Challenges to the HIV Care Continuum During the COVID-19 Pandemic in Mexico: A Mixed Methods Study.

The COVID-19 pandemic has been reported to disrupt the access to care of people who live with HIV (PWH). The impact of the pandemic on the longitudinal HIV care continuum, however, has not been properly evaluated. We performed a mixed-methods study using data from the Mexican System of Distribution, Logistics, and ART Surveillance on PWH that are cared for in the state of Oaxaca. We evaluated the number of HIV diagnoses performed in the state before and during the pandemic with an interrupted time series. We used the longitudinal HIV care continuum framework to describe the stages of HIV care before and during the pandemic. Finally, we performed a qualitative analysis to determine which were the challenges faced by staff and users regarding HIV care during the pandemic. New HIV diagnoses were lower during the first year of the pandemic compared with the year immediately before. Among 2682 PWH with enough information to determine their status of care, 728 started receiving care during the COVID-19 pandemic and 1954 before the pandemic. PWH engaged before the pandemic spent 42825 months (58.2% of follow-up) in optimal HIV control compared with 3061 months (56.1% of follow-up) for those engaged in care during the pandemic. Staff and users reported decreases in the frequency of appointments, prioritisation of unhealthy users, larger disbursements of ART medication, and novel communication strategies with PWH. Despite challenges due to government cutbacks, changes implemented by staff helped maintain HIV care due to higher flexibility in ART delivery and individualised attention.

Sustained use of liquefied petroleum gas following one year of free fuel and behavioral support in Puno, Peru.

Background: Existing efforts to promote cleaner fuels have not achieved exclusive use. We investigated whether receiving 12 months of free liquefied petroleum gas (LPG) and behavioral support could motivate continued purchase and use. Methods: The Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial enrolled 180 women. Half were randomly assigned to an intervention group, which included free LPG delivered in months 1-12 followed by a post-intervention period in which they no longer received free fuel (months 13-24). For the purposes of comparison, we also include months 1-12 of data from control participants. We tracked stove use with temperature monitors, surveys, and observations, and conducted in-depth interviews with 19 participants from the intervention group at the end of their post-intervention period. Results: Participants from the intervention group used their LPG stove for 85.4 % of monitored days and 63.2 % of cooking minutes during the post-intervention months (13-24) when they were not receiving free fuel from the trial. They used a traditional stove (fogón) on 45.1 % of days post-intervention, which is significantly lower than fogón use by control participants during the intervention period (72.2 % of days). In months 13-24 post-intervention, participants from the intervention group purchased on average 12.3 kg and spent 34.1 soles (10.3 USD) per month on LPG. Continued LPG use was higher among participants who said they could afford two tanks of LPG per month, did not cook for animals, and removed their traditional stove. Women described that becoming accustomed to LPG, support and training from the project, consistent LPG supply, choice between LPG providers, and access to delivery services facilitated sustained LPG use. However, high cost was a major barrier to exclusive use. Conclusion: A 12-month period of intensive LPG support achieved a high level of sustained LPG use post-intervention, but other strategies are needed to sustain exclusive use.

Teacher Motivation and Burnout of English-as-a-Foreign-Language Teachers: Do Demotivators Really Demotivate Them?

This study examined the relationships between teacher motivation (TM) and perceived burnout of English-as-a-foreign-language (EFL) teachers in Chile. A particular focus was given to demotivators and their impact on TM and burnout. The impact of COVID-19 was considered. Given that EFL teachers tend to be second language (L2) learners of English themselves, the study also investigated how TM and L2 motivation interact with each other. The participants were 154 school-level teachers with a range of backgrounds (teaching experience, geographic areas, and school sectors). In the questionnaire, four scales were included: (a) autonomous motivation for teaching; (b) demotivators; (c) perceived burnout; and (d) L2 motivation. Fifteen teachers were interviewed in order to triangulate the survey results. Structural equation modeling showed that TM negatively predicted perceived burnout, suggesting that it can counter teachers' emotional exhaustion and their perceived lack of personal accomplishment. Demotivators predicted TM positively, albeit weakly. L2 motivation was found to be only weakly related to TM. Qualitative findings indicated that teaching experience mediated the role that demotivators played in relation to TM. Experienced teachers, especially those who held intrinsic motivation to teach, channeled the impact of demotivators, including those relating to the pandemic, to a positive motivational force to teach. The study implies the importance of considering teachers as agents and devising an educational system in which their mental health is prioritized.

A Mixed Methods Research Study of Parental Perception of Physical Activity and Quality of Life of Children Under Home Lock Down in the COVID-19 Pandemic.

