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Background The level of satisfaction of donors with the blood donation system is an important factor which influences their intent to return for future donation. A 25-item questionnaire on the satisfaction of blood donors has been recently proposed to assess the donor satisfaction with the service provided by a blood bank. The objective of this study was to present a proposal for application and interpretation of a BDSQ considering a sample of blood donors of a Brazilian blood bank. Methods A sample of 1019 blood donors at the Regional Hemotherapy Center of Franca, Brazil, answered the BDSQ. A top-box analysis was used to assess the associations between the variables characterizing the profiles of blood donors and their overall satisfaction with the service provided by the blood bank. We proposed the use of a performance-importance plot (PIP) for the interpretation of the 25 items of the BDSQ. Results Older donors are more likely to report lower overall satisfaction with the service provided by the blood bank. PIP allows us to classify the items of BDSQ into long- and short-term improvement opportunities as well as into motivational and hygiene factors. Motivational factors (i.e. attributes that promote overall satisfaction when present) tend to be associated with the treatment offered by the blood bank staff. Donors seem to give more importance to the interpersonal aspects than to the physical structure of the service and other aspects of convenience. Conclusions Top-box analysis and PIP proved to be efficient strategies to interpret the results of the BDSQ.

Reevaluation of the deferral from voluntary blood donation by men who have sex with men (MSM) is being discussed in several countries, motivated by the need to ensure a blood supply free from transfusion-transmissible infections (e.g., HIV, syphilis). Policies being considered include: permanent exclusion for any male-male sexual encounter, temporary deferral (3 months, 12 months, 5 years) from the last encounter, or specifying behaviors that differentiate MSM at high risk from those at low risk. Current Brazilian regulations defer MSM from blood donation for 12-months after the last male-male sexual encounter. Broad epidemiological evidence indicates that many MSM are at increased risk for HIV in the present era, and few data exist to distinguish which men are likely to be in the immunological window for detection of these infections. A multicenter study developed in Brazil demonstrated that the history of male-male sex was the most strongly associated with being an HIV-positive blood donor. Meanwhile, the blanket deferral of MSM from blood donation has generated considerable controversy. Rejection of the deferral policies stems in part from perspectives defending human rights, promoting equality and citizenship, and alleging bias and discrimination. The objective of this report is to discuss the current situation of blood donation among MSM in Brazil. We highlight the lack of evidence for a true risk profile for male-male sex in the context of blood donation upon which to base sound policy. We recommend research to establish effective and acceptable criteria for blood donation by MSM and other blood donors. Keywords: Men who have sex with men, Blood donation, Temporary deferral, HIV, Risk behaviors

BACKGROUND: To investigate the association of religiosity with blood donation in a representative/stratified sample of primary healthcare users of Ribeirão Preto, São Paulo, Brazil. METHODS: A cross-sectional study was conducted using the Duke University Religious Index - DUREL (dimensions: organizational, non-organizational, and intrinsic religiosity). Odds ratios adjusted by sex and age were used as measures of association. RESULTS: 1,055 individuals participated (79.7% females; mean age=40.6 years); 23.3% had previously donated blood. Most reported having a religion and grew up in a religious environment. High frequencies of religiosity were observed. Similar DUREL scores were observed among participants who donated blood and those who did not. Family members and close friends had significant influence on participants’ blood donation practices. CONCLUSION: Religiosity was not directly associated with blood donation despite the high prevalence and scores of religiosity. However, possible associations between religion and blood donation should consider mediating variables in future studies.

Introduction The university period is often characterized as a critical period of vulnerability for smoking habit initiation. Objective The purpose of this cross-sectional study was to assess the relationship between religiosity and smoking among undergraduate students on health sciences courses. Methods A total of 336 students on four health sciences courses (occupational therapy, speech therapy, nutrition, and physiotherapy) completed a cigarette smoking questionnaire along with the Duke University Religion Index. Results Smoking prevalence was 8.3% among females and 12.7% among males. Prevalence among students who do not have a religion, but do believe in God, was higher than among those who do have a religion (16.3 and 6.3%, respectively). Organizational religious activity has a significant effect on smoking status. Conclusion The students have health habits that are not only motivated by the technical knowledge acquired on their undergraduate courses, since there was a possible influence of social norms stimulated by religious institutions on their attitudes, knowledge and practices in health.

