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1.
Health Aff (Millwood) ; 41(2): 195-202, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35130060

RESUMEN

Few studies have illustrated how racism influences Black women's use of reproductive health care services. This article presents findings of a collaborative study conducted by a research team and a reproductive justice organization to understand Black women's concerns with sexual and reproductive health services. The qualitative research was conducted with Black women living in Georgia and North Carolina, using a community-based participatory research approach. Themes were developed from participant accounts that highlight how racism, both structural and individual, influenced their reproductive health care access, utilization, and experience. Structural racism affected participants' finances and led some to forgo care or face barriers to obtaining care. Individual racism resulted in some women electing to receive care only from same-race medical providers. These findings suggest a need for policies and practices that address structural barriers to reproductive health care access and improve the reproductive health experience of Black women.


Asunto(s)
Racismo , Servicios de Salud Reproductiva , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Salud Reproductiva , Conducta Sexual
2.
Rev. enferm. UERJ ; 30: e64543, jan. -dez. 2022.
Artículo en Inglés, Portugués | LILACS-Express | LILACS | ID: biblio-1379017

RESUMEN

Objetivo: refletir sobre as políticas para a prevenção de IST, à luz da perspectiva teórica de Madeleine Leininger sobre o cuidado transcultural, com enfoque na população jovem universitária. Conteúdo: selecionadas 21 obras, entre artigos científicos, políticas e documentos oficiais em saúde no contexto (inter)nacional, discutidas em duas categorias: 1) Políticas públicas para a prevenção de infecções sexualmente transmissíveis e; 2) O papel da universidade nas ações de prevenção de infecções sexualmente transmissíveis na perspectiva da teoria transcultural de Madeleine Leininger. Conclusão: as políticas públicas de saúde relacionadas à prevenção de infecções sexualmente transmissíveis têm enfoque na saúde sexual e reprodutiva de cada segmento social. Salientam-se as peculiaridades e potencialidades envolvidas no ambiente universitário, permeado pela vulnerabilidade dos comportamentos sexuais, numa perspectiva transcultural. O espaço da universidade deve ser inserido nas ações de promoção da saúde e prevenção de doenças, como as infecções sexualmente transmissíveis, sob o prisma do cuidado culturalmente congruente.


Objective: to think, in the light of Madeleine Leininger's transcultural care theory, about policies for the prevention of sexually transmitted infections, focusing on the young university student population. Content: 21 documents were selected, including scientific papers, policies, and official documents on health in the (inter)national context. These were discussed in two categories: 1) policies for the prevention of sexually transmitted infections and; 2) the university's role in preventing sexually transmitted infections, as seen from the perspective of Madeleine Leininger's transcultural theory. Conclusion: policies for the prevention of sexually transmitted infections focus on sexual and reproductive health by social segment. The peculiarities and potentials of the university environment permeated by the vulnerability of sexual behaviors are highlighted from a transcultural perspective. The university space must be included, through the prism of culturally congruent care, in measures to promote health and prevent diseases, such as sexually transmitted infections.


Objetivo: reflexionar sobre las políticas de prevención de infecciones de transmisión sexual, a la luz de la teoría transcultural de Madeleine Leininger, dirigidas a la población joven universitaria. Contenido: fueron seleccionados 21 trabajos, entre artículos científicos, políticas y documentos oficiales en salud en el contexto (inter)nacional, discutidos en dos categorías: 1) Políticas públicas para la prevención de infecciones de transmisión sexual y; 2) El papel de la universidad en las acciones de prevención de infecciones de transmisión sexual desde la perspectiva de la teoría transcultural de Madeleine Leininger. Conclusión: las políticas públicas de salud relacionadas con la prevención de infecciones de transmisión sexual se enfocan en la salud sexual y reproductiva de cada segmento social. Se resaltan las peculiaridades y potencialidades involucradas en el ambiente universitario, permeado por la vulnerabilidad de las conductas sexuales, desde una perspectiva transcultural. El espacio universitario debe estar insertado en las acciones de promoción de la salud y prevención de enfermedades, -como las infecciones de transmisión sexual-, bajo el prisma de una atención culturalmente congruente.