Household confinement due to the rapid spread of the pandemic caused by COVID-19 has brought very significant changes, such as the forced stay-at-home of children due to the closure of schools. This has meant drastic changes in the organization of daily life and restrictions on their activities, including exercise, which could affect the quality of life of the children due to its importance. In order to study the relationship between physical activity and psychological well-being of minors, a study has been carried out with Mixed Methods Research, combining survey methodology with transversal design with qualitative methodology using discourse analysis. A total of 234 parents of minors in Spain and several Spanish-speaking countries in America participated. The instrument was a questionnaire in Google Forms, which included the Kidscreen-27 quality of life scale. The results show significant differences in both the type of physical activity and its frequency due to age, and differences in parents' perception of whether their children's physical activity levels were sufficient or not, both on the health, mood and school subscales, and in the categorization of open responses referring to concerns due to the pandemic, analyzed with the ALCESTE technique. The relationship between physical activity of children and adolescents and quality of life is clearly concluded.

"Making It Work": A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico.

Introduction Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. New Mexico, a rural and medically underresourced state, is a salient space to study these disparities. We examine how travel distance from trauma centers impacts injured patient outcomes and describe care delivery obstacles. Materials and Methods We conducted an explanatory mixed methods study by creating geospatial maps of New Mexico's trauma data, incorporating linear regression analyses on patient outcomes as a function of estimated travel distance from trauma centers. We also conducted qualitative semi-structured interviews with trauma providers to illuminate and provide context for the geospatial findings utilizing a systematic, collaborative, iterative transcript analysis process. We constructed a conceptual framework describing rural trauma care delivery obstacles. Results Geospatial analyses revealed that most New Mexicans face long travel times to trauma centers. Comparing regression analyses using different data sources suggests that solely hospital-derived data may undercount rural trauma deaths. Interviews with 10 providers suggest that elements that may contribute to these findings include on-the-ground resource-based challenges and those related to broader healthcare systems-based issues. Our conceptual framework denotes how these elements collectively may impact rural trauma outcomes and proposes potential solutions. Conclusions In addressing rural patients' needs, healthcare policy decision-makers should ensure that their datasets are comprehensive and inclusive. They must also take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework.

Life and labor on the internal colonial edge: Political economy of kolberi in Rojhelat.

Through the investigation of kolberi (cross-border labor), this paper sheds light on the state's policy of de-development (or internal colonialization) of the Kurdish region (known as Rojhelat) in Iran. While the most dangerous form of labor, kolberi has become a dominant employment opportunity for Rojhelat Kurds in the last decade. There are no Iranian state laws criminalizing kolberi, and yet those laborers die on a regular basis-being shot or thrown off mountain cliffs by the state forces, stepping into minefields, and so forth. Nevertheless, there is not a single scholarly paper on this subject. Using the mixed methods research approach, our study analyzes the existing data along with in-depth interviews with 20 people who are currently engaged in kolberi to contextualize this understudied phenomenon. Our finding demonstrates that kolberi is a direct outcome of a uni-ethno-religious policies of development and part and parcel of the state's Perso-Shi'ification strategy in Kurdistan. Therefore, kolberi is more of a political phenomenon than an economic one.

Using Community-Engaged Research to Explore Social Determinants of Health in a Low-Resource Community in the Dominican Republic: A Community Health Assessment.

INTRODUCTION: Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process. METHOD: A binational community-academic partnership adapted the Centers for Disease Control and Prevention's CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, interviews with key informants, and a household survey using GIS (geographical information systems) technology. RESULTS: Of all five priorities, unwanted pregnancies and sanitation received the lowest average CHANGE tool ratings for both policies and Systems and Environment. However, data gathered on the five public health priorities reflect the perceived needs and assets of Las Malvinas II, and are equally important in improving the community's health and well-being status. Community members identified as important goals the construction of a primary health clinic, as well as a bigger school, that includes pre-school and high school levels. CONCLUSION: A coalition emerged from the CHA to address the identified issues. The coalition used CHA findings to develop a community health improvement plan. The establishment of a primary health care center and a bigger school were identified as primary goals.

A conditional cash transfer and Women's empowerment: Does Bolsa Familia Influence intimate partner violence?

We apply mixed methods to explore how a conditional cash transfer (CCT) may influence intimate partner violence (IPV). Qualitative interviews with female beneficiaries of Bolsa Familia, Brazil's CCT program, and service providers suggest positive, negative, and null associations between CCTs and IPV are all plausible. These associations result from a combination of economic and psychological motivations. We also use quantitative methods to examine if the expansion of Bolsa Familia between 2004 and 2009 affects the female homicide rate and marital separations. Using municipal level data in a difference-in-differences analysis, we find null associations between Bolsa Familia and female homicides. When we examine the impact on marriages and separations, indicative of a change in the reservation utility of women within the household, we find no impact on marriages but Bolsa Familia is associated with an increase in separations, and, to a greater extent, separations of couples with children. These results suggest Bolsa Familia impacts women's agency within the family, but not to the extent that it reduces the most extreme form of IPV.

