Despite increases in HIV awareness, prevention and treatment, little is known about the contributing factors to medication adherence among adherent Black women with HIV. Understanding the protective factors that improve medication adherence and CD4 cell count for Black HIV+ women is essential and necessary to improve the treatment outcomes for this understudied population. The purpose of this study was to examine the relationship between spirituality, social support, trust in physician, and medication adherence among HIV+ Black women. While this study was not designed to test the influence on medication adherence, it was hypothesized that increased levels of spirituality, social support and trust in physician would positively relate to adherence. In this study, medication adherence was measured by 1) self-report on The AIDS Clinical Trial Group (ACTG) Adherence Questionnaire and 2) CD4 T-cell count. Baseline data was collected from 82 Black women in the Miami-Dade community and participants were administered the Spiritual Well-Being Scale (SWB), the Social Support Questionnaire (SSQ), and the Trust in Physician Scale (TPS). The results of this study indicate that medication adherence is not related to spiritual well-being, social support, or trust in physician. However, a significant positive correlation between spiritual well-being and trust in physician was found. Findings suggest that additional research is needed to explore the multifarious nature of the factors that enhance medication adherence for this population. Implications for research and practice are discussed with respect to the inclusion of spirituality, social support and trust in physician components within prevention and intervention programs designed to increase adherent behaviors among Black HIV+ women.

O consumo de drogas resulta em consequências para o indivíduo tanto no âmbito social quanto no de saúde. Conhecimentos sobre comportamentos de saúde dos usuários de drogas tornam-se relevante para melhor compreender esse grupo. O estudo teve por objetivo avaliar as propriedades psicométricas do Questionário Comportamentos de Saúde em usuários de substâncias psicoativas. Trata-se de um estudo quantitativo do tipo descritivo. O estudo foi desenvolvido no Centro de Atenção Psicossocial - Álcool e Drogas de Ribeirão Preto, SP, Brasil. A amostra foi composta por 140 usuários do serviço. O instrumento utilizado foi composto por: Informações sociodemográficas, Escala de Severidade da Dependência de Drogas, Severity Alcohol Dependence Data e o Questionário Comportamentos de Saúde. Utilizou-se a análise descritiva dos dados e a validade de construto por meio da análise fatorial. Para a consistência interna do instrumento e de seus fatores utilizou-se o coeficiente alfa de Cronbach. A amostra caracteriza-se predominantemente por usuários do sexo masculino, adultos, solteiros, cor da pele branca, com baixo nível de escolaridade. A maior parte deles já esteve em tratamento e a busca por atendimento ocorreu voluntariamente ou por meio de seus familiares. A droga de maior consumo foi o crack. Os usuários, em sua maioria apresentaram níveis graves de severidade da dependência alcoólica e também da dependência de cocaína e crack. A maconha foi a droga de primeiro uso. A análise fatorial resultou em um modelo composto por oito fatores, sendo: comportamentos sexuais seguros; autocuidado com poluição ambiental; saúde; atividades físicas; autocuidado com alimentação; alimentação saudável; automedicação e consumo de bebidas alcoólicas, além da segurança motorizada. Os coeficientes de alfa de Cronbach mostraram-se satisfatórios com índices acima de 0,50 para os fatores, e 0,82 para o questionário Comportamentos de Saúde global. Os resultados confirmam a confiabilidade do Questionário Comportamentos de Saúde na versão brasileira para sua aplicabilidade em usuários de substâncias psicoativas. / Drugs consumption results in consequences for the individual both in the social as in health environment. Knowledge about health behaviors of drug users becomes important to better understand this group. The study aimed to evaluate the pschycometric propriety of the health behavior questionnaires in users of psychoactive substances. It is about a quantitative descriptive study. The study was conducted at the Center of Psychosocial Care - Alcohol and Drugs from Ribeirão Preto, SP, Brazil. The sample consisted of 140 service users. The instrument used was composed of: Sociodemographic Information, Severity of Dependence Scale, Severity Alcohol Dependence Data and the Health Behaviors Questionnaire. It has been used a descriptive analyses of the data and construct validity using factor analysis. For the internal consistency of the instrument and it\'s factors it was used the Cronbach Alpha Coefficient. The sample is characterized predominantly by male users, adults, singles, white color (Caucasian) with a low educational level. Most of them have already been on treatment and the search for it happened voluntarily or through their families. The most consumed drug was crack. The majority of users presented serious levels of severity of alcohol dependence and also the dependence of cocaine and crack. Cannabis was the first used drug. Factor analysis resulted in a model composed of eight factors, as follows: safe sexual behavior; self care with environmental pollution; health; physical activity; self care with food; healthy eating; self medication and alcohol consumption, as well as motorized safety. The Cronbach\'s alpha coefficients were satisfactory with indexes above 0.50 for the factors, and 0.82for the global Health Behaviors Questionnaire. The results confirm the reliability of the Health Behaviors Questionnaire in Brazilian version forits applicability in users of psychoactive substances.

