ABSTRACT 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 longand 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.

Abstract 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.

Abstract 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.

ABSTRACT Objective A methodological study aimed at performing the cultural adaptation of the Child Feeding Questionnaire for its use in Brazil. Methods We collected data in a city in the northeastern region of the state of São Paulo, between March and September 2018; seven judges assessed its language standardization, and 85 parents of preschool children performed the cultural adaptation. Results The judges’ agreement level was above 80% for 54 of the 55 statements in the questionnaire. For the parents, the questionnaire is very good, they had no difficulties in using it; most of them understood the affirmative sentences and all parents considered the questionnaire important for the knowledge of child´s healthy eating. We estimated the internal consistency by considering the Kuder-Richardson coefficient for dichotomous variables, and the correlation of each item with the total score was also sought. The results showed values between 0.72 and 0.76, indicating a good consistency, which confirms the reliability of the Brazilian version of the questionnaire. Conclusions The Child Feeding Questionnaire was culturally adapted, aided by the parents. Future studies must be conducted in other Brazilian realities to allow the questionnaire to be widely used. It contributes to promoting the implementation of better practices in child feeding that favor healthy growth and development, as well as to encourage healthy habits in Brazilian families, and to reduce overweight and childhood obesity in the country.

RESUMO Objetivo Este estudo metodológico objetivou realizar a adaptação cultural do Questionário de Alimentação Infantil para uso no Brasil. Methods Os dados foram coletados em município do nordeste paulista, entre março e setembro de 2018. Sete juízes avaliaram a padronização idiomática, e 85 pais de crianças em idade pré-escolar realizaram a adaptação cultural. Results Entre os juízes, obteve-se concordância acima de 80% para 54 das 55 afirmações do questionário. Para os pais, o questionário é muito bom; não há dificuldade em utilizá-lo; a maioria compreendeu as frases afirmativas; e todos o julgaram de grande importância para o conhecimento da alimentação saudável da criança. A consistência interna foi estimada considerando o coeficiente Kuder-Richardson para variáveis dicotômicas; buscou-se também a correlação de cada item com o total. Obtiveram-se valores entre 0,72 e 0,76, ou seja, boa consistência, o que confirma a fidedignidade da versão brasileira do questionário. Conclusions O Questionário de Alimentação Infantil foi adaptado culturalmente com pais. Estudos futuros devem ser conduzidos em outras realidades brasileiras para permitir a ampla utilização do questionário. Ele contribui para fomentar a implementação de melhores práticas na alimentação infantil que favoreçam crescimento e desenvolvimento saudáveis, assim como para estimular hábitos saudáveis nas famílias brasileiras e a redução dos quadros de sobrepeso e obesidade infantil no país.

Abstract Introduction Studies based on knowledge, attitude, and practice (KAP) theory are conducted to identify ways to improve strategies aimed at preventing and combatting certain conditions or diseases, to understand the way how behavioral changes are assimilated by the populations, and to reorient interventions. In view of the coronavirus disease 2019 (COVID-19) pandemic, studies based on KAP theory have been useful to better understand certain behaviors, such as adherence to prevention measures and control of the spread of the virus. Objective To describe the process of cross-cultural adaptation of two complementary instruments for assessing KAP regarding the COVID-19 pandemic in the Brazilian population. Methods Two independent translators proposed a first Brazilian Portuguese version of the scales. The cultural adaptation and pre-test of the Brazilian Portuguese versions occurred at different stages, using a panel of specialists and a subsample of the target population, respectively. Results The pre-test of the adapted instruments involved 30 Brazilian adults (mean age = 41.8 years; standard deviation = 4.24) and was carried out to assess instrument understanding and applicability. The participants informed they did not have difficulties to self-complete the instruments and reported a high level of clarity and understanding. Conclusion Both instruments can bring an opportunity to study behavioral constructs about COVID-19 in the Brazilian population, aiming to articulate strategies that enable the fulfillment of effective preventive measures.