3.
BMC Med Res Methodol ; 22(1): 213, 2022 08 04.
Artículo en Inglés | MEDLINE | ID: mdl-35927636

RESUMEN

BACKGROUND: Adolescent pregnancies and sexually-transmitted infections continue to impact 15 - 19-year-olds across the globe. The lack of sexual reproductive health information (SRH) in resource-limited settings due to cultural and societal attitudes towards adolescent SRH could be contributing to the negative outcomes. Innovative approaches, including mobile phone technologies, are needed to address the need for reliable adolescent SRH information. OBJECTIVE: The study aimed to co-design a Unstructured Supplementary Service Data (USSD) based mobile app prototype to provide confidential adolescent SRH information on-demand and evaluate the mobile app's usability and user experience. METHODS: A human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. To participate, an adolescent must have been 15 to 19 years old, resided in Kibra and would be able to access a mobile phone. Adolescents were enrolled for the alpha and field testing of the app prototype at different time-points. The Mobile Application Rating Scale (MARS) a multidimensional mobile phone evaluation tool was used to access the functionality, engagement, aesthetics and quality of information in the app. Responses from the MARS were reported as mean scores for each category and a mean of the aggregate scores making the app's quality score. The MARS data was also evaluated as categorical data, A Chi square test of independence was carried out to show significance of any observed differences using cumulative and inverse cumulative distribution functions. RESULTS: During the usability test, 62/109 (54.9%) of the adolescents that were followed-up had used the app at least once, 30/62 (48.4%) of these were male participants and 32/62 (51.6%) female. On engagement, the app had a mean score of 4.3/5 (SD 0.44), 4.6/5 (SD 0.38) on functionality, 4.3/5 (SD 0.57) on aesthetics and 4.4/5 (SD 0.60) on the quality of information. The overall app quality mean score was 4.4/5 (SD 0.31). The app was described as 'very interesting' to use by 44/62 (70.9%) of the participants, 20/44 males and 24/44 females. The content was deemed to be either 'perfectly' or 'well targeted' on sexual reproductive health by 60/62 (96.7%) adolescents, and the app was rated 'best app' by 45/62 (72.6%) adolescents, 27/45 females and 18/45 males, with a p-value = 0.011. CONCLUSIONS: Adolescents need on-demand, accurate and trusted SRH information. A mobile phone app is a feasible and acceptable way to deliver adolescent SRH information in resource-limited settings. The USSD mobile phone technology shows promise in the delivery of much needed adolescent SRH information on-demand..


Asunto(s)
Teléfono Celular , Aplicaciones Móviles , Salud Sexual , Adolescente , Adulto , Femenino , Humanos , Masculino , Embarazo , Salud Reproductiva , Conducta Sexual , Adulto Joven
4.
J Prev Med Public Health ; 55(4): 342-350, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35940189

RESUMEN

OBJECTIVES: Human immunodeficiency virus (HIV) prevention among youth seems under-prioritised compared to other key populations. HIV knowledge and stigma are important parts of HIV prevention. To inform HIV prevention among youths, this study quantitatively analysed the associations between open communication regarding sexuality and sexual health, comprehensive HIV knowledge, and non-stigmatising attitudes in Indonesia. METHODS: This study used data from the Indonesian Demographic and Health Survey (IDHS) 2017. The analysis included unmarried men and women aged 15-25 years old. Comprehensive HIV knowledge and a stigmatising attitude were defined according to the IDHS 2017. Open communication about sexuality and sexual health was defined as the number of people with whom participants could openly discuss these topics in their direct network of friends, family, and service providers, with a scale ranging from 0 to a maximum of 7. Primary analysis used binomial logistic regression with weighting adjustments. RESULTS: The final analysis included 22 864 respondents. Twenty-two percent of youth had no one in their direct network with whom to openly discuss sexual matters, only 14.1% had comprehensive HIV knowledge, and 85.9% showed stigmatising attitudes. Youth mostly discussed sex with their friends (55.2%), and were less likely to discuss it with family members, showing a predominant pattern of peer-to-peer communication. Multivariate analysis showed that having a larger network for communication about sexuality and sexual health was associated with more HIV knowledge and less stigmatising attitudes. CONCLUSIONS: Having more opportunities for open sex communication in one's direct social network is associated with more HIV knowledge and less stigmatising attitudes.