No description available.

African Americans suffer worse health outcomes related to chronic disease than any other racial or ethnic group. The negative effects associated with poor dietary habits and a low propensity to exercise impact young adult African Americans who attend Historically Black Colleges/Universities (HBCUs) and can lead to higher mortality rates. It is important for HBCU campus health centers to address the perceptions and beliefs of students to positively impact health behaviors associated with diet and exercise. At the time of this study, there was limited research on-campus health centers and their impact on HBCU student health beliefs and behaviors. Therefore, this qualitative study was developed to help gain a better understanding of how HBCU health centers can influence student attitudes, perceptions, beliefs, and behaviors related to diet and exercise. This qualitative descriptive study used semistructured focus groups made up of currently enrolled HBCU students informed by the health belief model. Focus groups were conducted with a total of 13 participants who met predetermined criteria. Data were collected using an audio recording device and analyzed using NVivo to group and code like themes and patterns. Results yielded 4 distinct themes; (a) words of family and friends matter, (b) impact of campus environment, (c) internal motivation for action, and (d) involvement from the health center. Overall peers, social media, and health center marketing had the largest influence over behaviors related to physical activity and decisions on healthy eating. The social change implication of this study is to assist campus health centers in providing more effective care by understanding student health behaviors which can improve long-term health outcomes for African Americans.

No description available.

No description available.

No description available.

