5 (4.31 e 4.15).

Diversas plantas possuem compostos secundários com propriedades inseticidas e o óleo essencial de laranja amarga mostra-se com grande potencial para o controle de pragas. Recentemente, foi registrada no Brasil a espécie Helicoverpa armigera, uma das maiores pragas da agricultura mundial. Tendo em vista a falta de métodos alternativos aos inseticidas para o controle dessa praga, o objetivo desse trabalho foi avaliar os efeitos do óleo essencial de laranja amarga sobre H. armigera. Foi realizado um teste de escolha para avaliar a atividade deterrente. Folhas de tomate foram imersas em soluções contendo óleo de laranja amarga em três concentrações (1, 10 e 100 mg L-1). As folhas tratadas com óleo e folhas não tratadas foram oferecidas à lagartas de segunda instar e após 24h foi calculado o índice de deterrência alimentar (IDA). A concentração de 1 mg L-1 apresentou 71% de deterrência alimentar. Porém as concentrações de 10 e 100 mg L-1 causaram fitotoxidez às folhas de tomate, inviabilizando o consumo pelas lagartas e a estimativa do IDA. Novos testes devem ser realizados com concentrações menores para evitar a fitotoxidez.

Uptake of voluntary medical male circumcision (VMMC) as an intervention for prevention of HIV acquisition has been low among men aged ≥25 years in Nyanza region, western Kenya. We conducted a baseline survey of the prevalence and predictors of VMMC among men ages 25-39 years as part of the preparations for a cluster randomized controlled trial (cRCT) called the Target, Speed and Coverage (TASCO) Study. The TASCO Study aimed to assess the impact of two demand creation interventions-interpersonal communication (IPC) and dedicated service outlets (DSO), delivered separately and together (IPC + DSO)-on VMMC uptake.As part of the preparatory work for implementation of the cRCT to evaluate tailored interventions to improve uptake of VMMC, we conducted a survey of men aged 25-39 years from a traditionally non-circumcising Kenyan ethnic community within non-contiguous locations selected as study sites. We determined their circumcision status, estimated the baseline circumcision prevalence and assessed predictors of being circumcised using univariate and multivariate logistic regression.A total of 5,639 men were enrolled of which 2,851 (50.6%) reported being circumcised. The odds of being circumcised were greater for men with secondary education (adjusted Odds Ratio (aOR) = 1.65; 95% CI: 1.45-1.86, p

A interdisciplinaridade como prática pedagógica contribui para a interação das disciplinas e contextualização dos conteúdos. Entretanto, a maioria dos docentes encontram dificuldades para realizar essas atividades. O presente trabalho teve por objetivo analisar o desempenho de duas turmas da 1ª série do ensino médio, sobre o ciclo da água, com o intuito de identificar se a interdisciplinaridade adotada como método cotidiano de ensino motiva os discentes, desperta seu interesse e contribui para uma melhor aprendizagem. Por meio de ações interdisciplinares que integram as disciplinares de Biologia, Geografia e Artes, oferecemos aos alunos da turma A uma aula demonstrativa, com a utilização do flanelógrafo e contextualização. E a aplicação de uma aula expositiva para a turma B, sem a utilização de outros instrumentos didáticos e metodologia interdisciplinar. Observamos que a turma A apresentou melhor rendimento, o que contribuiu para maior socialização e participação dos alunos.