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1.
Arch Womens Ment Health ; 26(3): 341-351, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37032357

RESUMO

Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care.


Assuntos
Aborto Espontâneo , Violência por Parceiro Íntimo , Estupro , Criança , Humanos , Feminino , Gravidez , Estudos de Coortes , Aborto Espontâneo/epidemiologia , África do Sul/epidemiologia , Natimorto , Depressão/epidemiologia , Violência por Parceiro Íntimo/psicologia
2.
Eur J Psychotraumatol ; 14(2): 2237364, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37642373

RESUMO

Background: Survivors of sexual violence are at higher risk of adverse mental health outcomes compared to those exposed to other interpersonal traumas.Objective: To examine the trajectory of both post-traumatic stress disorder (PTSD) and depression as well as the role of early counselling over 24 months among rape survivors.Method: The South African Rape Impact Cohort Evaluation (RICE) study enrolled women aged 16-40 years attending post-rape care services within 20 days of a rape incident (n = 734), and a comparison group (n = 786) was recruited from primary health care. Women were followed for 24 months; the main study outcomes were depression and PTSD. Reports of early supportive counselling by the exposed group were also included. The analysis included an adjusted joint mixed model with linear splines to account for correlated observations between the outcomes.Results: At 24 months, 45.2% of the rape-exposed women met the cut-off for depression and 32.7% for PTSD. This was significantly higher than levels found among the unexposed. Although a decline in depression and PTSD was seen at 3 months among the women who reported a rape, mean scores remained stable thereafter. At 24 months mean depression scores remained above the depression cut-off (17.1) while mean PTSD scores declined below the PTSD cut-off (14.5). Early counselling was not associated with the trajectory of either depression or PTSD scores over the two years in rape-exposed women with both depression and PTSD persisting regardless of early counselling.Conclusion: The study findings highlight the importance to find and provide effective mental health interventions post-rape in South Africa.


Assuntos
Estupro , Transtornos de Estresse Pós-Traumáticos , Humanos , Feminino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Depressão/epidemiologia , Estudos de Coortes , Saúde Mental
3.
SSM Ment Health ; 2: 100112, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36688232

RESUMO

Background: Antiretroviral therapy (ART) has potential to eliminate perinatal HIV infections, but adherence to ART in late pregnancy and postpartum is often suboptimal. Intimate partner violence (IPV) may influence non-adherence among perinatal women living with HIV (WWH), but few quantitative studies have examined this over time or explored mechanisms for this association. Methods: We used secondary data from a parent trial in Johannesburg comprising WWH from the control arm (n=63) and WWH ineligible for the trial (n=133). Trained nurse researchers administered questionnaires at first antenatal visit on past-year psychological, physical, and/or sexual IPV (WHO instrument), socio-demographics (age, food security, education), and perinatal common mental symptoms of depression (Hospital Anxiety and Depression Screener-d); anxiety (HADS-a); post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire). At endline visit 2-4 months postpartum, nurse researchers assessed self-reported ART adherence using a visual analog scale (with ≥95% considered "good"). We fitted structural equation models (SEM) in MPlus to explore direct and indirect effects of IPV on ART adherence. Results: Of 196 perinatal WWH, 53.1% reported IPV exposure at baseline. The majority of participants (85.7%) had good perinatal ART adherence. In adjusted models, IPV at baseline was associated with halved odds of good adherence (aOR=0.51, 95%CI=0.20-0.96). IPV was associated with higher adjusted odds of probable depression (aOR=4.64), anxiety (aOR=2.85), and PTSD (aOR=3.42). In SEM, IPV had a direct (standardized coef=-0.22) and indirect effect (coef=-0.05) on ART via common mental disorders. The total effect of IPV on perinatal adherence was of moderate size (coef= -0.27) and the model had good fit (CFI=0.972; TLI=0.969; RMSEA=0.045; SRMR=0.076). Conclusion: IPV was longitudinally associated with perinatal ART non-adherence in part due to its relationship with mental health symptomology. Addressing IPV within clinical care has potential to improve perinatal mental health, maternal HIV outcomes, and HIV-free infant survival.