Heat-related illnesses and deaths are significant public health problems. Extreme heat is the No.1 deadliest form of weather on average in 1990-2019 in the US according to the National Weather Service. Measurements and forecasts made at regional weather stations are a common data source of Heatwave Early Warning Systems. However, regional weather stations provide inaccurate estimates of the heat index that people experience in different microclimates. Introducing a direct measurement of heat index experienced by individuals via wearable sensors will allow more accurate exposure assessment and identification of factors associated with dangerous exposures to extreme heat. The goal of this dissertation is to characterize the individually experienced heat index exposure via wearable sensors in an urban and a rural location in summer in a southern part of the United States. In the first study, 51 outdoor workers in Birmingham, Alabama wore a small thermometer attached to their shoe. Their occupational Wet Bulb Globe Temperatures (WBGT), a comprehensive heat exposure index, was estimated from either temperature from the shoe thermometers or nearby weather stations. In the second and third studies, 88 urban participants and 89 rural participants completed a seven-day intervention where they performed normal activity on Days 1-2 and spent an additional 30 minutes outdoors daily on Days 3-7. Participants wore a small thermometer attached to the shoe and a pedometer at their waist to track steps. Neighborhood hygrometers/thermometers were deployed close to participants' homes to measure neighborhood level heat indexes. In the fourth study, we conducted a phone survey including 101 participants in the same urban and rural locations to examine how their heat-health behaviors changed due to COVID-19 and high profiles of police brutality cases in Summer 2020 compared to previous summers. The results demonstrated that (1) a wearable thermometer on the shoe was a feasible way to measure individually experienced temperatures; (2) among outdoor workers, WBGT from shoe thermometer temperatures estimated more hours in dangerous exposure categories and recommended more protective work-rest schedules compared to WBGT from weather station temperatures; (3) neighborhood level heat indexes improved the prediction of individually experienced heat indexes compared to weather station data alone; (4) rural participants experienced higher heat index exposures than urban participants, after accounting for ambient conditions; (5) spending a small amount of additional time outdoors was a feasible and effective intervention where participants walked more steps and had lower individually experienced heat indexes during the intervention days compared to baseline days; (6) a significantly lower percent of participants reported they would use public cooling centers in Summer 2020 compared to previous summers. Taken together, the results of these studies identified methods for more accurate heat exposure assessment and its application in monitoring heat-safety while promoting physical activity via time spent outdoors in the summer. Future work could incorporate physiological response monitoring linked to simultaneous individually experienced heat exposure to further characterize exposure-response relationships across different populations. Additionally, a longer intervention and more advanced wearable devices such Fitbit, Apple Watches could be used to monitor sustainability of the intervention and intervention benefits beyond short term increases in physical activity, respectively. / Doctor of Philosophy / Extreme high temperatures/humidity can bring dangerous adverse effects in people. Extreme heat is on average the deadliest form of weather in 1990-2019 in the US estimated by National Weather Service. Heatwave Early Warning Systems are introduced to closely monitor extreme heat events, estimate the magnitude of health consequences due to extreme heat, send warning messages to vulnerable populations, and trigger response plans to reduce the dangerous health effects of heat. Heatwave Early Warning Systems generally rely on the measurement and forecasts from regional weather stations. However, the temperature/humidity measurements made at weather stations can be different from the temperature/humidity people experience. People can live far away from weather stations and they move through indoor and outdoor locations, where weather station measurements will not represent temperatures experienced, particularly in climate-controlled indoor settings. Therefore, we recruited participants in an urban and a rural location and had each participant wear a small thermometer clipped to their shoe to directly measure the temperature they experienced as they went about their normal activities. In the first study, 51 outdoor workers wore this small thermometer on their shoe at work. We calculated a comprehensive heat exposure index from either the shoe thermometer temperatures or nearby weather station temperatures. In the second and third studies, 88 urban participants and 89 rural participants completed a seven-day intervention where they performed normal activities on Days 1-2 and spent an additional 30 minutes outdoors daily on Days 3-7. Participants wore the small thermometer clipped to the shoe and a pedometer at their waist to track how many steps they walked. We placed temperature/humidity sensors close to participants' homes to take measurements at a neighborhood level. In the fourth study, we conducted a phone survey including 101 participants in the same urban and rural locations to examine whether they had different cooling methods due to the COVID-19 pandemic and high profiles of police brutality cases in Summer 2020 compared to previous summers. The results demonstrated that (1) a small thermometer clipped on the shoe was a feasible way to measure temperatures at the individual level; (3) among outdoor workers, the comprehensive heat exposure index using temperatures from the shoe thermometers estimated more hours when outdoor workers were at a risk of dangerous exposure to extreme heat, and it recommended more rest time for workers to cool off compared to using weather station temperatures alone; (3) neighborhood level temperature/humidity was more representative of the temperatures recorded from thermometers on the shoe compared to nearby weather stations; (4) rural participants experienced higher temperature/humidity than urban participants, even when their nearby weather station temperature measurements were the same; (5) spending a small amount of additional time outdoors is a feasible and effective intervention where participants walked more steps and experienced lower temperature/humidity during the intervention days compared to baseline days; (6) a smaller number of participants reported they would use public cooling centers/spaces (e.g., air-conditioned library, air-conditioned churches, waterparks) to cool down due to fear of contracting COVID-19 and safety concerns brought by the high profiles of police brutality cases in Summer 2020 compared to previous summers. Taken together, the results of these studies showed that the wearable thermometers clipped on the shoe could provide more accurate assessment of temperatures experienced by participants compared to weather stations. This method could be used in future outdoor time interventions to monitor and ensure participants safely spend time outdoors while minimizing the risk of heat-related illness. In future work, more advanced sensors (e.g., Fitbit, Apple Watch) can be worn by participants to measure physiological responses across different temperatures experienced. Additionally, a longer intervention time can be used to test if participants would continue to spend additional time outdoors.