ABSTRACT Objective: To develop a self-reporting questionnaire, namely the Blood Donor Satisfaction Questionnaire (BDSQ) in Brazilian Portuguese, to assess the blood donor satisfaction with the service provided by a blood bank. Method: This study was carried out in three stages: 1) a preliminary version of the instrument was proposed, based on a revision of a previous questionnaire and consideration of the focus groups blood donor perceptions; 2) a content validation to assess the relevance of the items, clarity, domain structure and comprehensiveness of the satisfaction measurement, and; 3) a pre-test of the instrument using a sample of blood donors. All the stages of the research were performed at the Regional Hemotherapy Center in Franca, São Paulo, Brazil. Results: The 25-item BDSQ being proposed has an additional question on overall satisfaction. Responses to items are presented on a five-point scale, including a neutral answer. The BDSQ has three domains: accessibility and convenience, technical aspects, and interpersonal aspects. Conclusion: The application of the BDSQ has shown that it can be a useful tool in generating information for managers on specific aspects of blood bank services which need to be improved, monitored or maintained, aiming to provide a service which meets the blood donor expectations and makes him or her feel satisfied with the care received.

Abstract Physical inactivity and sedentary behavior are associated with poor physical and mental health. The article aims to assess the changes in the habits of the Brazilian participants engaged in physical activities in relation to their practices, due the measures of social distancing during the COVID-19 epidemic in 2020. The secondary objective was to describe their levels of anxiety and depression. The questionnaire used in this online survey included demographic information, questions about self-perceptions of the impact of the COVID-19 in the life routines and the 14-item Hospital Anxiety Depression Scale. A total of 1,613 adults completed the questionnaire between May 11 and 15, 2020. Of those, 79.4% reported that the measures to contain the epidemic had any impact on their physical activities, and many had to interrupt or decrease the frequency of their practices. Participants who felt a higher impact of quarantine on their physical activities tend to have higher prevalence of anxiety and depression symptoms. Individuals who practiced physical activities reported that social distance had a high influence on their practices. Furthermore, changes in these habits are associated with high levels of poor mental health.

Resumo Inatividade física e sedentarismo são associados com baixa saúde física e mental. O objetivo deste artigo é avaliar as mudanças nos hábitos dos participantes brasileiros praticantes de atividades físicas em relação às suas práticas, devido às medidas de distanciamento social durante a epidemia COVID-19 em 2020. O objetivo secundário foi descrever seus níveis de ansiedade e depressão. O questionário utilizado nesta pesquisa on-line incluiu informações demográficas, questões sobre a autopercepção do impacto do COVID-19 nas rotinas da vida e a Escala de Depressão de Ansiedade Hospitalar de 14 itens. Um total de 1.613 adultos completou o questionário entre 11 e 15 de maio de 2020. Destes, 79,4% relataram que as medidas para conter a epidemia tiveram algum impacto em suas atividades físicas e muitos tiveram que interromper ou diminuir a frequência de suas práticas. Os participantes que sentiram um maior impacto da quarentena em suas atividades físicas tendem a ter maior prevalência de sintomas de ansiedade e depressão. Os indivíduos que praticavam atividades físicas relataram que o distanciamento social teve alta influência em suas práticas. Além disso, as mudanças destes hábitos são associadas com altos níveis de precária saúde mental.

Abstract 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.

Abstract 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.

Resumo Inatividade física e sedentarismo são associados com baixa saúde física e mental. O objetivo deste artigo é avaliar as mudanças nos hábitos dos participantes brasileiros praticantes de atividades físicas em relação às suas práticas, devido às medidas de distanciamento social durante a epidemia COVID-19 em 2020. O objetivo secundário foi descrever seus níveis de ansiedade e depressão. O questionário utilizado nesta pesquisa on-line incluiu informações demográficas, questões sobre a autopercepção do impacto do COVID-19 nas rotinas da vida e a Escala de Depressão de Ansiedade Hospitalar de 14 itens. Um total de 1.613 adultos completou o questionário entre 11 e 15 de maio de 2020. Destes, 79,4% relataram que as medidas para conter a epidemia tiveram algum impacto em suas atividades físicas e muitos tiveram que interromper ou diminuir a frequência de suas práticas. Os participantes que sentiram um maior impacto da quarentena em suas atividades físicas tendem a ter maior prevalência de sintomas de ansiedade e depressão. Os indivíduos que praticavam atividades físicas relataram que o distanciamento social teve alta influência em suas práticas. Além disso, as mudanças destes hábitos são associadas com altos níveis de precária saúde mental.