4.
Artigo em Inglês | MEDLINE | ID: mdl-30128161

RESUMO

BACKGROUND: In this period of unprecedented levels of displacement, scalable interventions are needed to address mental health concerns of forced migrants in low-resource settings. This paper describes the adaptation and piloting of a guided, multi-media, self-help intervention, Self-Help Plus (SH+), which was developed to reduce psychological distress in large groups of people affected by adversity. METHODS: Using a phased approach that included community consultations, cognitive interviewing, facilitator training, pilot implementation, and a qualitative process evaluation, we adapted SH+ for use among South Sudanese refugees in a refugee settlement in northern Uganda. RESULTS: The SH+ materials, including audio-recorded sessions and an accompanying illustrated manual, were translated into Juba Arabic. Cognitive interviewing primarily resulted in adaptations to language with some minor adaptations to content. Facilitator training and supervision led to further suggested changes to delivery methods. An uncontrolled pilot study (n = 65) identified changes in the expected direction on measures of psychological distress, functional impairment, depression, wellbeing, and psychological flexibility. The process evaluation resulted in further adaptations to intervention materials and the decision to focus future effectiveness evaluations of the intervention in its current form on South Sudanese female refugees. CONCLUSIONS: We found that this potentially scalable, guided self-help intervention could be adapted for and feasibly implemented among female South Sudanese refugees in northern Uganda. These findings lay the groundwork for a future rigorous evaluation of SH+ in this context.

5.
Artigo em Inglês | MEDLINE | ID: mdl-30128163

RESUMO

BACKGROUND: Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women. METHODS: A two-arm, single-blind cluster-randomised controlled trial will be conducted in 14 villages in Rhino Camp refugee settlement, with at least 588 women experiencing psychological distress. Villages will be randomly assigned to receive either SH+ with enhanced usual care (EUC), or EUC alone. SH+ is a five-session guided self-help intervention delivered in workshops with audio-recorded materials and accompanying pictorial guide. The primary outcome is reduction in overall psychological distress over time, with 3 months post-treatment as the primary end-point. Secondary outcomes are self-defined psychosocial concerns, depression and post-traumatic stress disorder symptoms, hazardous alcohol use, feelings of anger, interethnic relations, psychological flexibility, functional impairment and subjective wellbeing. Psychological flexibility is a hypothesised mediator, and past trauma history and intervention attendance will be explored as potential moderators. DISCUSSION: This trial will provide important information on the effectiveness of a scalable, guided self-help intervention for improving psychological health and wellbeing among people affected by adversity. TRIAL REGISTRATION: ISRCTN50148022; registered 13/03/2017.

6.
Soc Sci Med ; 168: 130-139, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27643847

RESUMO

Prevention of mother-to-child transmission (PMTCT) can virtually eliminate HIV infection among infants, yet up to one-third of women miss PMTCT steps. Little is known about how partner dynamics such as intimate partner violence (IPV) influence pregnant and postpartum women's adherence to PMTCT. We conducted 32 qualitative interviews with HIV-positive pregnant and postpartum women in Johannesburg who experienced IPV. Trained researchers conducted in-depth interviews over the period of May 2014-Nov 2015 using narrative and social constructionist approaches. Interviews were transcribed verbatim and analyzed thematically and inductively using Dedoose qualitative software. Twenty-six women experienced recent IPV and one-third had poor adherence to PMTCT. Women's experience of partner violence influenced PMTCT behaviors through four pathways. First, fear of partner disclosure led some women to hide their HIV status to avoid a violent reaction. Despite strategic non-disclosure, several maintained good adherence by hiding medication or moving out from their partner's home. Second, IPV caused feelings of depression and anxiety that led to intentionally or accidentally missing medication. Five women stopped treatment altogether, in a type of passive suicidality, hoping to end the distress of IPV. Third, men's controlling behaviors reduced access to friends and family, limiting social support needed for good adherence. Fourth, in a protective pathway, women reported good adherence partly due to their mothering role. The identity around motherhood was used as a coping technique, reminding women that their infant's wellbeing depended on their own health. PMTCT is essential to prevent vertical HIV transmission, but women living with IPV face multiple pathways to non-adherence. Addressing IPV in antenatal care can support the health of women and infants and may enhance PMTCT coverage.