BackgroundWhile considerable attention has been devoted to patients’ health complexity epidemiology, comparatively less attention has been paid to tools to identify and describe, in a personalized and comprehensive way, “complex patients” in primary health care (PHC).ObjectiveTo evaluate INTERMED tool’s validity and feasibility to assess health complexity in PHC.DesignCross-sectional psychometric study.SettingThree Brazilian PHC Units.Participants230 patients above 18 years of both sexes.MeasurementsSpearman’s rho assessed concurrent validity between the whole INTERMED and their four domains (biological, psychological, social, health system) with other well-validated instruments. Pearson’s X2 measured associations of the sum of INTERMED “current state” items with use of PHC, other health services and medications. Cronbach’s Alpha assessed internal consistency. INTERMED acceptability was measured through patients’ views on questions and answers’ understanding and application length as well as objective application length. Applicability was measured through patients’ views on its relevance to describe health aspects essential to care and INTERMED’s items-related information already existing in patients’ health records.Results18.3% of the patients were “complex” (INTERMED’s 20/21 cut-off). Spearman’s correlations located between 0.44 - 0.65. Pearson’s coefficients found were X2 = 26.812 and X2 = 26.883 (both p = 0.020) and X2 = 28.270 (p = 0.013). Cronbach’s Alpha was 0.802. All patients’ views were very favorable. Median application time was 7 minutes and 90% of the INTERMED’s interviews took up to 14 minutes. Only the biological domain had all its items described in more than 50% of the health records.LimitationsWe utilized the cutoff point used in all previous studies, found in research performed in specialized health services.ConclusionWe found good feasibility (acceptability and applicability), and validity measures comparable to those found from specialized health services. Further investigations of INTERMED predictive validity and suitability for routine PHC use are worthwhile.

Population-based studies on blood donation prevalence and its association with sociodemographic and behavioural factors are scarce, but remain the best approach to assess correlates of donation, including those which could be the target for donor recruitment campaigns. This study describes the population of primary healthcare users from the public system in a medium-sized Brazilian municipality to investigate the association of blood donation practice with other sociodemographic factors. A stratified, representative sample of primary healthcare users at 12 healthcare facilities in Ribeirão Preto, São Paulo, Brazil, were invited to participate. Analysis focused on demographic and psychosocial factors including, sex, age, marital status, socioeconomic status, educational level, health insurance, self-perception of health, religious beliefs, and blood donation history. Blood donors, self-defined ineligible donors, and never donors were compared. Multiple correspondence analysis (MCA) was used to assess positively and negatively associated variables in the dataset. MCA was conducted on respondents' age and monthly household income to assess dimensionality of other questionnaire responses. Of a total of 1,055 study participants, 79.7% were females and the mean age was 40.6 years. Blood donation practice was reported by 246 participants (23.3%), 669 (63.4%) had never donated, and 140 (13.3%) reported being unable to donate blood. Graphical presentation of the MCA showed that male, older age groups, those who have health insurance, and with higher socioeconomic and educational level are more likely to donate blood. Poor or average self-perception of health, lower socioeconomic status, and divorced or widowed marital status were associated with self-defined inability to donate blood. Thus, our results are useful to understand the multifactorial nature of blood donation behaviour. Our findings provide guidance for targeted recruitment campaigns focused on relevant contextual factors. The focus on reducing barriers to blood donation according to sociodemographic groups can be a relevant strategy to expand the donor base.