Asunto(s)
Infecciones por VIH , Salud Reproductiva , Adolescente , Adulto , Comunicación , Estudios Transversales , Femenino , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Humanos , Indonesia , Masculino , Adulto Joven
5.
BMJ Open ; 12(8): e062392, 2022 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-35940837

RESUMEN

OBJECTIVE: To determine intervention effects and synthesise qualitative research that explored women with or at high risk of kidney disease experiences of shared decision-making in relation to their reproductive health, family planning options and pregnancy. DESIGN: A systematic review of interventions and a qualitative evidence synthesis. DATA SOURCES: We searched Cochrane, CINAHL, MEDLINE, Scopus, ProQuest, Elsevier, PubMed, ScienceDirect and Web of Science. ELIGIBILITY CRITERIA: Shared decision-making interventions and qualitative studies related to reproductive health involving women with or at high risk of kidney disease published from 1980 until January 2021 in English (clinical settings, global perspective). DATA EXTRACTION AND SYNTHESIS: Titles were screened against the inclusion criteria and full-text articles were reviewed by the whole team. Framework synthesis was undertaken. RESULTS: We screened 1898 studies. No evidence-based interventions were identified. 18 qualitative studies were included, 11 kidney disease-specific studies and 7 where kidney disease was a common comorbidity. Women frequently felt unprepared and uninformed about their reproductive options. Conversations with healthcare professionals were commonly described as frustrating and unhelpful, often due to a perceived loss of autonomy and a mismatch in preferences and life goals. Examples of shared decision-making were rare. Kidney disease exacerbated societal expectations of traditional gender roles (eg, wife, mother, carer) including capability to have children and associated factors, for example, parenting, (sexual) relationships, body image and independent living (including financial barriers to starting a family). Local interventions were limited to types of counselling. A new health system model was developed to support new interventions. CONCLUSION: There is a clear need to establish new interventions, test those already in development and develop new clinical guidance for the management of women with or at high risk of kidney disease in relation to their reproductive health, including options to preserve fertility earlier. Other health conditions with established personalised reproductive care packages, for example, cancer, could be used to benchmark kidney practice alongside the new model developed here.


Asunto(s)
Servicios de Planificación Familiar , Enfermedades Renales , Niño , Femenino , Personal de Salud , Humanos , Enfermedades Renales/terapia , Embarazo , Investigación Cualitativa , Salud Reproductiva
6.
Front Public Health ; 10: 823228, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35910931

RESUMEN

American Indian (AI) youth in the United States experience disproportionate sexual and reproductive health (SRH) disparities relative to their non-Indigenous, white counterparts, including increased rates of sexually transmitted infections (STIs), earlier sexual debut, increased rates of teen birth, and reduced access to SRH services. Past research shows that to improve SRH outcomes for AI youth in reservation communities, interventions must address complex factors and multiple levels of community that influence sexual risk behaviors. Here, we describe development of a multi-level, multi-component randomized controlled trial (RCT) to intervene upon SRH outcomes in a Northern Plains American Indian reservation community. Our intervention is rooted in a community based participatory research framework and is evaluated with a stepped wedge design that integrates 5 reservation high schools into a 5-year, cluster-randomized RCT. Ecological Systems Theory was used to design the intervention that includes (1) an individual level component of culturally specific SRH curriculum in school, (2) a parental component of education to improve parent-child communication about SRH and healthy relationships, (3) a community component of cultural mentorship, and (4) a systems-level component to improve delivery of SRH services from reservation healthcare agencies. In this article we present the rationale and details of our research design, instrumentation, data collection protocol, analytical methods, and community participation in the intervention. Our intervention builds upon existing community strengths and integrates traditional Indigenous knowledge and values with current public health knowledge to reduce SRH disparities.


