RESUMEN
BACKGROUND: While scarce, literature suggests that women at the intersection of HIV status and gender and/or sexual minority identities experience heightened social and health disparities within health care systems. OBJECTIVES: This study examines the association between sexual and/or gender minority identities and: (1) experiences of poor treatment by health professionals and (2) being unable to access health services among a cohort of women living with HIV in Metro Vancouver, Canada. DESIGN: Data were drawn from a longitudinal community-based cohort of women living with HIV (Sexual Health and HIV/AIDS Women's Longitudinal Needs Assessment). METHODS: We examined associations between sexual and/or gender minority identities and the two outcomes. We drew on explanatory variables to measure sexual minority and gender minority identities independently and a combined variable measuring sexual and/or gender minority identities. The associations between each of these three variables and each outcome were analysed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios and 95% confidence intervals are reported. RESULTS: The study sample included 1460 observations on 315 participants over 4.5 years (September 2014 to February 2019). Overall, 125 (39.7%) reported poor treatment by health professionals and 102 (32.4%) reported being unable to access health care services when needed at least once over the study period. A total of 110 (34.9%) of participants reported sexual and/or gender minority identities, 106 (33.7%) reporting sexual minority identities, with 29 (9.2%) reporting gender minority identities. In multivariable analysis, adjusting for confounders, sexual minority identities, and combined sexual and/or gender minority identities were significantly associated with increased odds of experiencing poor treatment by health professionals (sexual minority adjusted odds ratio = 1.39 (0.94-2.05); sexual and/or gender minority adjusted odds ratio = 1.48 (1.00-2.18)) and being unable to access health services (sexual minority adjusted odds ratio = 1.89 (1.20-2.97); sexual and/or gender minority adjusted odds ratio = 1.91 (1.23-2.98)). In multivariable analysis, gender minority identities were not significantly associated with increased odds of experiencing poor treatment by health professionals (gender minority adjusted odds ratio = 1.38; 95% CI = 0.76-2.52) and being unable to access health services (gender minority adjusted odds ratio = 1.72; 95% CI = 0.89-3.31) possibly due to low sample size among women with gender minority identities. CONCLUSION: Our findings suggest the need for access to inclusive, affirming, trauma-informed health care services tailored specifically for and by women living with HIV with sexual and/or gender minority identities.
Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Humanos , Femenino , Estudios Longitudinales , Estudios de Cohortes , Canadá , Infecciones por VIH/epidemiologíaRESUMEN
To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥18 years were recruited using respondent-driven sampling (RDS) between March-August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6-10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4-28.7) were common and higher among TGW compared to MSM (p < 0.001). Anticipated (41%), perceived (36%), and enacted (45%) stigmas were highly prevalent, and were also significantly higher among TGW (p < 0.001). In multivariable RDS-adjusted analysis, anticipated (relative risk ratio (RRR), 1.88; 95% CI, 1.11-3.19) and perceived (RRR, 2.06; 95% CI, 1.12-3.79) stigmas were associated with a higher prevalence of depressive symptoms. Anticipated (RRR, 4.78; 95% CI, 1.74-13.13) and enacted (RRR, 3.09; 95% CI, 1.61-5.93) stigmas were also associated with a higher prevalence of depression. In secondary analyses, the significant differences between MSM and TGW were lost after adjusting for stigma. These data demonstrate a high burden of depressive symptoms and depression among MSM/TGW in Kigali. Conceptually, stigma is a likely antecedent of mental health stress among MSM and TGW suggesting the potential utility of scaling up stigma mitigation interventions to improve the quality of life and mental health outcomes among sexual and gender minority communities in Rwanda.
RESUMEN
BACKGROUND: There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA). OBJECTIVES: To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19. METHODS: Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values <0.001. RESULTS: Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100 000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100 000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites. CONCLUSIONS: The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.
Asunto(s)
COVID-19/epidemiología , Disparidades en el Estado de Salud , Hospitalización/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , COVID-19/mortalidad , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Sudáfrica/epidemiología , Adulto JovenRESUMEN
Erythrokeratoderma Variabilis (EKV) is a rare genodermatosis, characterized by variable erythematous and hyperkeratotic skin lesions. It is most often transmitted in autosomal dominant manner (AD). Casual mutations were found in the GJB3 and GJB4 genes encoding connexins 31 and 30.3, respectively. We report a 7-year-old girl with multiple dusky red and brown skin lesions on face, buttock, both arms and legs. This diagnosis was made on the basis of clinical and histological findings and further genetic analysis detected a G > C transition at position 125 of the coding sequence, which replaces arginine with a proline at residue 42 of the protein (R42P). Here, we report a first case of Nepalese patient with EKV resulting from the GJB3 mutation.
Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/transmisión , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , COVID-19 , Comprensión , Infecciones por Coronavirus/prevención & control , Costo de Enfermedad , Países en Desarrollo , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Femenino , Humanos , Incidencia , Gripe Humana/epidemiología , Masculino , Pandemias/prevención & control , Neumonía Viral/prevención & control , Valor Predictivo de las Pruebas , Medición de Riesgo , Sudáfrica , Análisis de SupervivenciaRESUMEN
The article "Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia" written by Y. Wang, C. A. Comins, A. Mulu, S. A. Abebe, K. Belete, T. T. Balcha, S. Baral, S. R. Schwartz, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 27th May 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 19th September 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
RESUMEN
Supporting resilience among people living with HIV (PLHIV) is crucial to their sustained uptake of HIV services as well as psychological and social wellbeing. However, no measures exist to assess resilience specifically in relation to living with HIV. We developed the PLHIV Resilience Scale and evaluated its performance in surveys with 1207 PLHIV in Cameroon, Senegal and Uganda as part of the PLHIV Stigma Index-the most widely used tool to track stigma and discrimination among PLHIV worldwide. Factor analyses demonstrated satisfactory psychometric properties and reliability (alphas = 0.81-0.92). Levels of resilience (e.g., whether one's self-respect has been positively, negatively, or not affected by one's HIV status) varied substantially within and across countries. Higher resilience was associated with less depression in each country (all p < 0.001), and, in Cameroon and Uganda, better self-rated health and less experience of stigma/discrimination (all p < 0.001). The final 10-item PLHIV Resilience Scale can help inform interventions and policies.
Asunto(s)
Infecciones por VIH/psicología , Psicometría/estadística & datos numéricos , Resiliencia Psicológica , Estigma Social , Encuestas y Cuestionarios/normas , Adulto , Camerún , Análisis Factorial , Femenino , Infecciones por VIH/diagnóstico , Humanos , Masculino , Reproducibilidad de los Resultados , Senegal , Discriminación Social/psicología , UgandaRESUMEN
Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February-June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Tamizaje Masivo , Conducta Sexual/estadística & datos numéricos , Población Suburbana/estadística & datos numéricos , Adolescente , Demografía , Etiopía/epidemiología , Femenino , Humanos , Masculino , Instituciones Académicas , Factores Socioeconómicos , Adulto JovenRESUMEN
SETTING: Multidrug-resistant tuberculosis (MDR-TB) patients in the national TB treatment programme of Nepal. OBJECTIVE: To estimate the prevalence of depression and anxiety in people receiving treatment for MDR-TB, identify potential risk factors for depression and anxiety and determine temporal changes in their severity during treatment. DESIGN: An observational study using a screening tool, the Hopkins Symptom Checklist (HSCL-25) for depression and anxiety, administered monthly to a group of 135 patients in Nepal. Logistic and multilevel linear regression models were used to identify any patient characteristics associated with depression and anxiety. RESULTS: Most of the 135 patients were male (76%) and living with their families (68%). The period prevalences of depression and anxiety were respectively 22.2% and 15.6%. Patients reporting physical side effects of MDR-TB treatment had a higher depression score on HSCL by 2.63 points (95%CI 0.77-4.48) and a 1.59 point higher anxiety score (95%CI 0.45-2.73) than those who did not report any side effects. Being single was associated with having anxiety (aOR 0.2, 95%CI 0.03-1.0). CONCLUSION: Given the high rates of depression observed among MDR-TB patients, national TB treatment programmes should ensure their patients are routinely screened for depression and anxiety, and effective treatment offered.
RESUMEN
AIM: To test and refine a performance-based management system to improve health worker performance in Nepal. METHODS: A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes. RESULTS: Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. CONCLUSION: The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.