Abstract Physical inactivity and sedentary behavior are associated with poor physical and mental health. The article aims to assess the changes in the habits of the Brazilian participants engaged in physical activities in relation to their practices, due the measures of social distancing during the COVID-19 epidemic in 2020. The secondary objective was to describe their levels of anxiety and depression. The questionnaire used in this online survey included demographic information, questions about self-perceptions of the impact of the COVID-19 in the life routines and the 14-item Hospital Anxiety Depression Scale. A total of 1,613 adults completed the questionnaire between May 11 and 15, 2020. Of those, 79.4% reported that the measures to contain the epidemic had any impact on their physical activities, and many had to interrupt or decrease the frequency of their practices. Participants who felt a higher impact of quarantine on their physical activities tend to have higher prevalence of anxiety and depression symptoms. Individuals who practiced physical activities reported that social distance had a high influence on their practices. Furthermore, changes in these habits are associated with high levels of poor mental health.

Abstract Objective To assess the psychometric properties of the Medical Outcomes Study Social Support Survey (MOS-SSS) considering a sample of elderly users of the primary healthcare facilities of Ribeirão Preto, state of São Paulo, southeast Brazil. Methods The MOS-SSS is a widely used measurement of social support in different contexts, consisting of 19 items with answer categories that range on a 7-point rating scale. Data collection regarding the psychometric properties of the MOS-SSS was performed in a stratified sample of elderly users of primary healthcare facilities of Ribeirão Preto. Data were collected at five district basic health units located in the city through face-to-face interviews. Polychoric correlation matrix and exploratory (EFA) and confirmatory (CFA) factor analyses were performed. Results A total of 357 elderly subjects aged 60 years or older participated in the study (62.7% females). According to the polychoric correlation matrix, higher coefficients of correlation (> 0.90) were detected among 12 pairs of items and grouped into four factors, as suggested for EFA. The results of the CFA confirmed the construct validity of the four-factor structure of the MOS-SSS when applied to our sample, as well as the stability of this model in distinct subsamples. Conclusion The four-factor structure of the MOS-SSS was found to be suitable and presented adequate construct validity for the assessment of social support in elderly users of primary healthcare facilities.

Resumo Objetivo Avaliar as propriedades psicométricas do Medical Outcomes Study Social Support Survey (MOS-SSS), considerando uma amostra de idosos usuários das unidades de atenção primária à saúde de Ribeirão Preto, São Paulo, sudeste do Brasil. Métodos O MOS-SSS é uma escala para investigação do suporte social amplamente utilizada e aplicável a diferentes contextos. A escala é composta por 19 itens com categorias de respostas que variam em uma escala de 7 pontos. A coleta de dados foi realizada em uma amostra estratificada de idosos usuários de serviços de atenção primária à saúde de Ribeirão Preto. Os dados foram coletados em cinco unidades distritais básicas de saúde (UBDS) do município por meio de entrevistas pessoais. A análise dos dados foi feita utilizando-se matriz de correlações policóricas e análise fatorial exploratória (AFE) e confirmatória (AFC). Resultados Participaram do estudo 357 idosos com 60 anos ou mais (62,7% do sexo feminino). De acordo com a matriz de correlações policóricas, maiores coeficientes de correlação (> 0,90) foram detectados em 12 pares de itens e agrupados em quatro fatores, conforme sugerido pela AFE. Os resultados da AFC confirmaram a validade de construto da estrutura de quatro fatores do MOS-SSS quando aplicado à amostra do estudo, bem como a estabilidade desse modelo em subamostras distintas. Conclusão A estrutura de quatro fatores do MOS-SSS mostrou-se apropriada para a população estudada e apresentou validade de construto adequada para a avaliação do suporte social em idosos usuários de serviços de atenção primária à saúde.