Asunto(s)
Indios Norteamericanos , Enfermedades de Transmisión Sexual , Adolescente , Indios Norteamericanos o Nativos de Alaska , Humanos , Salud Reproductiva , Conducta Sexual , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos
7.
Medwave ; 22(6)2022 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-35917236

RESUMEN

Introduction The COVID- 19 pandemic discontinued sexual and reproductive health care in Chile and the world. The national focus on hospital care led primary care teams to respond in natural and diverse ways. Understanding the factors involved in this process may improve future responses from the judgment of good practices. Therefore, this study aimed to identify and systematize sexual and reproductive health initiatives raised by primary care teams in response to the COVID- 19 pandemic in Chile. Methods We systematically evaluated initiatives and practices in sexual and reproductive health in prima-ry care between June 2020 and November 2021. This study was developed in three methodological phases: a review of documents, a collection of experiences through an electronic instrument sent to the 29 health services in Chile, and in-depth interviews. According to best practice criteria, mapping and characterizing the initiatives and critical discourse analysis of narratives and interviews were carried out. Results Forty-one initiatives from 19 health services were identified, mainly from the South Central macro zone and urban areas. In these areas, care was recognized. These practices were relevant, aligned with their objectives, rapidly implemented, and used novel strategies through new technologies. However, these initiatives had little intercultural relevance or evaluation. Perceived success was related to motivation, leadership, and institutional and community resilience. The adaptability of initiatives emerged as a new need and criterion of analysis. Conclusion The lessons learned from these initiatives invite us to consider health care teams' mental health, their relationship with the community, the use of new technologies, the evaluation of practices considering satisfaction, cross- cutting approaches, and their adaptability. In all, these aspects may improve primary care response in sexual and reproductive health to new crises.


Introducción La pandemia de COVID- 19 ha implicado la discontinuidad de atención en salud sexual y reproductiva en Chile y el mundo. El foco en la contención hospitalaria de la pandemia llevó a los equipos de atención primaria a responder de manera innata y diversa. Por lo tanto, el objetivo de este estudio fue identificar y sistematizar iniciativas de salud sexual y reproductiva planteadas por equipos de atención primaria en respuesta a la pandemia COVID- 19 en Chile, con el fin de comprender y aprender de los factores involucrados en esta, para mejorar futuras respuestas desde la lógica de buenas prácticas. Metodología Estudio de sistematización de iniciativas y prácticas en salud sexual y reproductiva en atención primaria, entre junio de 2020 y noviembre de 2021. Fue desarrollado en tres fases metodológicas: revisión de documentos, recolección de experiencias a través de instrumento electrónico enviado a los 29 servicios de salud de Chile y entrevistas de profundización. Se realizó un mapeo y caracterización de las iniciativas y análisis crítico de discurso de narrativas y entrevistas, según criterios de buenas prácticas. Resultados Se identificaron 41 iniciativas de 19 servicios de salud, principalmente de la Macro Zona Centro- sur, urbanas y de reorganización de atención. Fueron prácticas pertinentes, alineadas a sus objetivos, con procesos rápidos de implementación, estrategias innovadoras, alto uso de tecnologías con escasa pertinencia intercultural ni evaluación. El éxito percibido se relacionó con motivación, liderazgo, y resiliencia institucional y comunitaria. La adaptabilidad de las iniciativas emergió como una nueva necesidad y criterio. Conclusión Son importantes los aprendizajes emanados de las iniciativas que invitan a considerar la salud mental de los equipos, su relación con la comunidad, el uso de tecnologías, la evaluación de las prácticas considerando satisfacción, enfoques transversales y la adaptabilidad de estas, para mejorar la respuesta de atención primaria en salud sexual y reproductiva ante nuevas crisis.


Asunto(s)
COVID-19 , Chile , Humanos , Pandemias , Atención Primaria de Salud , Salud Reproductiva
8.
Sex Reprod Health Matters ; 30(1): 2083809, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35929964