Asunto(s)
Agentes Comunitarios de Salud/normas , Satisfacción en el Trabajo , Aceptación de la Atención de Salud/estadística & datos numéricos , Rendimiento Laboral/organización & administración , Implementación de Plan de Salud , Humanos , NepalRESUMEN
The Asia Pacific Observatory on Health Systems and Policies is a collaborative partnership which supports and promotes evidence-based health policy making in the Asia Pacific Region. Based in WHO’s Regional Office for South-East Asia, it brings together governments, international agencies, foundations, civil society and the research community with the aim of linking systematic and scientific analysis of health systems in the Asia Pacific Region with the decision-makers who shape policy and practice.
Asunto(s)
Planes de Sistemas de SaludRESUMEN
The successful treatment of multidrug-resistant tuberculosis (MDR-TB) is a global health priority and a key pillar of the World Health Organization's (WHO's) End TB strategy. There has been significant global investment in diagnostic capabilities in recent years. However, we argue that the mental distress of those with MDR-TB and their families continues to be overlooked by TB programmes. Priorities in the End TB Strategy of 'patient-centred care' and 'patient support' are still to be delivered in practice in many low-income settings, and in particular consideration of mental distress. Our experience of undertaking MDR-TB operational research in China, Pakistan, Bangladesh, Nepal and Swaziland has given us detailed insight into the challenges facing patients, their families, health professionals and wider health systems. We are increasingly concerned that psychosocial support, and particularly support focused on mental health, is being insufficiently addressed in national MDR-TB programmes. We suggest that the presence of comorbid mental disorders reduces treatment adherence. We recommend the trialling within TB programmes of brief screening tools for common mental disorders and the incorporation of principles from the WHO Mental Health Gap Action Programme programme into TB programme treatment guidance. Our work in Nepal also suggests that brief psychological counselling delivered by non-specialist counsellors may be feasible.
Asunto(s)
Trastornos Mentales/epidemiología , Programas Nacionales de Salud/organización & administración , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Antituberculosos/administración & dosificación , Familia/psicología , Salud Global , Humanos , Tamizaje Masivo/métodos , Trastornos Mentales/diagnóstico , Apoyo Social , Tuberculosis Resistente a Múltiples Medicamentos/psicología , Organización Mundial de la SaludRESUMEN
SETTING: Twenty-two districts of Nepal, where intensified case-finding (ICF) activities for tuberculosis (TB) were implemented among risk groups under the TB REACH initiative in collaboration with the National TB Programme from July 2013 to November 2015. OBJECTIVES: To assess the yield of TB screening using an algorithm with smear microscopy followed by Xpert(®) MTB/RIF. DESIGN: A descriptive study using routinely collected data. RESULTS: Of 145 679 individuals screened, 28 574 (19.6%) had presumptive TB; 1239 (4.3%) of these were diagnosed with TB and 1195 (96%) were initiated on anti-tuberculosis treatment. The yield of screening was highest among people living with the human immunodeficiency virus (PLHIV) (6.1%), followed by household contacts (3.5%) and urban slum dwellers (0.5%). Among other risk groups, such as prisoners, factory workers, refugees and individuals with diabetes, the yield was less than 0.5%. The number needed to screen to diagnose an active TB case was 17 for PLHIV, 29 for household contacts and 197 for urban slum dwellers. Of 11 525 patients from ICF and the routine programme, 112 (1%) were diagnosed with multidrug-resistant TB. CONCLUSION: There was a substantial yield of TB cases among risk groups such as PLHIV and household contacts. Although the yield in urban slum dwellers was found to be moderate, some intervention should nonetheless be targeted because of the large population and poor access to care in this group.
Contexte : Vingt-deux districts du Népal où des activités intensifiées de recherche des cas (ICF) de la tuberculose (TB) ont été mises en Åuvre au sein de groupes à risque sous l'égide du projet TB REACH en collaboration avec le programme national TB entre juillet 2013 et novembre 2015.Objectifs : Evaluer le rendement du dépistage de la TB grâce à un algorithme basé sur la microscopie de frottis suivie d'un test Xpert® MTB/RIF.Schéma : Etude descriptive basée sur des données recueillies en routine.Résultats : Sur un total de 145 679 individus dépistés, 28 574 (19,6%) ont été présumés atteints de TB ; 1239 (4,3%) d'entre eux ont eu une confirmation du diagnostic de TB ; parmi ces derniers, 1195 (96%) ont mis en route un traitement anti-tuberculose. Le rendement a été le plus élevé parmi les personnes vivant avec le virus l'immunodéficience humaine (PVVIH) (6,1%) suivies par les contacts domiciliaires (3,5%) et les habitants des bidonvilles (0,5%). Dans d'autres groupes à risque comme les prisonniers, les travailleurs d'usine, les réfugiés et les diabétiques, le rendement a été inférieur à 0,5%. Le nombre de personnes à dépister (NNS) pour diagnostiquer un cas de TB active a été de 17 pour les PVVIH, de 29 pour les contacts domiciliaires et de 197 pour les habitants des bidonvilles urbains. Sur 11 525 patients émanant soit du programme ICF soit du dépistage de routine, 112 (1%) ont eu un diagnostic de TB multirésistante.Conclusion : Le rendement en termes de cas de TB dépistés parmi les groupes à risque comme les PVVIH et les contacts domiciliaires a été substantiel. Même si ce rendement a été modeste parmi les habitants des bidonvilles, ceux-ci justifient néanmoins une intervention en raison de leur nombre élevé et de leur médiocre accès aux soins.