Assuntos
Comportamentos Relacionados com a Saúde , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Adulto , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Gravidez , Pesquisa Qualitativa , África do Sul , Inquéritos e Questionários
7.
Bone ; 35(1): 170-7, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15207753

RESUMO

Osteoblast survival is one of the determinants of postmenopausal osteoporosis development. Recent data from animal experiments suggest that cytokines, in particular Fas ligand (FasL), contribute to postmenopausal osteoporosis. We now address the effect of Fas activation in postmenopausal osteoblast survival and the potential modulatory effect of estrogen and raloxifene analog (LY117018). The expression of Fas mRNA, Fas protein, and the sensitivity to Fas-induced apoptosis were studied in primary cultures of human osteoblasts from postmenopausal women and in osteoblastic MG-63 cells. Human postmenopausal osteoblasts constitutively expressed Fas receptors in the cell surface. TNFalpha increased the expression of Fas mRNA and cell surface Fas expression. Neither estradiol nor raloxifene analog prevented this increase in Fas expression. In addition, activation of Fas receptor resulted in apoptosis of postmenopausal osteoblasts. While TNFalpha did not induce human osteoblast apoptosis, it did increase the lethal effect of Fas activation. Therapeutic concentrations of estradiol or raloxifene analog did not modulate lethal cytokine-induced apoptosis. Both postmenopausal osteoblasts and MG-63 cells express FasL. FasL expression was not modulated by TNFalpha. In conclusion, estrogen and raloxifene analog do not appear to affect the sensitivity of postmenopausal osteoblasts to Fas-mediated apoptosis.


Assuntos
Estradiol/farmacologia , Estrogênios/farmacologia , Osteoblastos/patologia , Pirrolidinas/farmacologia , Moduladores Seletivos de Receptor Estrogênico/farmacologia , Tiofenos/farmacologia , Idoso , Apoptose/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Feminino , Humanos , Pessoa de Meia-Idade , Osteoblastos/efeitos dos fármacos , Osteoblastos/metabolismo , Osteoporose Pós-Menopausa/patologia , Pós-Menopausa , Receptores do Fator de Necrose Tumoral/biossíntese , Fator de Necrose Tumoral alfa/farmacologia , Receptor fas
8.
Bone ; 22(3): 233-9, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9580147

RESUMO

Alendronate is an aminobisphosphonate with a potent anti-reabsorptive action that does not appear to interfere with bone mineralization, and is even able to increase bone mineral density in osteoporotic postmenopausal women through a still not fully understood mechanism. This study was conducted to assess the direct effect of alendronate on diverse aspects of normal human osteoblast physiology. For that purpose, the in vitro effect of a wide range of concentrations [from 10(-1) to 10(-12) mol/L] of alendronate on cell viability, proliferation, collagen synthesis, and the mineral-depositing capacity of normal human osteoblasts was tested. Alendronate effects were examined at 48 and 96 h of culture in the presence or absence of fetal calf serum. In vitro alendronate affected osteoblast viability at concentrations equal to or higher than 10(-4) mol/L. At concentrations equal to or higher than 10(-3) mol/L, no viable cells were observed in cultures. In vitro alendronate at concentrations between 10(-5) and 10(-12) mol/L did not have any effect on the proliferative capacity of normal human osteoblasts determined by two different techniques: (1) tritiated thymidine incorporation to DNA and (2) cell counting. Collagen synthesis by normal human osteoblasts showed a tendency to decrease following incubation with alendronate supplemented with fetal calf serum. This decrease was only statistically significant after 96 h of culture; however, a dose-response effect could not be documented. Finally, no effect of alendronate was observed on calcium deposition in vitro by normal human osteoblasts at concentrations equal to or lower than 10(-5) mol/L. In conclusion, the present study shows that alendronate in vitro does not affect viability, proliferation, and mineral deposit capacity of normal human osteoblasts at the concentration at which it inhibits by 50% the resorptive capacity of osteoclasts that for this drug has been reported as 2 x 10(-9) mol/L.


