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1.
Int J Epidemiol ; 2020 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-33326019

RESUMEN

BACKGROUND: Intimate partner violence (IPV) damages health and is costly to families and society. Individuals experience different forms and combinations of IPV; better understanding of the respective health effects of these can help develop differentiated responses. This study explores the associations of different categories of IPV on women's mental and physical health. METHODS: Using data from the World Health Organization (WHO) Multi-Country Study on Women's Health and Domestic Violence, multilevel mixed effects logistic regression modelling was used to analyse associations between categories of abuse (physical IPV alone, psychological IPV alone, sexual IPV alone, combined physical and psychological IPV, and combined sexual with psychological and/or physical IPV) with measures of physical and mental health, including self-reported symptoms, suicidal thoughts and attempts, and nights in hospital. RESULTS: Countries varied in prevalence of different categories of IPV. All categories of IPV were associated with poorer health outcomes; the two combined abuse categories were the most damaging. The most common category was combined abuse involving sexual IPV, which was associated with the poorest health [attempted suicide: odds ratio (OR): 10.78, 95% confidence interval (CI) 8.37-13.89, thoughts of suicide: 8.47, 7.03-10.02, memory loss: 2.93, 2.41-3.56]. Combined psychological and physical IPV was associated with the next poorest outcomes (attempted suicide: 5.67, 4.23-7.60, thoughts of suicide: 4.41, 3.63-5.37, memory loss: 2.33, 1.88-2.87-). CONCLUSIONS: Understanding the prevalence and health impact of different forms and categories of IPV is crucial to risk assessment, tailoring responses to individuals and planning services. Previous analyses that focused on singular forms of IPV likely underestimated the more harmful impacts of combined forms of abuse.

2.
BMC Health Serv Res ; 20(1): 1085, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33243236

RESUMEN

BACKGROUND: Domestic violence and abuse is a violation of human rights which damages the health and wellbeing of victims, their families and their friends. There has been less research on the experiences and support needs of male victims than those of women. Historically research on men's experiences has not focused on what constitutes effective, needs-led service provision. The aim of this paper was to conduct an integrated mixed methods synthesis of systematic review evidence on the topic of help-seeking by male victims of domestic violence and abuse. METHODS: An integrated mixed methods synthesis approach was taken to enhance our understanding of the complex phenomenon of help seeking by, and service provision to male victims. This process also identifies gaps in the evidence. Using previously identified systematic review data; mixed methods data from four primary-level service evaluation studies, along with expert and patient consultation were used to develop research propositions. Primary-level qualitative interview and survey data from 12 studies of men experiences were mapped onto the propositions to support them. RESULTS: Fourteen propositions were composed. Seven propositions were supported or at least partly supported by the qualitative data. These supported propositions were used to make recommendations for policy and practice particularly concerning service preferences of male victims. The remaining seven propositions were not specifically supported by the qualitative data. These unsupported propositions were used to develop research recommendations concerning the need to further understand the potential blurred boundaries of victim-perpetrator, hybrid perpetrator-victim experiences, men who are/have been victims of childhood sexual abuse and determining the level of risk for men. They also highlight the need to produce better guidance for the response of the police & the criminal justice system. Finally, they highlight the need to produce the most appropriate service for men in terms of access, linkage, substance/alcohol abuse, mental health, sexuality, and race. CONCLUSION: Integrated mixed-methods synthesis of systematic review evidence is a relatively novel approach. This approach can lead to recommendations for policy and practice as well as highlighting gaps in the research agenda as shown in this example.

4.
Am J Clin Oncol ; 43(4): 298-304, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31895096

RESUMEN

The incidence of pancreatic ductal adenocarcinoma has risen rapidly. By 2030, it is likely to be the second most prevalent cause of death by cancer, following cancer of the lung. Unfortunately, most patients present with advanced disease. In fact, only 20% of patients are candidates for surgery. More research is needed to find dependable treatment options for this disease. Although we wait for more effective treatments to be developed, we continue using chemotherapy, radiation, and surgery-all with less than optimal outcomes. There is a debate about using chemotherapy in the neoadjuvant setting and counter-debate about better outcomes in the adjuvant settings. In the neoadjuvant setting, not everyone is able to make it to surgery; conversely, in the adjuvant setting, not everyone is able to make it to chemotherapy. Drop-out data after surgery are widely available, but similar drop-out rates after neoadjuvant treatment are not widely published. Here, we will analyze the literature to better understand the treatment strategies and outcomes of pancreatic ductal adenocarcinoma. We argue in favor of an upfront surgery and adjuvant therapy strategy for better outcomes and patient quality of life.