Abstract Introduction: Instruments aimed to investigate general aspects of quality of life are scarce in the literature. Flanagan's Quality of Life Scale (QoLS) is an alternative instrument which provides a more comprehensive evaluation of quality of life in different contexts. Objective: To investigate some psychometric properties of the QoLS and discuss the measurement of quality of life using this scale in heterogeneous and large populations. Methods: The QoLS comprises 16 items divided into five dimensions. Responses were measured using a 7-point rating scale. Data were collected from a stratified sample of primary health care users in the municipality of Ribeirão Preto, state of São Paulo, Brazil. Polychoric correlation matrix and exploratory and confirmatory factor analyses were performed. Results: A total of 1,054 primary health care users in 12 health care facilities were interviewed: 79.7% female; mean age = 36.97 years (standard deviation = 15.1). Moderate to low correlation coefficients were observed between almost all pairs of QoLS items. Items 7 and 9 as well as items 14 and 15 were the pairs presenting the highest correlation coefficient. The original structure of the QoLS, with five dimensions, showed adequate psychometric properties regarding the data collected. The inclusion of a single item on life satisfaction was proposed. Conclusion: The original structure of the QoLS was validated and found to be reliable when applied to primary health care users. A new general item was suggested for future studies to improve the interpretations and associations regarding general aspects of quality of life in large and heterogeneous populations.

Resumo Introdução: Instrumentos destinados a investigar aspectos gerais da qualidade de vida são escassos na literatura. A Escala de Qualidade de Vida de Flanagan (Flanagan's Quality of Life Scale – QoLS) é um instrumento alternativo que fornece uma avaliação mais abrangente da qualidade de vida em diferentes contextos. Objetivo: Investigar propriedades psicométricas da QoLS e discutir a mensuração da qualidade de vida utilizando essa escala em populações amplas e heterogêneas. Métodos: A QoLS é composta de 16 itens divididos em cinco dimensões, cujas categorias de resposta variam em uma escala de 7 pontos. Os dados foram coletados em uma amostra estratificada de usuários da atenção primária do município de Ribeirão Preto, SP. Matriz de correlação policórica e análise fatorial exploratória e confirmatória foram realizadas. Resultados: Foram entrevistados 1.054 usuários da atenção primária em 12 unidades de saúde: 79,7% mulheres; idade média = 36,97 anos (desvio padrão = 15,1). Coeficientes de correlação moderados a baixos foram observados entre quase todos os pares de itens da escala. Os pares de itens 7 e 9, e 14 e 15 foram os que apresentaram o maior coeficiente de correlação. A estrutura original da QoLS, com cinco dimensões, apresentou propriedades psicométricas adequadas em relação aos dados coletados. A inclusão de um item único sobre satisfação com a vida foi proposto. Conclusão: A estrutura original da QoLS foi considerada válida e confiável quando aplicada a usuários da atenção primária. Um novo item geral foi sugerido para estudos futuros, a fim de melhorar as interpretações e associações sobre aspectos gerais da qualidade de vida em populações amplas e heterogêneas.

ABSTRACT 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.

Abstract 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.

Abstract The aim of this cross-sectional study was to estimate the prevalence of self-reportedhypertension and diabetes among elderly users of primary healthcare facilities in Ribeirão Preto, Brazil, and to investigate the association between these chronic conditions and physical activity and the degree of independence on the performance of activities of daily living. The study included 357 subjects aged 60 years or older. The classification of physical activity was based on the International Physical Activity Questionnaire (IPAQ) and the Pfeffer FunctionalActivities Questionnaire (PFAQ) was applied to assess activities of daily living. Prevalence of diabetes was associated with the level of physical activity, the self-perception of health and the degree of independence on the performance of activities of daily living. No significant associations were found between the prevalence of hypertension and these variables. These findings reinforce the relevance of continuous strategies of management of diabetes in the primary healthcare facilities based on the promotion of physical and occupational activities.

Resumo O objetivo deste estudo transversal foi estimar a prevalência auto-reportada de hipertensãoe diabetes entre idosos usuários das unidades de atenção primária à saúde de Ribeirão Preto, Brasil, e investigar a associação entre estas condições crônicas e a atividade física e o grau de independência na realização das atividades da vida diária. O estudo incluiu 357 participantes com idade de 60 anos ou mais. A classificação da atividade física baseou-se no International Physical Activity Questionnaire (IPAQ), e o Pfeffer Functional Activities Questionnaire (PFAQ) foi aplicado para avaliar a realizaçãodas atividades da vida diária. Prevalência de diabetes foi associada com o nível de atividade física, a autopercepção da saúde e o grau de independência na realização das atividades da vida diária. Não foram encontradas associações significantes entre a prevalência de hipertensão e estas variáveis. Estes achados reforçam a relevância de estratégias contínuas de manejo da diabetes nas unidades de atenção primária à saúde, baseadas na promoção de atividades físicas e ocupacionais.