RESUMEN

Young people, particularly adolescent girls and young women, represent a growing proportion of those living with HIV. Edutainment programmes have been widely used throughout the world to "educate" and "entertain" audiences and tackle serious social issues in bold and engaging ways. This paper examines the extent to which an edutainment programme, MTV-Shuga, was reported to influence young people's engagement with sexual and reproductive health (SRH) information in rural KwaZulu-Natal, South Africa. In 2019 we conducted eight community-based screenings of MTV-Shuga episodes followed by 25 individual in-depth interviews and 13 focus group discussions with young people aged between 15 and 30. Interviews were audio recorded and transcribed verbatim. Data analysis was thematic and complemented by constant comparison and deviant case analysis techniques. In this rural and poor setting with a high burden of HIV, young people exhibited high levels of awareness of SRH and HIV but had constrained access to services, and limited ability to engage with parents or guardians on SRH matters. MTV Shuga provided an entertaining guide of ways to navigate the risks that they faced in a way that resonated with them. The findings highlight the importance of enabling young people in rural areas to watch MTV Shuga with peers in a safe space in which discussion of the content is facilitated. There is also value in encouraging parents to watch MTV Shuga as a means of enabling discussions between children and adults in their lives about SRH matters.


Asunto(s)
Infecciones por VIH , Salud Sexual , Adolescente , Adulto , Niño , Femenino , Infecciones por VIH/prevención & control , Humanos , Salud Reproductiva , Conducta Sexual , Sudáfrica , Adulto Joven
9.
Nat Microbiol ; 7(8): 1116-1126, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35918418

RESUMEN

Women are disproportionately affected by sexually transmitted infections (STIs) throughout life. In addition to their high prevalence in women, STIs have debilitating effects on female reproductive health due to female urogenital anatomy, socio-cultural and economic factors. In this Review, we discuss the prevalence and impact of non-HIV bacterial, viral and parasitic STIs on the reproductive and sexual health of cisgender women worldwide. We analyse factors affecting STI prevalence among transgender women and women in low-income settings, and describe the specific challenges and barriers to improved sexual health faced by these population groups. We also synthesize the latest advances in diagnosis, treatment and prevention of STIs.


Asunto(s)
Infecciones por VIH , Enfermedades de Transmisión Sexual , Femenino , Infecciones por VIH/diagnóstico , Humanos , Prevalencia , Salud Reproductiva , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control
10.
Medwave ; 22(6): e002555, 29-07-2022.
Artículo en Inglés, Español | LILACS-Express | LILACS | ID: biblio-1381419

RESUMEN

Introducción La pandemia de COVID- 19 ha implicado la discontinuidad de atención en salud sexual y reproductiva en Chile y el mundo. El foco en la contención hospitalaria de la pandemia llevó a los equipos de atención primaria a responder de manera innata y diversa. Por lo tanto, el objetivo de este estudio fue identificar y sistematizar iniciativas de salud sexual y reproductiva planteadas por equipos de atención primaria en respuesta a la pandemia COVID- 19 en Chile, con el fin de comprender y aprender de los factores involucrados en esta, para mejorar futuras respuestas desde la lógica de buenas prácticas. Metodología Estudio de sistematización de iniciativas y prácticas en salud sexual y reproductiva en atención primaria, entre junio de 2020 y noviembre de 2021. Fue desarrollado en tres fases metodológicas: revisión de documentos, recolección de experiencias a través de instrumento electrónico enviado a los 29 servicios de salud de Chile y entrevistas de profundización. Se realizó un mapeo y caracterización de las iniciativas y análisis crítico de discurso de narrativas y entrevistas, según criterios de buenas prácticas. Resultados Se identificaron 41 iniciativas de 19 servicios de salud, principalmente de la Macro Zona Centro- sur, urbanas y de reorganización de atención. Fueron prácticas pertinentes, alineadas a sus objetivos, con procesos rápidos de implementación, estrategias innovadoras, alto uso de tecnologías con escasa pertinencia intercultural ni evaluación. El éxito percibido se relacionó con motivación, liderazgo, y resiliencia institucional y comunitaria. La adaptabilidad de las iniciativas emergió como una nueva necesidad y criterio. Conclusión Son importantes los aprendizajes emanados de las iniciativas que invitan a considerar la salud mental de los equipos, su relación con la comunidad, el uso de tecnologías, la evaluación de las prácticas considerando satisfacción, enfoques transversales y la adaptabilidad de estas, para mejorar la respuesta de atención primaria en salud sexual y reproductiva ante nuevas crisis.