Focusing on the Fundamentals: A Simplistic Differentiation Between Qualitative and Quantitative Research.

This article describes qualitative, quantitative, and mixed methods research. Various classifications of each research design, including specific categories within each research method, are explored. Attributes and differentiating characteristics, such as formulating research questions and identifying a research problem, are examined, and various research method designs and reasons to select one method over another for a research project are discussed.

Percepción Intraoperatoria del Paciente sobre la Preparación de la Cavidad de Acceso Endodóntico / Patient Intraoperatory Perception About Endodontic Access Cavity Preparation

RESUMEN: La creencia de que el tratamiento de endodoncia es el tratamiento dental más doloroso es algo habitual. A pesar de ello, la percepción intraoperatoria durante el tratamiento de endodoncia ha sido poco estudiada. Por ello, el objetivo de esta investigación fue describir la percepción de dolor y la experiencia intraoperatoria del paciente tratado en endodoncia, durante la etapa de acceso endodóntico. Se analizaron las valoraciones sobre dolor intraoperatorio realizadas por 20 pacientes, tratados en la clínica de especialidad de una universidad tradicional chilena, durante la etapa de acceso endodóntico en molares. Para ello se utilizaron escalas cuantitativas de valoración de la intensidad del dolor y el análisis de contenido cualitativo de una entrevista semi-estructurada. Se observó que los participantes de sexo femenino, los tratamientos en molares mandibulares y en dientes con diagnóstico de pulpitis irreversible sintomática obtuvieron medias mayores en cuanto a la valoración de la intensidad del dolor. Sin embargo, en la mayoría de los casos el dolor fue descrito como leve. En el análisis cualitativo lo descrito por los participantes se agrupó en 10 categorías. Se observó un mayor porcentaje de referencias a la categoría "Ansiedad ante el tratamiento" (16 %) seguido de "Percepción de la atención profesional" (14 %). Sin embargo, también destacaron las referencias al dolor en su totalidad (25 %) ya sea a "Ausencia de dolor" (13 %) o a "Presencia de dolor en algún grado" (12 %). Se concluyó que entre los participantes de esta investigación existió percepción de dolor intraoperatorio durante la etapa de acceso endodóntico, sin embargo, este fue de carácter leve en la mayoría de los casos.

ABSTRACT: There is a common belief that endodontic treatment is the most painful dental treatment of all. Despite this idea, intraoperative perception during endodontic treatment has not been fully studied. Therefore, the aim of this research was to describe the perception of pain and the intraoperative experience of endodontic treated patients, during the endodontic access cavity preparation. We analyzed the valuations on intraoperative pain completed by 20 patients, treated at the endodontic clinic of a traditional Chilean university, during the endodontic access cavity preparation in molars. For this purpose, quantitative scales of pain intensity assessment and qualitative content analysis of a semi-structured interview were employed. Female participants, treatments in mandibular molars and in teeth diagnosed with symptomatic irreversible pulpitis obtained higher means in terms of assessment of pain intensity. However, in most cases the pain was described as mild. In the qualitative analysis the participant's descriptions were grouped into 11 categories. There was a higher percentage of references to the category "Anxiety before treatment" (16 %) followed by "Perception of professional care" (14 %). However, references to pain in its totality (25 %) either to "Absence of pain" (13 %) or to "Presence of pain to some degree" (12 %) also stood out. It was concluded that among the participants of this investigation there was perception of intraoperative pain during the endodontic access stage, however, this was mild in most cases.

Transcultural Adaptation of Questionnaire to Evaluate Drug Use Among Students: The Use of the EU-Dap European Questionnaire in Brazil.

BACKGROUND: Social and cultural differences between countries stress the need for adapting existent instruments for adequately comparing epidemiological results. However, there are controversies in literature on how to carry out this process. OBJECTIVES: This study aimed to describe the process of cultural adaptation and evaluation of the Brazilian Portuguese language of the European Drug Addiction Prevention Trial (EU-Dap) questionnaire to identify alcohol, tobacco, and other drug use among adolescents. METHODS: The cross-sectional study took place in 16 public schools in three Brazilian cities during the year 2013 in a sample of 2,969 adolescents between the ages of 11 and 16. Operating steps involved analysis of qualitative data collected through student's focus group and field notes by interviewers and quantitative data from test-retest evaluation and nonresponse to item. RESULTS: The results revealed moderate reliability for the primary outcomes and high levels of nonresponse, mainly in the 2/3 final questions. Focus group provided high-quality information about misconception for the semantic and structure of the questionnaire. Participatory observation helped researchers to tap into the main difficulties of the application context. CONCLUSIONS: Sociocultural issues related to Brazilian students, the application context, and the structure of the original questionnaire contributed to the unsatisfactory results of the transcultural adaptation process. The results further highlighted the challenge of adapt questionnaires investigating sensitive issues in an age group particularly influenced by educational factors, especially when the countries have different standards of achievement in education.

