Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Clin Pediatr (Phila) ; 59(4-5): 380-387, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32037858

RESUMO

Disadvantaged children often show disparities in early language development. We tested the feasibility, acceptability, and preliminary efficacy of introducing finger puppets in the primary care setting at the 2-month well visit to support caregivers talking with their infants. Caregivers completed a sociodemographic survey and were contacted by phone 2 weeks later to assess initial usage and satisfaction. Ages & Stages Questionnaires (ASQ-3) were independently recorded at well visits. A family cumulative risk score was calculated from the sociodemographic survey. Thirty-four caregiver-child pairs were enrolled. Caregivers reported high satisfaction with the intervention. ASQ-3 Communication and Total scores at 6, 12, and 18 months were significantly higher for high puppet users across all age levels with no significant interactions with age or cumulative risk. Finger puppets provide a low-cost way to promote language-rich interactions. Preliminary evidence suggests that high puppet usage may have long-lasting effects on child development and should be further evaluated.


Assuntos
Desenvolvimento Infantil , Desenvolvimento da Linguagem , Relações Pais-Filho , Jogos e Brinquedos , Atenção Primária à Saúde , Adulto , Colorado , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Projetos Piloto , Inquéritos e Questionários
2.
Vaccines (Basel) ; 7(4)2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31635270

RESUMO

Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO's 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother's education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (ß: 0.56, P = 0.0001), however, mothers in Ethiopia (ß: -0.54, P < 0.0001) and Guatemala (ß: -0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.

3.
Vaccine ; 37(42): 6192-6200, 2019 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-31492475

RESUMO

OBJECTIVE: Millions of infants worldwide remain under-immunized and at risk for unnecessary morbidity and mortality. Text messaging may offer a low-cost solution. We aimed to evaluate text message reminders to improve infant immunization in Guatemala. METHODS: A randomized clinical trial was conducted at four public health clinics in rural and urban Guatemala. Infants ages six weeks to six months presenting for the first visit of the primary immunization series were randomly and equally allocated to an intervention or usual care group. Intervention participants were sent three text reminders before the second and third vaccine visits. The main outcome was timeliness of the second and third visits of the primary immunization series. RESULTS: Of 1088 families approached for enrollment between March to November 2016, 871 were eligible and 720 (82.7%) participated; only 54 families did not own a cell phone. Due to country-wide vaccine shortages, visit completion was used as a proxy for overall immunization coverage. In intention to treat analysis, both intervention and usual care groups had high rates of visit completion, but intervention participants presented on the scheduled date more often (151 [42.2%] of 358 intervention vs. 111 [30.7%] of 362 usual care participants for visit 2, p = 0.001, and 112 [34.0%] of 329 intervention vs. 90 [27.0%] of 333 usual care participants for visit 3, p = 0.05). Intervention caregivers were significantly more likely to want to receive future text message reminders for vaccines and other appointments and were more willing to pay for these reminders. CONCLUSION: Caregivers who were sent text message reminders in urban and rural Guatemala were less delayed for their child's immunization visits and reported high user satisfaction. Text message reminders may be an effective tool to increase infant vaccination coverage in low-income settings by reminding parents to vaccinate. TRIAL REGISTRATION: NCT02567006 at clinicaltrials.gov.


Assuntos
Imunização , Sistemas de Alerta , Envio de Mensagens de Texto , Adulto , Agendamento de Consultas , Telefone Celular , Escolaridade , Feminino , Guatemala , Humanos , Lactente , Masculino , Idade Materna , População Rural , População Urbana
4.
Glob Health Promot ; 26(2): 61-69, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-28805505