Assuntos
Alendronato/farmacologia , Osteoblastos/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/metabolismo , Contagem de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas/efeitos dos fármacos , Colágeno/biossíntese , DNA/biossíntese , Feminino , Humanos , Masculino , Osteoblastos/metabolismo , Timidina/metabolismo
9.
Bone ; 16(4 Suppl): 295S-300S, 1995 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-7626317

RESUMO

The long-term effect of ovariectomy on the loss of bone mineral density (BMD) was evaluated in rats with and without estrogen treatment; BMD was studied in the lumbar and caudal vertebrae, measured by DXA, to find how the losses of BMD occur in the axial skeleton. Seventy female Wistar rats of 3 months of age were divided into four groups as follows: group 1: control animals; group 2: ovariectomized animals; group 3: ovariectomized animals undergoing treatment with estrogen (0.25 mg/kg per week of 17-beta estradiol); group 4: ovariectomized rats undergoing estrogen treatment only during the last 3 months of the experimental period. No significant differences were found among the groups in regard to the BMD values of the caudal vertebrae at either 3 or 6 months. Likewise, in the lumbar vertebrae there were no significant differences among the groups after 3 months. However, at 6 months, a decrease in the BMDs of the ovariectomized animals with respect to the remaining groups was found: 226 +/- 11 mg/cm2 in the ovariectomized group; 262 +/- 14 mg/cm2 in the controls; 255 +/- 4 mg/cm2 in the rats receiving estrogen treatment for 6 months; and 259 +/- 5 mg/cm2 in the animals receiving estrogen for 3 months. The study also reveals the absence of differences in the bone mineral density between the ovariectomized and control rats when the former received estrogen treatment.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Densidade Óssea/fisiologia , Vértebras Lombares/fisiologia , Coluna Vertebral/fisiologia , Absorciometria de Fóton , Fosfatase Alcalina/sangue , Análise de Variância , Animais , Peso Corporal/fisiologia , Densidade Óssea/efeitos dos fármacos , Desenvolvimento Ósseo/efeitos dos fármacos , Desenvolvimento Ósseo/fisiologia , Reabsorção Óssea/fisiopatologia , Cálcio/urina , Creatinina/urina , Modelos Animais de Doenças , Estradiol/administração & dosagem , Estradiol/uso terapêutico , Estrogênios/farmacologia , Feminino , Humanos , Hidroxiprolina/urina , Vértebras Lombares/efeitos dos fármacos , Osteocalcina/sangue , Osteoporose Pós-Menopausa/fisiopatologia , Ovariectomia , Ratos , Ratos Wistar , Coluna Vertebral/efeitos dos fármacos , Cauda
11.
Clin Chim Acta ; 285(1-2): 121-9, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10481928

RESUMO

Anorexia nervosa (AN) is a very extended pathology among adolescent girls nowadays. These patients show a high degree of osteopenia; hence, study of their bone remodelling is of great interest. Serum bone alkaline phosphatase (bAP) and aminoterminal propeptide of procollagen I (PINP) provide good sensitivity in the analysis of bone alterations in postmenopausal osteoporosis. The aim of this study was to compare the usefulness of bAP and PINP in the study of bone remodelling in AN, and their possible correlation with the degree of osteopenia in this pathology. In order to help in the interpretation of the results, levels of the beta-isomer of urinary carboxyterminal propeptide of collagen I (beta-CTX) have also been included. Serum bAP (IRMA) Tandem R-Ostase, Hybritech), PINP (RIA, Orion Diagnostica) and CTX (CrossLaps ELISA, Osteometer) were determined in 41 girls with AN, aged 18.5+/-2.2 years (mean+/-SD) and in 31 healthy control women, aged 19+/-2.3 years. Bone mineral density (BMD) in lumbar spine was measured by DEXA in the AN group. We found that 41 of the 43 patients had BMD z-scores under -2. No significant differences were found in the levels of serum bAP nor in PINP and beta-CTX levels between controls and patients, although values in the AN group were highly variable. All the BMD z-score values were negative, and their absolute value correlates positively with bAP (P = 0.0279) and almost with beta-CTX (P = 0.0921) but not with PINP (P = 0.4627). Bone AP correlates with PINP in control girls (P = 0.017), but not in the AN group (P = 0.3573). Patients with AN were divided into three groups according to their levels of bAP: low (I), normal (II) or high (III). Patients with the highest bAP levels also presented the highest increase in bone resorption, according to their beta-CTX levels, and the highest degree of osteopenia. However, values of PINP were similar in the three groups of patients. The bAP/beta-CTX ratios in subgroups I, II and III of AN patients were 0.035, 0.065 and 0.073, a finding that suggests that bAP is not indicating the real degree of bone mineralization in these patients, because it is a contradiction that the formation/resorption ratio should be higher in the patients who have the highest bone loss. These results could suggest that bone loss in AN is produced by an increase in bone resorption (beta-CTX), without variations in bone matrix formation (PINP); bAP levels are a good marker in the follow-up of osteopenia degree, but not a real indicator of bone mineralization, a similar situation to that of osteomalacia.