Dental students' performance and perceptions on canal preparation: a mixed methods study / Performance e percepções de estudantes de odontologia no preparo de canais: um estudo de métodos mistos

This study explored dental students' performance (quantitative data) and perceptions (qualitative data) on canal preparation with NiTi rotary vs. hand instruments and discussed interactions between technical findings and students' insights. A mixed methods design was used. Each student (n=20) instrumented two canals using hand K-files and two canals using ProTaper Universal® rotary Ni-Ti instruments. Participants had no previous experience with rotary instrumentation but were familiar with hand instrumentation. Quantitative data: apical transportation, working time for instrumentation and procedural errors were statistically analyzed. Qualitative data (students' perceptions) were collected and perceptions were identified from interview contents using thematic analysis. Lower level of apical transportation, fewer procedural errors (ledge/perforation/blockage), and a longer working time were associated with rotary instrumentation. Working time was shorter in the second canal instrumented with both techniques. Perceptions associated with hand instrumentation were: better domain and practice/confidence due to the students being used to the hand technique. Ni-Ti rotary instrumentation perceptions were: good initial expectations before its use, perceptions of doubts and difficulties concerning workability right after its first use, and increase in confidence after its second use in a second canal. It was concluded that: (i) students show a cautious attitude towards rotary instrumentation; (ii) confidence increases after rotary instrumentation of the second canal; (iii) students show good expectations in terms of optimizing root canal treatment with rotary instrumentation and they think it would be possible after some training; and (iv) Ni-Ti rotary instrumentation should be included in the undergraduate curriculum of dental schools (AU).

Este estudo explorou o desempenho dos estudantes de odontologia (dados quantitativos) e percepções (dados qualitativos) em relação ao preparo do canal com instrumentos rotatórios de Ni-Ti versus instrumentos manuais e discutiu interações entre os achados técnicos e os insights dos estudantes. O delineamento usado foi o de métodos mistos. Cada estudante (n=20) instrumentou dois canais usando instrumentos manuais e dois canais usando instrumentos rotatórios de Ni-Ti (ProTaper Universal®). Os participantes não tinham experiência com instrumentação rotatória, mas estavam familiarizados com instrumentação manual. Dados quantitativos, tais como transporte apical, tempo de trabalho para a instrumentação e erros de procedimento foram estatisticamente analisados. Dados qualitativos (percepções dos estudantes) foram coletados, sendo que as percepções foram identificadas a partir do conteúdo das entrevistas utilizando a análise temática. Baixos valores de transporte apical, poucos erros de procedimento (desvio/perfuração/bloqueio), e tempo de trabalho mais longo foram associados à instrumentação rotatória. O tempo de trabalho foi mais curto no segundo canal instrumentado por ambas as técnicas. Percepções associadas com instrumentação manual foram: melhor domínio e prática/segurança em virtude de os estudantes estarem acostumados com a técnica. Percepções para a instrumentação rotatória: boas expectativas iniciais, antes de utilizar; percepção de dúvidas e dificuldades em relação ao manejo do instrumento logo antes de utilizar; e, aumento da segurança na utilização depois do segundo uso, no segundo canal. A combinação dos achados quantitativos e qualitativos levou às seguintes conclusões: (i) os estudantes mostraram uma atitude de precaução frente à instrumentação rotatória de Ni-Ti; (ii) a segurança amentou depois da instrumentação do segundo canal; (iii) os estudantes mostraram expectativas boas em termos da otimização do tratamento de canal radicular com a instrumentação rotatória e pensam que isso será possível após algum treinamento; e (iv) a instrumentação rotatória com NiTi deveria ser incluído no currículo de graduação das escolas de odontologia (AU).

Mixed Methods Research With Internally Displaced Colombian Gay and Bisexual Men and Transwomen.

We discuss the use of mixed methods research to further understanding of displaced Colombian gay and bisexual men and transwomen, a marginalized population at risk. Within the framework of communicative action, which calls for social change through egalitarian dialog, we describe how our multinational, interdisciplinary research team explored the subjective, objective, and social worlds of participants through life history interviews and surveys. We also describe the unique Colombian context, conscious efforts to establish egalitarian relationships among research team members, and efforts to disseminate and reflect on findings. Through discussion of our research process and results, we aim to demonstrate how mixed methods research can be utilized to facilitate noncoercive discourse and contribute to social change.