Marco de referencia: Veintidós distritos de Nepal, en los cuales se ejecutaron actividades de búsqueda intensiva de casos (ICF) de tuberculosis (TB) en los grupos de riesgo, en el marco del proyecto TB REACH en colaboración con el programa nacional contra la TB de julio del 2013 a noviembre del 2015.Objetivos: Evaluar el rendimiento de la detección sistemática de la TB aplicando un algoritmo que comporta la baciloscopia, seguida de la prueba Xpert® MTB/RIF.Método: Fue este un estudio descriptivo a partir de los datos recogidos de manera sistemática.Resultados: De las 145 679 personas en quienes se practicó la detección, en 28 574 hubo una presunción diagnóstica de TB (19,6%); en 1239 de estos pacientes se estableció el diagnóstico de TB (4,3%); e iniciaron el tratamiento 1195 pacientes (96%). El rendimiento diagnóstico fue más alto en las personas viviendo con el virus de la inmunodeficiencia humana (PVVIH, 6,1%), seguidas de los contactos domiciliarios (3,5%) y los residentes en tugurios (0,5%). En otros grupos de riesgo de contraer la TB como los reclusos, los obreros de fábricas, los refugiados o los pacientes diabéticos el rendimiento diagnóstico fue inferior a 0,5%. El número de personas que se debieron examinar con el fin de detectar un caso de TB activa fue 17 en las PVVIH, 29 en los contactos domiciliarios y 197 en los habitantes de los tugurios. De las 11 525 personas examinadas en la ICF y el programa corriente, se diagnosticó TB multiresistente en 112 casos (1%).Conclusión: La detección sistemática de casos de TB exhibió un alto rendimiento en los grupos de riesgo como las PVVIH y los contactos domiciliarios. Aunque el desempeño en los tugurios urbanos fue moderado, es importante dirigir intervenciones a estos entornos, dado el tamaño de estas poblaciones y su acceso deficiente a la atención de salud.
RESUMEN
Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators. Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) among mothers who delivered in health facilities, to understand their challenges. Design: Cross-sectional study involving semi-structured interviews with mothers conducted in 2015. Results: Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery (n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery (n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%). Conclusion: To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.
Contexte : Huit comités de développement villageois de Mugu, un district de montagne isolé du Népal avec des indicateurs de santé maternelle médiocres.Objectifs : 1) Evaluer la proportion de mères qui ont accouché dans des structures de santé (accouchement en institution), 2) comprendre les raisons de celles qui ont accouché à domicile, et 3) comprendre les défis qu'ont affronté les mères qui ont accouché dans des structures de santé.Schéma : Etude transversale impliquant des entretiens semi-structurés de mères réalisés en 2015.Résultats : Sur 275 mères, 97 (35%) ont accouché en institution. Une analyse de régression logistique multivariée a montré que les femmes qui résidaient à une distance de moins d'une heure du centre d'accouchement, avaient une exposition suffisante aux media ou avaient un seul enfant étaient plus susceptibles d'accoucher dans un hôpital. Les motifs d'accouchement hors institution (n = 178) ont été liés à l'accès géographique (49%), aux préférences personnelles (18%) et à une perception de la qualité médiocre des soins (4%). Les mères qui ont eu accès à l'accouchement en institution (n = 97) ont également fait part des difficultés liées au transport (60%), au coût (28%), à un système de santé fonctionnant mal (18%) et à des attitudes désagréables des prestataires de soins de santé (7%).Conclusion : Pour améliorer l'accès, le gouvernement devrait établir un réseau d'ambulances d'urgence disponible en permanence, y compris un transport aérien. Les problèmes liés au système de santé, notamment l'attitude désagréable du personnel, doivent être abordés d'urgence afin de gagner la confiance des mères.