Assuntos
Fosfatase Alcalina/metabolismo , Anorexia Nervosa/metabolismo , Reabsorção Óssea , Osso e Ossos/enzimologia , Colágeno/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Colágeno/química , Feminino , Humanos
12.
J Agric Food Chem ; 49(1): 423-9, 2001 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11170608

RESUMO

A treatment with cyanide for the analysis of S-sulfonates in meat and meat derivatives, after a study of the effectiveness of this agent and that of dithiothreitol (DTT), is proposed. Once the protein-bound sulfite has been released, it is determined by HPLC ion exclusion with electrochemical detection. In the assay on the reproducibility of the method, standard deviations were 7.4, 9.2, and 11.4 for mean S-sulfonate values of 69, 107, and 130 microg of SO(2)/g, respectively. Mean recovery was 91.2% for different amounts (56, 111, and 223 microg of SO(2)/g) of S-sulfocysteine added. A study was made of the formation of S-sulfonates in model systems and in meat from different species-chicken and beef-with different fat contents. In the assays with meat, two different levels of sulfite addition were used: 600 and 1200 microg of SO(2)/g. From the assays carried out in model systems with sulfite and cystine it may be concluded that one factor limiting the interaction is the accessibility to disulfide groups. The proportion of S-sulfonates in sulfited meat remains relatively constant and does not seem to be governed by the meat component, the level of sulfite addition, or the fat content. However, the latter two factors are inversely correlated with the retention of sulfite in the foods analyzed.


Assuntos
Produtos da Carne/análise , Ácidos Sulfônicos/análise , Cromatografia Líquida de Alta Pressão , Cianetos/farmacologia , Ditiotreitol/farmacologia , Produtos Avícolas/análise , Reprodutibilidade dos Testes , Sulfitos/análise , Sulfitos/metabolismo
13.
Int J Gynaecol Obstet ; 78 Suppl 1: S119-22, 2002 09.
Artigo em Inglês | MEDLINE | ID: mdl-12429451

RESUMO

The paper summarizes the activities of the WHO in response to violence against women. These focus on research and development of norms and standards.


Assuntos
Violência , Organização Mundial da Saúde , Feminino , Saúde Global , Humanos , Papel Profissional , Maus-Tratos Conjugais , Saúde da Mulher
14.
J AOAC Int ; 76(3): 565-9, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8318849

RESUMO

A method for the determination of sulfites in shrimp developed by Kim and Kim and modified by Paíno-Campa et al. for sausages has been further modified. Total sulfites are extracted by initially adding aluminum oxide to the sample and using an extraction solution at pH 12. In the reproducibility assays, coefficients of variation (CVs) were 4.8% for free sulfite and 7.8% for total sulfite in the edible part of the shrimp. In the inedible part, CVs were 7.5% and 8.9% for free and total sulfite, respectively. Mean recovery was 87.8% for the edible part and 84.4% for the inedible part of the shrimp. The method was compared with the optimized Monier-Williams method. The results obtained with both methods for determination of total SO2 in the edible part of the shrimp did not show significant differences (P = 0.05).


Assuntos
Decápodes/química , Sulfitos/análise , Animais , Cromatografia Líquida , Concentração de Íons de Hidrogênio , Indicadores e Reagentes , Reprodutibilidade dos Testes
20.
Lancet ; 359(9316): 1509-14, 2002 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-11988263

RESUMO

This article is an overview of the role of health services in secondary and tertiary prevention of intimate partner violence. In it, I review the evidence, which comes mostly from developed countries, on the effectiveness and limitations of in-service training programmes to identify and care for women who have experienced intimate partner violence. I also discuss recent initiatives in developing countries to integrate concerns on gender-based violence into health-care services at different levels, some of the dilemmas and challenges posed by the current approaches to intimate partner violence, and recommendations for future interventions.


Assuntos
Violência Doméstica/prevenção & controle , Serviços de Saúde da Mulher/normas , Mulheres Maltratadas/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Sexuais , Saúde da Mulher , Serviços de Saúde da Mulher/organização & administração , Direitos da Mulher/normas
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