The physiotherapy has an important role in the health promotion and autonomy for the elderly, and the healthcare system should be able to provide adequate support for older age groups. Objective: The objectives of this cross-sectional study were to determine the lifetime prevalence of physiotherapy utilization among elderly users (60 years of age or more) of primary healthcare facilities in Ribeirão Preto, Brazil, and to investigate its association with variables such as sex, age, educational level and socioeconomic status. Methods: Data were collected during face-to-face interviews. Participants were invited to participate in the study while they waited for their medical appointment in a primary healthcare facility. Log-binomial regression models were used for adjusting the data. The sample was composed of 224 (63%) women and 133 (37%) men. Results: Overall, 141 (39.5%) individuals reported undertaking physiotherapy sessions some time along their lifetimes. The prevalence of physiotherapy utilization among women was 42.0% (95% CI: 35.4 - 48.7) and among men was 35.3% (95% CI: 27.2 - 44.1). The utilization of physiotherapy was more frequent among elderlies who had health insurance coverage, higher socioeconomic status and higher educational level. This suggests that some groups of population have more access to physiotherapy due to a higher capacity to pay for healthcare when compared to uninsured people. Conclusion: The participation of physiotherapists in the primary care setting should be encouraged, in order to reduce inequalities in access to such resources.

Síndrome de Burnout e consumo de álcool em estudantes de Odontologia

Aims: To evaluate the contribution of the psychosocial and behavioral aspects of pain to the perception of oral health in a sample of Brazilian dental patients. Methods: This cross-sectional study involved 436 patients who sought dental care in the School of Dentistry of Sao Paulo State University and who reported some type of orofacial pain. The study group's mean age (± standard deviation [SD]) was 39.9 ± 13.6 years, and the sample was 74.5% female. The Portuguese version of the Oral Health Impact Profile Short Form (OHIP-14) and the Multidimensional Pain Inventory (MPI) were used. The data were included in a structural equation model in which perception of oral health was considered the dependent variable. The evaluation of the contribution of psychosocial and behavioral aspects of pain to the perception of oral health was based on the statistical significance of causal paths (β) evaluated by z tests (α = 5%). Results: The fit of the models of OHIP-14 and MPI were adequate. Interference, self-control, negative mood, and punishing responses provided significant contributions to the perception of oral health. The structural model presented adequate fit to the data (explained variance = 28.0%). Conclusion: These findings provide evidence that psychosocial and behavioral aspects of pain such as interference of pain in activities, self-control, negative mood, and punishing responses contribute to the perception of oral health.

The objective of this cross-sectional study is to examine the association between religious involvement and tobacco use in a large representative sample of users of primary healthcare units of Ribeirão Preto, Southeast Brazil. Current and past smoking habits were determined among 1055 users of primary healthcare units. Participants' religiosity was measured using the DUREL questionnaire. The prevalence of smoking among men was 16.8% [95% confidence interval (CI) 12.0-22.5] and among women was 12.6% (95% CI 10.4-15.0). Among the current smokers, 40.9% were light smokers, 24.6% were moderate smokers, and 34.5% were heavy smokers. The mean number of cigarettes smoked per day was 13.5. Respondents who have a religion had a lower smoking prevalence than people who had no religion. Current smoking prevalence tended to be higher among people who do not practice their religion than people who practice their religion. Smoking status is also associated with self-reported religiosity, organizational religious activity and some aspects of intrinsic religiosity. Religiosity is an important factor in influencing the smoking behavior in Brazilian users of the public health services.

INTRODUCTION This study investigated the prevalence of blood donors’ test-seeking behavior and related factors among health sciences undergraduate students. METHODS A total of 750 students were invited. Data regarding sociodemographic and behavioral characteristics, blood donation practices, and test-seeking behavior were collected. RESULTS: Of the invited students, 341 (45.5%) agreed to participate and answered questions regarding test-seeking behavior. The sample comprised 83.1% females, 96.8% singles, 87.2% heterosexuals, and 32.6% of them had previously donated blood. A high prevalence of blood donor test-seeking behavior (14.4%; 95% CI: 10.8%-18.5%) was observed and associated with blood donation practices. CONCLUSIONS: Test-seeking behavior was common among the interviewed students, thereby highlighting the importance of developing a better understanding of its determinants to prevent this behavior in key populations.

INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences.

Background A number of studies have been reported on the role of religiosity in health beliefs and behaviors. Objective The objective of this cross-sectional study is to examine the association between religious involvement and patterns of alcohol consumption in a large representative sample of users of primary healthcare facilities in Ribeirão Preto, Southeast Brazil. Method Data were collected through personal interviews. Religiosity was measured using the Duke University Religion Index (DUREL) and the alcohol consumption was measured using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Multinomial logistic regression models were used to evaluate the associations between the participant characteristics, the AUDIT risk levels, and the drinking groups. Results The sample was composed of 841 women with a mean age of 39.5 years old and 214 men with a mean age of 45.1 years old. A significant relationship between patterns of alcohol consumption and the multiple dimensions of religiosity was detected, such as religious affiliation, religious practices, self-perception of the level of religiosity and the ORA, NORA and IR components of DUREL. Lower levels of drinking risk were detected among religious individuals and among those who practice their religions compared to individuals who have no religion and/or non-practicing individuals, respectively. Conclusion A lifestyle motivated by religious concerns is associated with alcohol use habits among the Brazilian users of the public healthcare facilities. Resumo Introdução Vários estudos têm mostrado o papel da religiosidade nas crenças e comportamentos em saúde. Objetivo O objetivo deste estudo transversal é examinar a associação entre envolvimento religioso e padrões de consumo de álcool em uma amostra representativa de usuários de unidades de atenção primária à saúde de Ribeirão Preto, Brasil. Método Os dados foram obtidos por entrevistas pessoais. A religiosidade foi mensurada usando o Duke University Religion Index (DUREL) e o consumo de álcool foi mensurado pelo Alcohol Use Disorders Identification Test (AUDIT). Modelos de regressão logística multinomiais foram usados para avaliar as associações entre as características dos participantes, os níveis do AUDIT e os grupos de consumo de álcool. Resultados A amostra foi composta por 841 mulheres com idade média de 39,5 anos e 214 homens com média de idade de 45,1 anos. Foram evidenciadas associações significativas entre padrões de consumo de álcool e as múltiplas dimensões da religiosidade, como afiliação religiosa, práticas religiosas, autopercepção do nível de religiosidade e os componentes do DUREL. Baixos níveis de ingestão de álcool foram detectados entre indivíduos religiosos e entre aqueles que praticam sua religião, comparados com aqueles que não possuem uma religião e/ou não praticam uma religião, respectivamente. Conclusão Um estilo de vida motivado por interesses religiosos é associado com os hábitos de uso de álcool entre os usuários de unidades de atenção primária à saúde.

There is a consensus on the importance of education of the population for blood donation. Considering that health sciences undergraduate students will play an important role of opinion makers in their social/professional networks in the future, the present study aimed to investigate the knowledge, attitude and practice of the blood donation and religious beliefs among students of a public Brazilian university. All students enrolled in courses of Ribeirao Preto Medical School in 2019 were invited (N = 550). The questionnaire was composed by sociodemographic and behavioral variables, an instrument regarding blood donation attitude and practice, the Blood Donation Knowledge Questionnaire (BDKQ-Brazil) and the Duke University Religious Index (DUREL). Multinomial logistic regression was used to estimate sex- and age-adjusted odds ratios for the relations between sociodemographic/behavioral characteristics and blood donation practice. The association between the responses to the BDKQ-Brazil and blood donation practice was performed using Fisher's Exact Test. Three hundred and forty students were included (81.5% females). Blood donation has been a common practice for part of the students, who have almost entirely shown a positive attitude towards donation and a high rate of self-efficacy regarding their practice. However, less than expected knowledge was observed. Regarding religious beliefs, lower scores of non-organizational and intrinsic religiosity were detected among those male students who never donated blood. Our results suggest the need to develop educational activities for students aiming, in addition to their awareness of the practice of donation, the spread of information regarding blood donation in the future.