Introdução: Uma das estratégias de cuidado ao usuário com hipertensão sistêmica e diabetes mellitus é o grupo educativo. Ao participar dos grupos, a pessoa tem um espaço para expressar pensamentos, opiniões, pontos de vista, em um processo democrático e solidário de trocas de saberes e experiências. O grupo educativo também é recurso importante para a reflexão crítica das pessoas acerca das condições de vida e saúde que têm. O presente estudo teve o propósito de reolhar criticamente a prática de um grupo educativo na UBS Parque Novo Mundo II, na Zona Norte de São Paulo, com base no questionamento: Como organizar grupos educativos para o autocuidado das pessoas com doenças crônicas, na Atenção Básica? Objetivo: Propor a reorganização do Grupo do Parque, tendo em vista o autocuidado apoiado na DM e HAS. Desenvolvimento do projeto (Método): estudo de pesquisa aplicada para aprimoramento das atividades educativas na UBS Parque Novo Mundo II. Proposta de intervenção (Resultados): da revisão da literatura sobre a temática resultou o substrato teórico para a reorganização do grupo. Com isso, reconheceu-se a necessidade de estratificar os usuários segundo o risco de complicação. A estratificação contribui para a melhoria na assistência e na organização do processo de trabalho, pois ao invés de dar a mesma atenção a todos os usuários com as condições crônicas é possível o planejamento da assistência, segundo a gravidade de cada um. Para efetuar a estratificação, usou-se a informação sobre 13 fatores de complicação: tabagismo, uso de álcool, medicação, atividade física, dieta, pressão arterial, hemoglobina glicada, circunferência abdominal. Os cálculos cruzados dos dados sobre esses fatores, com auxílio de uma planilha elaborada em MS Excell, permitiram a classificação em três níveis de risco: baixo, médio e alto. De acordo com o nível, o fluxo de atendimento proposto prevê consultas, visitas domiciliares e grupo educativo, em periocidades e com objetivos distintos. Para a reorganização do Grupo do Parque, levaram-se em conta as características dos grupos operativos como dinamicidade, reflexão, democracia e autonomia, a fim de fomentar mudanças de comportamento, por meio da empatia e alteridade entre os participantes. O intuito era o autocuidado acompanhado como forma de cuidado da equipe de saúde da família para as pessoas com doenças crônicas, com vistas à que sejam agentes sociais produtores da saúde. Propôs-se a reorganização do Grupo, com nove encontros quinzenais e dois para monitoramento e apoio, no 3° e 6° mês após o último encontro quinzenal. Com isso, o Grupo proposto tem, no total, 11 encontros. / Introduction: The educative groups are a strategy for the care of those with systemic hypertension and diabetes mellitus. With the participation in these type of groups, the users have the opportunity to express thoughts, opinions, views in a democratic and supportive sharing process of knowledge and experiences. The educative group is also an important resource for the critical reflection of people about their living conditions and health. This study aimed to critically review the practice of an educative group at UBS Parque Novo Mundo II, in the north region of São Paulo, based on the question: How to organize educative groups focused on the self-care of those with chronic diseases at the Primary Care? Objective: To propose the reorganization of the Group of the Park focused on self-care for those with diabetes and hypertension. Development of the project (method): Applied research for the improvement of the educative activities at the UBS Parque Novo Mundo II. Intervention proposal (Results): the literature review on the topic built the theoretical basis for the group\'s reorganization. Thus, it was recognized the need to stratify users according to their risk of complication. The stratification helps to improve the care and the organization of the work process, because instead of giving equal attention to all patients with chronic conditions it is possible to personalize the care according to the severity of each one. For the stratification we used the information about 13 complicating factors: smoking, use of alcohol, medication, physical activity, diet, blood pressure, glycated hemoglobin, waist circumference. The values for these factors were crossed through sheets of the MS Excell. The stratification was done through a scale of risk with three levels: low, medium and high. According to the level, we proposed different settings of consultations, home visits and educative groups. The reorganization of the Group of the Park took into account the characteristics of the operative groups as dynamics, reflection, democracy and autonomy in order to promote behavioral change, through empathy and alterity among the participants. The reorganization of the group was based on the self-care as a type of care of the family health team care for those with chronic diseases, in order to make of each one the producer of his/her own health. We proposed the reorganization of the Group, with nine fortnightly meetings and two meetings for monitoring and support, on the 3rd and 6th month after the last meeting fortnightly. Thus, the Group totalized 11 meetings.