Asunto(s)
Carcinoma Ductal Pancreático/cirugía , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Carcinoma Ductal Pancreático/tratamiento farmacológico , Carcinoma Ductal Pancreático/patología , Quimioterapia Adyuvante , Humanos , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/patología
5.
Am J Cancer Res ; 9(9): 1871-1888, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31598392

RESUMEN

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer mortality among men and women in the United States. Its incidence has been on the rise, with a projected two-fold increase by 2030. PDAC carries a poor prognosis due to a lack of effective screening tools, limited understanding of pathophysiology, and ineffective treatment modalities. Recently, there has been a revolution in the world of oncology with the advent of novel treatments to combat this disease. However, the 5-year survival of PDAC remains unchanged at a dismal 8%. The aim of this review is to bring together several studies and identify various recent modalities that have been promising in treating PDAC.

6.
BMJ Open ; 9(6): e021960, 2019 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-31186243

RESUMEN

OBJECTIVES: To understand help-seeking by male victims of domestic violence and abuse (DVA) and their experiences of support services by systematically identifying qualitative and mixed-method studies and thematically synthesising their findings. DESIGN: Systematic review and qualitative evidence synthesis. Searches were conducted in 12 databases and the grey literature with no language or date restrictions. Quality appraisal of the studies was carried out using the Critical Appraisal Skills Programme tool. Reviewers extracted first and second order constructs related to help-seeking, identified themes and combined them by interpretative thematic synthesis. SETTING: DVA experienced by male victims and defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse among people aged 18 or over who are or have been intimate partners or family members, regardless of gender or sexuality. PARTICIPANTS: Male victims of DVA. INTERVENTIONS: Any intervention which provides practical and/or psychological support to male victims of DVA including but not limited to DVA-specific services, primary healthcare and sexual health clinics. PRIMARY AND SECONDARY OUTCOME MEASURES: Qualitative data describing help-seeking experiences and interactions with support services of male victims of domestic violence RESULTS: We included twelve studies which were published between 2006 and 2017. We grouped nine themes described over two phases (a) barriers to help-seeking: fear of disclosure, challenge to masculinity, commitment to relationship, diminished confidence/despondency and invisibility/perception of services; and (b) experiences of interventions and support: initial contact, confidentiality, appropriate professional approaches and inappropriate professional approaches. CONCLUSION: The recent publication of the primary studies suggests a new interest in the needs of male DVA victims. We have confirmed previously identified barriers to help-seeking by male victims of DVA and provide new insight into barriers and facilitators to service provision. PROSPERO REGISTRATION NUMBER: CRD42016039999.


Asunto(s)
Violencia Doméstica , Aceptación de la Atención de Salud , Apoyo Social , Víctimas de Crimen/psicología , Violencia Doméstica/psicología , Humanos , Masculino , Investigación Cualitativa
7.
Clin Teach ; 15(5): 382-386, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-28984416

RESUMEN

BACKGROUND: Domestic violence and abuse (DVA) is a leading contributor to the physical and mental ill health of women. Recent international guidance recommends that undergraduate medical curricula should include DVA. We do not know what is currently taught about DVA to medical students in the UK. Recent international guidance recommends that undergraduate medical curricula should include DVA METHOD: Teaching leads from all UK medical schools (n = 34) were invited to participate in an 18-item online survey about what DVA education is provided, their views of this provision and any feedback provided by students. Descriptive statistics were used to analyse the data. RESULTS: A total of 25 out of 34 medical schools participated in the survey (74%). All respondents felt that there should be formal teaching on DVA in the medical curriculum. Eighty-four per cent of respondents reported that there was some formal teaching in their medical school, and 90% of these reported that it was mandatory. Of those who delivered some teaching, 52% reported that the provision was 0-2 hours in total. Most commonly content was delivered in year 4. DVA teaching was delivered in different modules, by different methods and delivered by a range of different providers. Seventy-five per cent of respondents reported that they felt the provision at their medical school was inadequate or not enough. Barriers to providing DVA education identified included time constraints, failure to perceive it as a medical problem and the assumption that it will be covered elsewhere. CONCLUSION: Most medical students in the UK receive a small amount of teaching on DVA towards the end of the curriculum. This is perceived as inadequate.


Asunto(s)
Violencia Doméstica , Educación de Pregrado en Medicina/organización & administración , Educación de Pregrado en Medicina/estadística & datos numéricos , Concienciación , Instrucción por Computador , Estudios Transversales , Curriculum , Conocimientos, Actitudes y Práctica en Salud , Humanos , Enseñanza/organización & administración , Factores de Tiempo , Reino Unido
8.
Trop Med Int Health ; 20(7): 903-13, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25754063

RESUMEN

OBJECTIVE: To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. METHODS: In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. RESULTS: The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care. CONCLUSIONS: Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , Cumplimiento de la Medicación , Trastornos Mentales/complicaciones , Estrés Psicológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Cultura , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Necesidades y Demandas de Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Pobreza , Prevalencia , Estigma Social , Apoyo Social , Esposos , Estrés Psicológico/etiología , Pensamiento , Zimbabwe
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