Introducción La pandemia de COVID- 19 ha implicado la discontinuidad de atención en salud sexual y reproductiva en Chile y el mundo. El foco en la contención hospitalaria de la pandemia llevó a los equipos de atención primaria a responder de manera innata y diversa. Por lo tanto, el objetivo de este estudio fue identificar y sistematizar iniciativas de salud sexual y reproductiva planteadas por equipos de atención primaria en respuesta a la pandemia COVID- 19 en Chile, con el fin de comprender y aprender de los factores involucrados en esta, para mejorar futuras respuestas desde la lógica de buenas prácticas. Metodología Estudio de sistematización de iniciativas y prácticas en salud sexual y reproductiva en atención primaria, entre junio de 2020 y noviembre de 2021. Fue desarrollado en tres fases metodológicas: revisión de documentos, recolección de experiencias a través de instrumento electrónico enviado a los 29 servicios de salud de Chile y entrevistas de profundización. Se realizó un mapeo y caracterización de las iniciativas y análisis crítico de discurso de narrativas y entrevistas, según criterios de buenas prácticas. Resultados Se identificaron 41 iniciativas de 19 servicios de salud, principalmente de la Macro Zona Centro- sur, urbanas y de reorganización de atención. Fueron prácticas pertinentes, alineadas a sus objetivos, con procesos rápidos de implementación, estrategias innovadoras, alto uso de tecnologías con escasa pertinencia intercultural ni evaluación. El éxito percibido se relacionó con motivación, liderazgo, y resiliencia institucional y comunitaria. La adaptabilidad de las iniciativas emergió como una nueva necesidad y criterio. Conclusión Son importantes los aprendizajes emanados de las iniciativas que invitan a considerar la salud mental de los equipos, su relación con la comunidad, el uso de tecnologías, la evaluación de las prácticas considerando satisfacción, enfoques transversales y la adaptabilidad de estas, para mejorar la respuesta de atención primaria en salud sexual y reproductiva ante nuevas crisis.

11.
Am J Mens Health ; 16(4): 15579883221106052, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35815925

RESUMEN

Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated for men's involvement in SRH and FP, yet related research remains limited and implementation not fully realized in many countries. This systematic review of literature seeks to summarize the barriers and facilitators to men's involvement in SRH/FP services in the Philippines. It is limited to publications in English from 1994 to 2021 regarding studies conducted in the Philippines whose research questions focused on men's involvement in SRH/FP. Eligible studies were assessed for methodological quality using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Rating Scale. The Ecological Model for Health Promotion was used as the guiding theoretical framework for analysis and to report findings. Barriers and facilitators were identified at every ecological level except that of policy. The most common barrier identified was men's deficit in knowledge about SRH/FP; the most common facilitator was the positive influence of their social network on men's attitudes, beliefs, and practices pertaining to SRH/FP. A range of factors from the individual to the community level influenced men's involvement, including religious beliefs, economic means, and cultural gender roles. More studies are needed to provide a fuller understanding of the multilevel ecological factors influencing men's involvement in SRH/FP and inform interventions with men that can positively affect their behavior related to SRH/FP decision making.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Salud Reproductiva , Toma de Decisiones , Femenino , Humanos , Masculino , Hombres , Filipinas
12.
Artículo en Inglés | MEDLINE | ID: mdl-35805479

RESUMEN

Electronic waste management is a global rising concern that is primarily being handled by informal recycling practices. These release a mix of potentially hazardous chemicals, which is an important public health concern. These chemicals include polybrominated diphenyl ethers (PBDEs), used as flame retardants in electronic parts, which are persistent in nature and show bioaccumulative characteristics. Although PBDEs are suspected endocrine disruptors, particularly targeting thyroid and reproductive hormone functions, the relationship of PBDEs with these health effects are not well established. We used the Navigation Guide methodology to conduct a systematic review of studies in populations exposed to e-waste to better understand the relationships of these persistent flame retardants with hormonal and reproductive health. We assessed nineteen studies that fit our pre-determined inclusion criteria for risk of bias, indirectness, inconsistency, imprecision, and other criteria that helped rate the overall evidence for its quality and strength of evidence. The studies suggest PBDEs may have an adverse effect on thyroid hormones, reproductive hormones, semen quality, and neonatal health. However, more research is required to establish a relationship of these effects in the e-waste-exposed population. We identified the limitations of the data available and made recommendations for future scientific work.