Introdução: Uma das estratégias de cuidado ao usuário com hipertensão sistêmica e diabetes mellitus é o grupo educativo. Ao participar dos grupos, a pessoa tem um espaço para expressar pensamentos, opiniões, pontos de vista, em um processo democrático e solidário de trocas de saberes e experiências. O grupo educativo também é recurso importante para a reflexão crítica das pessoas acerca das condições de vida e saúde que têm. O presente estudo teve o propósito de reolhar criticamente a prática de um grupo educativo na UBS Parque Novo Mundo II, na Zona Norte de São Paulo, com base no questionamento: Como organizar grupos educativos para o autocuidado das pessoas com doenças crônicas, na Atenção Básica? Objetivo: Propor a reorganização do Grupo do Parque, tendo em vista o autocuidado apoiado na DM e HAS. Desenvolvimento do projeto (Método): estudo de pesquisa aplicada para aprimoramento das atividades educativas na UBS Parque Novo Mundo II. Proposta de intervenção (Resultados): da revisão da literatura sobre a temática resultou o substrato teórico para a reorganização do grupo. Com isso, reconheceu-se a necessidade de estratificar os usuários segundo o risco de complicação. A estratificação contribui para a melhoria na assistência e na organização do processo de trabalho, pois ao invés de dar a mesma atenção a todos os usuários com as condições crônicas é possível o planejamento da assistência, segundo a gravidade de cada um. Para efetuar a estratificação, usou-se a informação sobre 13 fatores de complicação: tabagismo, uso de álcool, medicação, atividade física, dieta, pressão arterial, hemoglobina glicada, circunferência abdominal. Os cálculos cruzados dos dados sobre esses fatores, com auxílio de uma planilha elaborada em MS Excell, permitiram a classificação em três níveis de risco: baixo, médio e alto. De acordo com o nível, o fluxo de atendimento proposto prevê consultas, visitas domiciliares e grupo educativo, em periocidades e com objetivos distintos. Para a reorganização do Grupo do Parque, levaram-se em conta as características dos grupos operativos como dinamicidade, reflexão, democracia e autonomia, a fim de fomentar mudanças de comportamento, por meio da empatia e alteridade entre os participantes. O intuito era o autocuidado acompanhado como forma de cuidado da equipe de saúde da família para as pessoas com doenças crônicas, com vistas à que sejam agentes sociais produtores da saúde. Propôs-se a reorganização do Grupo, com nove encontros quinzenais e dois para monitoramento e apoio, no 3° e 6° mês após o último encontro quinzenal. Com isso, o Grupo proposto tem, no total, 11 encontros. / Introduction: The educative groups are a strategy for the care of those with systemic hypertension and diabetes mellitus. With the participation in these type of groups, the users have the opportunity to express thoughts, opinions, views in a democratic and supportive sharing process of knowledge and experiences. The educative group is also an important resource for the critical reflection of people about their living conditions and health. This study aimed to critically review the practice of an educative group at UBS Parque Novo Mundo II, in the north region of São Paulo, based on the question: How to organize educative groups focused on the self-care of those with chronic diseases at the Primary Care? Objective: To propose the reorganization of the Group of the Park focused on self-care for those with diabetes and hypertension. Development of the project (method): Applied research for the improvement of the educative activities at the UBS Parque Novo Mundo II. Intervention proposal (Results): the literature review on the topic built the theoretical basis for the group\'s reorganization. Thus, it was recognized the need to stratify users according to their risk of complication. The stratification helps to improve the care and the organization of the work process, because instead of giving equal attention to all patients with chronic conditions it is possible to personalize the care according to the severity of each one. For the stratification we used the information about 13 complicating factors: smoking, use of alcohol, medication, physical activity, diet, blood pressure, glycated hemoglobin, waist circumference. The values for these factors were crossed through sheets of the MS Excell. The stratification was done through a scale of risk with three levels: low, medium and high. According to the level, we proposed different settings of consultations, home visits and educative groups. The reorganization of the Group of the Park took into account the characteristics of the operative groups as dynamics, reflection, democracy and autonomy in order to promote behavioral change, through empathy and alterity among the participants. The reorganization of the group was based on the self-care as a type of care of the family health team care for those with chronic diseases, in order to make of each one the producer of his/her own health. We proposed the reorganization of the Group, with nine fortnightly meetings and two meetings for monitoring and support, on the 3rd and 6th month after the last meeting fortnightly. Thus, the Group totalized 11 meetings.