RESUMO

BACKGROUND: The first three years of a child's life are a critical period for brain growth and development. Caregiver interventions during this period that improve early childhood health and development have the potential to enhance a child's physical, mental, and social well-being. METHODS: This was a pretest/posttest quasi experimental program evaluation. Early childhood education materials were adapted to create two separate interventions consisting of 30-page interactive flipchart talks to educate mothers on health and development topics relevant to 0-6 and 6-12 month old children. Three community health workers performed the talks with groups of 5-8 mothers. Short learning assessments were given individually to each mother pre-intervention (pretest), immediately post-intervention (posttest 1), and two weeks post-intervention (posttest 2). Demographic surveys and focus group discussions were conducted with all participants. RESULTS: Mothers (n = 77) had an average age of 33.6 years and had an average of 3.6 living children. Most of the mothers (71%) had received some primary education, but 23% had received no formal schooling. For the 0-6 months flipchart learning assessment (n = 38), the mean pretest score was 77% correct. The mean posttest 1 score improved to 87% (p < 0.0001), and the mean posttest 2 score improved further from the mean posttest 1 score to 90% (p = 0.01). For the 6-12 months flipchart learning assessment (n = 39), the mean pretest score was 78%. The mean posttest 1 score improved to 89% (p < 0.0001), and the mean posttest 2 score improved further from the mean posttest 1 score to 92% (p = 0.03). CONCLUSIONS: Mothers in an impoverished region of southwestern Guatemala significantly increased their knowledge about child health topics following a short interactive group talk. Mothers further increased their knowledge two weeks after the intervention, without specific re-exposure to the intervention materials, suggesting assimilation and informal reinforcement through group based learning with other mothers in their community.


Assuntos
Cuidadores/educação , Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Relações Mãe-Filho , Mães/educação , Adulto , Pesquisa Participativa Baseada na Comunidade , Escolaridade , Feminino , Processos Grupais , Guatemala , Humanos , Lactente , Aprendizagem , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , População Rural , Adulto Jovem
5.
Vaccine ; 36(35): 5273-5281, 2018 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-30061026

RESUMO

BACKGROUND: Despite safe and effective childhood immunizations, decreased acceptance of vaccines has become an emerging global problem. The WHO SAGE Working Group on Vaccine Hesitancy developed a common diagnostic tool, the Vaccine Hesitancy Scale (VHS), to identify and compare hesitancy in different global settings. We field tested the VHS in rural and urban Guatemala. METHODS: We analyzed data from the enrollment visit of a study conducted at four public health clinics in Guatemala. Infants ages 6 weeks-6 months presenting for their first wellness visit were enrolled March-November 2016. Parents completed a demographic survey that included the 10 dichotomous and 10 Likert scale VHS questions. Chi-square or Fisher's exact for categorical and ANOVA test for continuous variables were used to assess significance levels in survey differences. We conducted a factor analysis to assess the Likert scale questions. RESULTS: Of 1088 families screened, 871 were eligible and 720 (82.7%) participated. No parent had ever refused a vaccination, and only eight parents (1.1%) had been reluctant or hesitated to get a vaccination for their children. However, only 40.8% (n = 294) of parents said that they think most parents like them have their children vaccinated with all the recommended vaccines. Factor analysis identified two underlying constructs that had eigenvalues of 1.0 or greater and a substantive lack of variability in response across the Likert scale. There were consistent differences between how study clinics responded to the ordinal scaling. CONCLUSION: Our results suggest problems with interpretation of the VHS, especially in the presence of vaccine shortages and using a Likert scale that does not resonate across diverse cultural settings. Our factor analysis suggests that the Likert scale items are more one-dimensional and do not represent the multiple constructs of vaccine hesitancy. We suggest more work is needed to refine this survey for improved reliability and validity. Clinical Trial Registry: NCT02567006.


Assuntos
Vacinas/uso terapêutico , Adolescente , Adulto , Análise de Variância , Feminino , Guatemala , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Recusa do Paciente ao Tratamento , Adulto Jovem
6.
Mhealth ; 4: 9, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29780812