Asunto(s)
Residuos Electrónicos , Retardadores de Llama , Residuos Electrónicos/análisis , Retardadores de Llama/toxicidad , Éteres Difenilos Halogenados/análisis , Salud Reproductiva , Análisis de Semen
13.
BMC Health Serv Res ; 22(1): 873, 2022 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-35794551

RESUMEN

BACKGROUND: Access to sexual and reproductive health services remains a challenge for many in Kenya, Tanzania, Uganda and Zambia. Health service delivery in the four countries is decentralised and provided by the public, private and private not-for-profit sectors. When accessing sexual and reproductive health services, clients encounter numerous challenges, which might differ per sector. Healthcare workers have first-hand insight into what impediments to access exist at their health facility. The aim of this study was to identify differences and commonalities in barriers to access to sexual and reproductive health services across the public, private and private not-for-profit sectors. METHODS: A cross-sectional survey was conducted among healthcare workers working in health facilities offering sexual and reproductive health services in Kenya (n = 212), Tanzania (n = 371), Uganda (n = 145) and Zambia (n = 243). Data were collected in July 2019. Descriptive statistics were used to describe the data, while binary logistic regression analyses were used to test for significant differences in access barriers and recommendations between sectors. RESULTS: According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%). Following, issues with supply of commodities (42.5%) and frequent stockouts (36.0%) were most often raised in the public sector; in the other sectors these were also raised as an issue. Patient costs were a more significant barrier in the private (33.3%) and private not-for-profit sectors (21.1%) compared to the public sector (4.6%), and religious beliefs were a significant barrier in the private not-for-profit sector compared to the public sector (odds ratio = 2.46, 95% confidence interval = 1.69-3.56). In all sectors delays in the delivery of supplies (37.4-63.9%) was given as main stockout cause. Healthcare workers further believed that it was common that clients were reluctant to access sexual and reproductive health services, due to fear of stigmatisation, their lack of knowledge, myths/superstitions, religious beliefs, and fear of side effects. Healthcare workers recommended client education to tackle this. CONCLUSIONS: Demand and supply side barriers were manifold across the public, private and private not-for-profit sectors, with some sector-specific, but mostly cross-cutting barriers. To improve access to sexual and reproductive health services, a multi-pronged approach is needed, targeting client knowledge, the weak supply chain system, high costs in the private and private not-for-profit sectors, and religious beliefs.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud Reproductiva , Estudios Transversales , Personal de Salud , Humanos , Kenia , Tanzanía , Uganda , Zambia
14.
Int J Prison Health ; ahead-of-print(ahead-of-print)2022 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-35833902

RESUMEN

PURPOSE: Young incarcerated male offenders are at risk of poorer sexual health, adolescent parenthood and lack opportunities for formative relationship and sexuality education (RSE) as well as positive male role models. The purpose of this paper is to report the process of co-production and feasibility testing of a novel, gender-transformative RSE programme with young male offenders to encourage positive healthy relationships, gender equality, and future positive fatherhood. DESIGN/METHODOLOGY/APPROACH: Using a rights-based participatory approach, the authors co-produced an RSE programme with young offenders and service providers at two UK prison sites using a sequential research design of: needs analysis, co-production and a feasibility pilot. Core components of the programme are grounded in evidence-based RSE, gender-transformative and behaviour change theory. FINDINGS: A needs analysis highlighted the men's interest in RSE along with the appeal of film drama and peer-group-based activities. In the co-production stage, scripts were developed with the young men to generate tailored film dramas and associated activities. This co-production led to "If I Were a Dad", an eight-week programme comprising short films and activities addressing masculinities, relationships, sexual health and future fatherhood. A feasibility pilot of the programme demonstrated acceptability and feasibility of delivery in two prison sites. The programme warrants further implementation and evaluation studies. ORIGINALITY/VALUE: The contribution of this paper is the generation of an evidence-based, user-informed, gender-transformative programme designed to promote SRHR of young male offenders to foster positive sexual and reproductive health and well-being in their own lives and that of their partners and (future) children.