Marco de referencia: Ocho comités de desarrollo de las aldeas en Mugu, un remoto distrito montañoso de Nepal que presenta indicadores de salud materna insatisfactorios.Objectivos: 1) Evaluar la proporción de madres cuyo parto se atendió en los establecimientos de salud (parto institucional); 2) comprender las razones de las madres cuyo parto tuvo lugar en el hogar; 3) comprender las dificultades de las madres atendidas en los establecimientos de salud.Método: Fue este un estudio transversal con entrevistas semiestructuradas a las madres, realizado en el 2015.Resultados: De las 275 mujeres que participaron, 97 tuvieron un parto institucional (35%). El análisis de regresión logística multivariante reveló que el parto intrahospitalario era más frecuente en las mujeres que residían a menos de una hora de distancia del centro de maternidad, que contaban con una exposición adecuada a los medios de información o que tenían un solo hijo. Las razones del parto domiciliario (n = 178) guardaron relación con el acceso geográfico (49%), las preferencias personales (18%) y la percepción de una atención de baja calidad (4%). Las madres que accedieron al parto institucional (n = 97) refirieron además dificultades relacionadas con el desplazamiento (60%), los costos (28%), las deficiencias del sistema de salud (18%) y las actitudes poco amables de los profesionales de salud (7%).Conclusión: Con el propósito de mejorar el acceso, el gobierno debería poner en funcionamiento una red permanente de ambulancias de urgencia, que cubra también los desplazamientos aéreos. Es urgente abordar los problemas provenientes del sistema de salud como la actitud hostil del personal, a fin de ganar la confianza de las madres.
RESUMEN
An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM.
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Europa (Continente) , Humanos , Masculino , Profilaxis Posexposición , Factores de Riesgo , Asunción de Riesgos , Sexo SeguroRESUMEN
Little is known about the impact of combination HIV prevention interventions for men who have sex with men (MSM) and the impacts on the wider epidemics. Modelling analyses of MSM-specific interventions across varied HIV epidemics may inform evidence-based responses. The Goals model was adapted to project the impacts of providing HIV interventions for MSM and access to expanded coverage of antiretroviral therapy (ART) for adults to measure the effects on the MSM and adult epidemics in Peru, Ukraine, Kenya and Thailand. Positive impacts were observed in all four countries. Across epidemics, 14-25% of infections among MSM may be averted between 2012 and 2016 when MSM interventions are brought to scale and MSM have equal access to expanded ART for adults. Among adults, MSM interventions may avert up to 4000 new infections, in addition to the benefits associated with increased ART. Greatest impacts from expanded interventions were observed in countries where same sex transmission contributes significantly to the HIV epidemic. While significant benefits are observed among the adult and MSM populations with expansion of ART, consideration should be given to the synergies of combining ART expansion with targeted interventions to reach hidden, high-risk populations for HIV testing and counselling and linkages to care.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Modelos Teóricos , Adulto , Epidemias , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Accesibilidad a los Servicios de Salud , Humanos , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Perú/epidemiología , Factores de Riesgo , Tailandia/epidemiología , Resultado del Tratamiento , Ucrania/epidemiologíaRESUMEN
Dyslipidemia is one of the primary causes for cardio vascular disease (CVD) and development of myocardial infarction (MI) which often leads to coronary artery disease (CAD). The elevated level of total cholesterol (TC), triglycerides (TG), low-density lipoproteins-cholesterol (LDL-C), and lowered high-density lipoprotein-cholesterol (HDL-C) are the predictable risk factor for CAD with type-II diabetic patient. The present study was undertaken taken with an objective to frame out the lipid profile in type-II diabetic patients attending OPD (outpatient department) of Nepal Medical College Teaching Hospital (NMCTH) Jorpati, Kathmandu. Samples of 148 individuals with age varying from 30-73 were analyzed. Out of which 96 patients were diabetic and 52 were control group. The mean +/- SD (mg/dl) levels of Cholesterol, TG and LDL-C were found significantly higher compared to non-diabetic, and these are statistically significant when compared with healthy control group. The study concludes that the study of accessing fasting lipid profile in type-II diabetic will be a tool of accessing risk for cardiovascular and other coronary artery complications.