Background and objectives The objective of the present study was to investigate the fear of blood, injections and fainting as barriers to blood donation in a sample of primary healthcare users in a Brazilian municipality. Materials and methods This is a cross-sectional survey of primary care patients in 12 randomly selected healthcare facilities in Ribeirao Preto, Brazil in 2015-2016. Key variables were lifetime blood donation history, intentions to donate blood among non-donors and current donation practice. To assess fear of blood in general (FBG), fear of injections in general (FIG) and fear of fainting due to fear of injection (FFI), we used the Blood Injection/Fear Scale (BIFS). We tested associations between variables using regression models and conditional inference trees (CIT). Results A total of 1055 primary healthcare users participated (79·7% female, mean age 40·6 years [SD = 15·2]), 63·4% never donated blood, 13·3% reported they are unable to donate, 6·1% donated only once, 17·2% donated multiple times. Women had higher scores for FIG and FBG. FFI was associated with middle socioeconomic status. Those who never intended to donate exhibited the highest scores in the three dimension of fear. By CIT analysis, being female and high scores for FBG are associated with decreased blood donation. Among males, blood donation frequency is low among those aged 33 years and under. Conclusion Fear of blood, injections and fainting are barriers to blood donation in Brazil. Efforts to recruit and retain blood donors should convey information on blood donation processes and address misconceptions that may increase fear.

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient’s quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL. This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions. A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity. Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL. Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Background: To present the results of the application of the Blood Donation Knowledge Questionnaire in a large and representative sample of users of primary care services in order to extend the evaluation of the metrics of the items and to assess knowledge about blood donation in association with sociodemographic variables. Method: The Blood Donation Knowledge Questionnaire is composed of 24 items based on blood donation requirements of the Brazilian Ministry of Health and on some popular beliefs and concepts of the Brazilian population regarding the blood donation process. Data collection was carried out in 12 healthcare facilities of Ribeirão Preto, São Paulo. The analysis of items was performed using classical test theory with associations being assessed using the multivariate Tobit regression model. Results: A total of 1055 individuals participated (79.7% females and a mean age of 40.6 years). Previous blood donation was reported by 246 (23.3%) participants, 669 (63.4%) had never donated, and 140 (13.3%) reported being ineligible to donate blood. This questionnaire is comprised of items considered easy-to-understand, with a facility level of medium to high and generally an adequate capability of discrimination. Higher means of correct answers were detected among females, individuals with more schooling, and subjects who had already donated blood. Conclusion: The Blood Donation Knowledge Questionnaire is an instrument that aims to measure some general aspects of knowledge regarding blood donation and can be used in different contexts. There is evidence that knowledge of primary healthcare users regarding blood donation is correlated to sex, educational level, and previous blood donation. Keywords: Blood donation, Knowledge, Scales, Primary healthcare users, Blood donor beliefs

Background Blood/injection phobia may have important consequences for health. These phobic individuals, in most cases, avoid contact with health systems, postpone or avoid medical procedures, avoid invasive treatments and do not participate in health promotion and early detection of disease initiatives such as vaccination, consultations, preventive exams or blood donation. Thus, specific and validated instruments are necessary to assess this variable. In addition, a lack of studies on this theme may be associated with the low availability of instruments. This study aimed to propose a Portuguese version of the Blood/Injection Fear Scale (BIFS-P) and assess its psychometric properties. Methods Translation and back-translation were performed. Content validity was assessed in two steps by a panel of 20 experts. The psychometric properties were assessed in a stratified and representative sample of primary health care service users of Ribeirao Preto, southeastern Brazil. Exploratory and confirmatory factor analyses were conducted using a polychoric correlation matrix. Results A total of 1054 primary health care users participated; 79.7% were female and the mean age was 40.6 (standard deviation = 15.16) years. According to the exploratory factor analysis, the items can be grouped into three or five factors with best fits being detected for the three- and five-factor models in confirmatory factor analysis. Conclusion Blood/Injection Fear Scale (Portuguese version) is easy to understand and apply in the general population, showed adequate psychometric properties, and represents an alternative in the assessment of blood/injection phobia for future studies.