RESUMO

Background: Despite efforts to promote vaccination in low- and middle-income countries (LMICs), over 20 million infants remain under-immunized and at risk for unnecessary morbidity and mortality. Mobile health technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management. Patient reminder systems are an important mechanism for improving childhood vaccination coverage and can be easily adapted to SMS platforms. However, current research lacks an understanding of the barriers and facilitators to mHealth program design, implementation, and scale in LMICs. Methods: We analyzed survey data collected March-November 2016 at the enrollment visit from a randomized controlled trial conducted at public health clinics in urban and rural Guatemala. Participants included eligible infants 6 weeks to 6 months of age receiving the first dose of the primary immunization series. At least one parent needed to own a mobile phone and be capable of deciphering SMS. Chi-square or Fisher's exact and Student's t-test were used to assess significance levels in demographic differences to describe factors that contribute to the feasibility of using an SMS-based vaccination reminder system. Results: Of 1,088 families approached for enrollment, 871 were eligible and 720 (82.7%) participated with equal numbers of urban and rural children enrolled; 54 parents did not own a mobile phone with SMS capability and three parents could not use SMS. There was no significant difference between urban and rural maternal mobile phone ownership (94.4% vs. 93.3%, P=0.53), but more urban fathers owned mobile phones (72.8% vs. 47.1%, P<0.0001) and, overall, more mothers compared to fathers owned mobile phones (93.9% vs. 61.1%, P<0.0001). Most families (90.4%) chose to have reminders sent to the mother. Urban participants reported more mobile phones present in the home (P<0.0001), but rural participants reported more telephone landlines (34.7% vs. 15.6%, P<0.0001). Most participants reported a daily average of ≤5 telephone calls made (87.4%), ≤10 texts sent (91.0%), and ≤10 texts received (89.9%), with urban families reporting greater telephone usage (P=0.006, P<0.001, and P<0.001 respectively). Parents preferred to make calls over sending texts (74.7% vs. 25.3%, P<0.0001), with more urban families preferring text messaging (31.9% vs. 18.6%, P<0.0001). Conclusions: Our study results provide important insight into mobile phone access, usage, and preferences for voice and text communication across rural and urban populations of an LMIC that can be used to inform future mHealth interventions. Our findings suggest that offering a combination of more traditional communication methods with newer, modern technologies may be more effective at reminding families about vaccination visits, particularly for our rural population, and that targeting mothers for mobile phone interventions may provide the greatest benefits. Overall, our study suggests that using SMS reminders in LMICs can be a feasible tool for public health interventions.

8.
Front Public Health ; 5: 60, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28405582

RESUMO

Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and show that a telehealth program between a US-based university and a rural community health program in a low- and middle-income country is both feasible and acceptable.

9.
Vaccine ; 34(21): 2437-2443, 2016 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-27026145

RESUMO

BACKGROUND: Patient reminder systems are an evidence-based way to improve childhood vaccination rates but are difficult to implement in low- and middle-income countries (LMICs). Short Message Service (SMS) texts may offer a potential low-cost solution, especially in LMICs where mobile phones are becoming more ubiquitous. OBJECTIVE: To determine if an SMS-based vaccination reminder system aimed at improving completion of the infant primary immunization series is feasible and acceptable in Guatemala. METHODS: A pilot randomized controlled trial was conducted at two public health clinics in Guatemala City. Infants aged 8-14 weeks presenting for the first dose of the primary immunization series were enrolled in March-April 2013. Participants randomized into the intervention received three SMS reminders one week before the second and third dose. A follow-up acceptability survey was administered to both groups. RESULTS: The participation rate was 86.8% (321/370); 8 did not own a cell phone and 12 could not use SMS. 96.9% of intervention parents were sent at least one SMS reminder prior to visit 2 and 96.3% prior to visit 3. Both intervention and usual care participants had high rates of vaccine and visit completion, with a non-statistically significant higher percentage of children in the intervention completing both visit 2 (95.0% vs. 90.1%, p=.12) and visit 3 (84.4% vs. 80.7%, p=.69). More intervention vs. usual care parents agreed that SMS reminders would be helpful for remembering appointments (p<.0001), agreed to being interested in receiving future SMS reminders (p<.0001), and said that they would be willing to pay for future SMS reminders (p=.01). CONCLUSION: This proof of concept evaluation showed that a new application of SMS technology is feasible to implement in a LMIC with high user satisfaction. Larger studies with modifications in the SMS system are needed to determine effectiveness (Clinical Trial Registry NCT01663636).


Assuntos
Pais , Sistemas de Alerta , Envio de Mensagens de Texto , Vacinação , Adulto , Agendamento de Consultas , Telefone Celular , Feminino , Guatemala , Humanos , Lactente , Masculino , Inquéritos e Questionários , Adulto Jovem
10.
J Trop Pediatr ; 56(6): 440-2, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20185559

RESUMO

As HIV-positive children continue to gain more access to antiretroviral therapy and survive into young adulthood, caregivers face the difficult process of disclosing a child's HIV status to that child. Although disclosure has many proven benefits for mental health, psychosocial development, caregiver well-being, treatment adherence and future planning, such a process is still often met with resistance. This article discusses the main reasons given for delaying or avoiding disclosure of a child's HIV status. Each barrier to disclosure is discussed and debunked as an insufficient reason to delay the positive benefits that the disclosure process has shown to produce. HIV disclosure is a critical and multifaceted issue in children. Such a process has been shown to best involve a multi-disciplinary support team that assists caregivers in continually adapting the disclosure discussion to meet the developmental needs and understanding of each individual child over time.


