RESUMO
ABSTRACT: With regard to tobacco cessation, persons living with HIV (PLWH) are an underserved population, given the high prevalence of use and lack of evidence-based cessation programs tailored to this population. This study examined barriers and facilitators to tobacco use and cessation among PLWH in southern Brazil. We interviewed a total of 36 PLWH: 26 current smokers, of whom eight had a previous diagnosis of pulmonary TB, and 10 former smokers. Motivations for smoking included anxiety relief, social influence, and habitual behaviors. Motivations to quit included bad smell/taste and consequences/symptoms. Barriers to cessation included cost of pharmacological aids, distance to treatment, and reluctance to seek tobacco cessation services at the public primary care clinics due to confidentiality concerns. Participants favored individual or group interventions, no-cost pharmacologic aids, and assured confidentiality. There are specific contextual factors associated with tobacco cessation among PLWH in Brazil, which have important clinical, research, and policy implications.
Assuntos
Infecções por HIV/psicologia , Motivação , Avaliação das Necessidades , Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Uso de Tabaco/psicologia , Adulto , Brasil , Estudos Transversais , Feminino , Infecções por HIV/complicações , Comportamentos Relacionados com a Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
BACKGROUND: Rhesus monkeys have a high prevalence of obesity and spontaneous type 2 diabetes mellitus after the age of 10 years. These monkeys go through a defined, sequential set of metabolic phases, including fasting hyperinsulinemia, impaired glucose tolerance, and fasting hyperglycemia. Using these monkeys, we addressed the hypothesis that renal structural features characteristic of diabetic nephropathy might precede the appearance of overt diabetes. METHODS: We carried out a quantitative analysis of renal tissue, using light microscopy and electron microscopy, from 6 metabolically normal young monkeys, 7 metabolically normal aged monkeys, 7 hyperinsulinemic monkeys, and 18 diabetic monkeys. RESULTS: Glomerular volume was increased significantly in hyperinsulinemic monkeys and diabetic monkeys compared with aged normal monkeys. In the normal monkey, glomerular basement membrane (GBM) width rises with age but reaches a plateau at about 20 years of age; the presence of diabetes was associated with markedly increased GBM width. Glomerular tuft volume and GBM width were correlated most closely with age and with glucose tolerance. CONCLUSION: Diabetic monkey kidneys are characterized by glomerular enlargement, glomerulosclerosis, and thickening of the GBM. Glomerular hypertrophy begins in the prediabetic hyperinsulinemic phase. This finding suggests that early intervention may be required in human patients to preserve normal glomerular structure.