Aims: To evaluate the psychometric properties of the Multidimensional Pain Inventory (MPI) in a Brazilian sample of patients with orofacial pain. Methods: A total of 1,925 adult patients, who sought dental care in the School of Dentistry of Sao Paulo State University’s Araraquara campus, were invited to participate; 62.5% (n = 1,203) agreed to participate. Of these, 436 presented with orofacial pain and were included. The mean age was 39.9 (SD = 13.6) years and 74.5% were female. Confirmatory factor analysis was conducted using χ²/df, comparative fit index, goodness of fit index, and root mean square error of approximation as indices of goodness of fit. Convergent validity was estimated by the average variance extracted and composite reliability, and internal consistency by Cronbach’s alpha standardized coefficient (α). The stability of the models was tested in independent samples (test and validation; dental pain and orofacial pain). The factorial invariance was estimated by multigroup analysis (Δχ²). Results: Factorial, convergent validity, and internal consistency were adequate in all three parts of the MPI. To achieve this adequate fit for Part 1, item 15 needed to be deleted (λ = 0.13). Discriminant validity was compromised between the factors “activities outside the home” and “social activities” of Part 3 of the MPI in the total sample, validation sample, and in patients with dental pain and with orofacial pain. A strong invariance between different subsamples from the three parts of the MPI was detected. Conclusion: The MPI produced valid, reliable, and stable data for pain assessment among Brazilian patients with orofacial pain.

A religiosidade é uma variável importante para a pesquisa em saúde, considerando suas conhecidas associações com o processo saúde-doença e questões importantes sobre o bem-estar, atitudes, práticas e satisfação em relação a cuidados e serviços. No entanto, na pesquisa em Saúde Coletiva, é frequentemente usada a afiliação religiosa como única dimensão da religiosidade. O presente estudo objetivou investigar a adequação do uso do instrumento Duke Religious Index (DUREL) no âmbito da pesquisa em Saúde Coletiva, ao avaliar as capacidades psicométricas do instrumento quando aplicado a uma população representativa de usuários dos serviços de atenção primária à saúde de um município de porte médio do interior do Estado de São Paulo. Foi encontrada uma adequada consistência interna para o instrumento e validade convergente-discriminante. Os resultados sugerem que o uso do DUREL não é restrito à pesquisa em saúde mental e que sua utilização pode trazer novas perspectivas para o entendimento de eventos de interesse na área da Saúde Coletiva. Religiosity is an important variable in health research, given its known association with the health-disease process and important questions about the well-being, attitudes, practices and satisfaction with care and services. However, in the research in Public Health, it is often used religious affiliation as the only dimension of religiosity. This study aims to investigate the appropriateness of using the Duke Religious Index scale (DUREL) in the context of the Public Health research, evaluating the psychometric capabilities of the instrument when applied to a representative sample of users of primary care services to health in a medium-sized city of the interior of São Paulo State, Southeast Brazil. It was found an adequate internal consistency for the instrument and satisfactory convergent-discriminant validity. The results suggest that the use of DUREL is not restricted to research in mental health, and that its use can bring new perspectives for the understanding of events of interest in the field of Public Health.

INTRODUCTION: Although congenital syphilis is preventable, its incidence has increased in Brazil. METHODS: In this ecological study, a Bayesian spatio-temporal model was used to estimate the attributable fraction of congenital syphilis cases due to the lack of prenatal care recorded between 2010 and 2015 in the state of São Paulo, Southeast Brazil. RESULTS: For the year 2016, it was estimated that between 79.4% and 95.3% of the congenital syphilis cases among women who did not have prenatal care could have been prevented. CONCLUSIONS: A significant proportion of congenital syphilis cases can be prevented if prenatal care coverage is expanded.