Assuntos
Cuidadores/psicologia , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Revelação da Verdade , Adaptação Psicológica , Antirretrovirais/uso terapêutico , Criança , Família , Infecções por HIV/tratamento farmacológico , HIV-1 , Humanos , Pediatria
12.
J Dev Behav Pediatr ; 30(2): 147-50, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19363366

RESUMO

With the increasing global accessibility of antiretrovirals, many HIV-positive children now face a future once thought impossible. As these children grow, they face unique psychosocial stressors that differ from any previous chronic or incurable childhood illness. Studies have already described an increased prevalence of mental health disorders among this population. In addition, other studies have illustrated the known future health consequences of adverse childhood experiences, similar but not related to the HIV/AIDS epidemic. This article connects these studies and predicts the grave future health consequences likely to be faced if pediatric mental health care is not addressed. Practical solutions are described that often go hand-in-hand with the current global scale-up of antiretroviral accessibility. These include scaling-up mental health services, educating communities, supporting school-based programs, promoting the role of nongovernmental organizations, and strengthening families and the community to provide a safe and secure home environment for children. HIV-positive children are likely to face future physical and psychological health consequences related to the psychosocial challenges they face as children if mental health care is not made a priority in the current global fight against AIDS.


Assuntos
Síndrome de Imunodeficiência Adquirida/psicologia , Transtornos Mentais/complicações , Transtornos Mentais/prevenção & controle , Prática de Saúde Pública , Síndrome de Imunodeficiência Adquirida/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança , Surtos de Doenças , Família , Humanos , Transtornos Mentais/terapia , Serviços de Saúde Mental
13.
J Mol Biol ; 366(1): 230-43, 2007 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-17157870

RESUMO

The Tyr35-->Gly replacement in bovine pancreatic trypsin inhibitor (BPTI) has previously been shown to dramatically enhance the flexibility of the trypsin-binding region of the free inhibitor and to destabilize the interaction with the protease by about 3 kcal/mol. The effects of this replacement on the enzyme-inhibitor interaction were further studied here by X-ray crystallography and isothermal titration calorimetry (ITC). The co-crystal structure of Y35G BPTI bound to trypsin was determined using 1.65 A resolution X-ray diffraction data collected from cryopreserved crystals, and a new structure of the complex with wild-type BPTI under the same conditions was determined using 1.62 A data. These structures reveal that, in contrast to the free protein, Y35G BPTI adopts a conformation nearly identical with that of the wild-type protein, with a water-filled cavity in place of the missing Tyr side-chain. The crystallographic temperature factors for the two complexes indicate that the mutant inhibitor is nearly as rigid as the wild-type protein when bound to trypsin. Calorimetric measurements show that the change in enthalpy upon dissociation of the complex is 2.5 kcal/mol less favorable for the complex containing Y35G BPTI than for the complex with the wild-type inhibitor. Thus, the destabilization of the complex resulting from the Y35G replacement is due to a more favorable change in entropy upon dissociation. The heat capacity changes for dissociation of the mutant and wild-type complexes were very similar, suggesting that the entropic effects probably do not arise from solvation effects, but are more likely due to an increase in protein conformational entropy upon dissociation of the mutant inhibitor. These results define the biophysical role of a highly conserved core residue located outside of a protein-binding interface, demonstrating that Tyr35 has little impact on the trypsin-bound BPTI structure and acts primarily to define the structure of the free protein so as to maximize binding affinity.


Assuntos
Aprotinina/química , Inibidores de Proteases/química , Tripsina/química , Aprotinina/genética , Aprotinina/metabolismo , Sítios de Ligação , Calorimetria , Cristalização , Modelos Moleculares , Ligação Proteica , Estrutura Terciária de Proteína , Solventes/química , Relação Estrutura-Atividade , Temperatura , Termodinâmica , Tripsina/metabolismo
15.
Dev World Bioeth ; 4(1): 1-16, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15086371

RESUMO

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community.


Assuntos
Doenças Transmissíveis , Política de Saúde , Saúde Pública/ética , Síndrome de Imunodeficiência Adquirida , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Atitude , Guerra Biológica , Controle de Doenças Transmissíveis , Doenças Transmissíveis/mortalidade , Doenças Transmissíveis/terapia , Doenças Transmissíveis/transmissão , Países em Desenvolvimento , Humanos , Vírus da SARS , Fatores Socioeconômicos , Tuberculose
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...