Asunto(s)
Salud Sexual , Adolescente , Niño , Estudios de Factibilidad , Humanos , Masculino , Prisiones , Salud Reproductiva , Sexualidad
15.
Kennedy Inst Ethics J ; 32(2): 127-171, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35815503

RESUMEN

In this article, I argue that adolescent medical transition is ethical by analogizing it to abortion and birth control. The interventions are similar insofar as they intervene on healthy physiological states by reason of the person's fundamental self-conception and desired life, and their effectiveness is defined by their ability to achieve patients' embodiment goals. Since the evidence of mental health benefits is comparable between adolescent medical transition, abortion, and birth control, disallowing transition-related interventions would betray an unacceptable double standard. While great enough risks can override autonomy over fundamental aspects of personal identity, I demonstrate that the available scientific evidence does not corroborate the view that adolescent medical transition is dangerous. Consequently, adolescent medical transition should be recognized as ethical and remain available.


Asunto(s)
Principios Morales , Salud Reproductiva , Adolescente , Femenino , Humanos , Salud Mental , Embarazo , Autoimagen
18.
Ann Fam Med ; 20(4): 336-342, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35831175

RESUMEN

PURPOSE: Established models of reproductive health service delivery were disrupted by the coronavirus disease 2019 (COVID-19) pandemic. This study examines rapid innovation of remote abortion service operations across health care settings and describes the use of telehealth consultations with medications delivered directly to patients. METHODS: We conducted semi-structured interviews with 21 clinical staff from 4 practice settings: family planning clinics, online medical services, and primary care practices-independent or within multispecialty health systems. Clinicians and administrators described their telehealth abortion services. Interviews were recorded, transcribed, and analyzed. Staff roles, policies, and procedures were compared across practice settings. RESULTS: Across all practice settings, telehealth abortion services consisted of 5 operational steps: patient engagement, care consultations, payment, medication dispensing, and follow-up communication. Online services and independent primary care practices used asynchronous methods to determine eligibility and complete consultations, resulting in more efficient services (2-5 minutes), while family planning and health system clinics used synchronous video encounters requiring 10-30 minutes of clinician time. Family planning and health system primary care clinics mailed medications from clinic stock or internal pharmacies, while independent primary care practices and online services often used mail-order pharmacies. Online services offered patients asynchronous follow-up; other practice settings scheduled synchronous appointments. CONCLUSIONS: Rapid innovations implemented in response to disrupted in-person reproductive health care included remote medication abortion services with telehealth assessment/follow-up and mailed medications. Though consistent operational steps were identified across health care settings, variation allowed for adaptation of services to individual sites. Understanding remote abortion service operations may facilitate dissemination of a range of patient-centered reproductive health services.Annals "Online First" article.


Asunto(s)
Aborto Inducido , COVID-19 , Telemedicina , Femenino , Humanos , Pandemias , Embarazo , Salud Reproductiva , Telemedicina/métodos
19.
Ann Fam Med ; 20(4): 304, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35879073
20.
Front Public Health ; 10: 925626, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35899172

RESUMEN

Objective: The differences in sexual knowledge, attitudes, behaviors, seeking behaviors for sex-related knowledge, and sexual and reproductive health (SRH) outcomes among only-child students and students with siblings in China, was examined for sex- and region- specific effects. Research Design and Methods: Data on 49,569 students from the 2019 National College Student Survey on Sexual and Reproductive Health, conducted across 31 provinces in mainland China was utilized. Multivariable regression and stratified analyses were employed to analyze the differences in sexual and reproductive health between only-child students and students with siblings. Results: Only-child students reported higher sexual knowledge, more liberal sexual attitudes, and fewer adverse SRH outcomes compared to those with siblings. Results were found to be influenced by sex and hometown region after controlling for socio-economic factors, parent-child relationship, and sexuality education. Conclusions: Female students with siblings who resided in rural regions were more likely to have poorer SRH compared to male only-child students who resided in urban regions. Comprehensive sexual education for students should aim to better include females and students from rural areas both offline and online, and public healthcare should offer subsidized consultations and contraceptives.


Asunto(s)
Salud Reproductiva , Hermanos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Conducta Sexual , Estudiantes
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