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1.
BMC Pediatr ; 21(1): 142, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761902

RESUMO

BACKGROUND: Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents' interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants' behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. METHODS: The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers' individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining. DISCUSSION: This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT04555590 , Registered on 8/19/2020.


Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Criança , Atenção à Saúde , Humanos , Recém-Nascido , Pais
2.
Int J Gynaecol Obstet ; 153(1): 154-159, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33098114

RESUMO

OBJECTIVE: To examine whether group prenatal care (PNC) increased key services and educational topics women reported receiving, compared with individual PNC in Malawi and Tanzania. METHODS: Data come from a previously published randomized trial (n=218) and were collected using self-report surveys. Late pregnancy surveys asked whether women received all seven services and all 13 topics during PNC. Controlling for sociodemographics, country, and PNC attendance, multivariate logistic regression used forward selection to produce a final model showing predictors of receipt of all key services and topics. RESULTS: In multivariate logistic regression, women in group PNC were 2.49 times more likely to receive all seven services than those in individual care (95% confidence interval [CI] 1.78-3.48) and 5.25 times more likely to have received all 13 topics (95% CI 2.62-10.52). CONCLUSION: This study provides strong evidence that group PNC meets the clinical standard of care for providing basic clinical services and perinatal education for pregnant women in sub-Saharan Africa. The greater number of basic PNC services and educational topics may provide one explanatory mechanism for how group PNC achieves its impact on maternal and neonatal outcomes. ClinicalTrials.gov: NCT03673709, NCT02999334.


Assuntos
Cuidado Pré-Natal/métodos , Educação Pré-Natal/métodos , Adulto , Feminino , Humanos , Modelos Logísticos , Malaui , Projetos Piloto , Gravidez , Gestantes , Tanzânia , Adulto Jovem
3.
BMC Public Health ; 20(1): 205, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32039721

RESUMO

BACKGROUND: Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes. METHODS: Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. DISCUSSION: This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.


Assuntos
Saúde do Lactente , Saúde Materna , Avaliação de Resultados em Cuidados de Saúde , Cuidado Pré-Natal/métodos , Feminino , Humanos , Recém-Nascido , Malaui , Gravidez
4.
Hisp Health Care Int ; 18(4): 191-197, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31906721

RESUMO

OBJECTIVES: To understand key factors influencing Chilean health care providers' perceived comfort performing oral rapid HIV testing. DESIGN: One hundred and fifty health care providers completed a self-administered questionnaire that included a five-item scale measuring self-perceived comfort in conducting HIV pretest counseling, oral rapid testing, finger-prick testing, and delivering test results. RESULTS: Most participants (60%) envisioned good overall comfort performing oral rapid HIV testing (mean score of 16.21; range 0-20), including doing at least four of the five steps. They perceived least comfort delivering HIV-positive test results during posttest counseling. HIV stigmatizing attitudes reduced self-perceived comfort. CONCLUSIONS: Providing training to counter HIV stigmatization while increasing comfort in performing oral rapid testing would help facilitate its successful implementation.

5.
J Perinatol ; 40(6): 858-866, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31913324

RESUMO

OBJECTIVE: To examine whether the H-HOPE (Hospital to Home: Optimizing the Preterm Infant's Environment) intervention reduced birth hospitalization charges yielding net savings after adjusting for intervention costs. STUDY DESIGN: One hundred and twenty-one mother-preterm infant dyads randomized to H-HOPE or a control group had birth hospitalization data. Neonatal intensive care unit costs were based on billing charges. Linear regression, propensity scoring and regression analyses were used to describe charge differences. RESULTS: Mean H-HOPE charges were $10,185 lower than controls (p = 0.012). Propensity score matching showed the largest savings of $14,656 (p = 0.003) for H-HOPE infants, and quantile regression showed a savings of $13,222 at the 75th percentile (p = 0.015) for H-HOPE infants. Cost savings increased as hospital charges increased. The mean intervention cost was $680 per infant. CONCLUSIONS: Lower birth hospitalization charges and the net cost savings of H-HOPE infants support implementation of H-HOPE as the standard of care for preterm infants.


Assuntos
Recém-Nascido Prematuro , Mães , Feminino , Hospitalização , Hospitais , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal
6.
Artigo em Inglês | MEDLINE | ID: mdl-34764823

RESUMO

Youth-driven approaches to HIV prevention can engage youth and improve health outcomes. Photovoice has been used to engage youth in identifying the assets and challenges in their communities. In sub-Saharan Africa, youth remain vulnerable to HIV infection. This article describes a photovoice project, named Youth Photovoice, conducted in rural Malawi, which focused on community places and situations relating to risky sexual behaviors that place youth at risk of HIV infection. Twenty-four youth, ages 13-17 (12 males and 12 females), participated in Youth Photovoice. During the photovoice process, youth identified five community situations and places that put them at risk of unsafe sex and thus HIV infection: initiation ceremonies, isolated places, community celebrations, local businesses such as bars and rest houses, and church-sponsored activities. Youth used a systematic action planning process to develop action plans. They presented their action plans to local leaders and parents. Parents and leaders responded positively and agreed to help the youth carry out their plans. If their plans to address community situations that put them at risk of unsafe sex succeed, there will be a direct impact on reducing the risk of HIV infection among youth. Youth Photovoice provided the opportunity for youth to obtain new skills, build new partnerships, and present their ideas to community leaders. Integrating this action planning process into photovoice helped to guide the youth toward actualizing their HIV prevention plans in their community. This process can increase the effectiveness of photovoice initiatives to address other community issues in a wide variety of settings.

7.
J Pediatr Health Care ; 33(5): 561-567, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31153727

RESUMO

INTRODUCTION: Rates and relationships of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) of mothers in rural Haiti were examined. Prelacteal and complementary feedings were identified. METHODS: With a cross-sectional descriptive design, survey data from mothers (N = 195) were collected at three intervals after birth. Data were analyzed for indicators of EIBF, EBF, and complementary feedings. RESULTS: Overall, 148 (75.9%) mothers reported EIBF, and 75 (38.5%) reported EBF. EIBF was associated with EBF, with an adjusted relative risk 1.35 (95% confidence interval = [0.84, 2.18]). Several nutritive and nonnutritive substances interrupted EBF during the first 6 months of life. DISCUSSION: Haiti has an under-five mortality rate of 67.0/1,000 live births, exceeding the mean of 46.5/1,000 live births for developing regions. Both EIBF and EBF are associated with decreased neonatal and early infant mortality. Country-specific data are needed to inform and develop breastfeeding initiatives and community-level campaigns to improve the prevalence of EIBF and EBF in Haiti.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Adulto , Aleitamento Materno/psicologia , Estudos Transversais , Cultura , Feminino , Haiti , Humanos , Lactente , Recém-Nascido , Masculino , Mães/psicologia , Mães/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários
8.
Glob Qual Nurs Res ; 6: 2333393619850775, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192272

RESUMO

We conducted this qualitative, phenomenological study to further understanding of how second-generation Mexican American adolescent mothers perceive their young motherhood experience, drawing on the context of their Mexican heritage background. Through in-person interviews with 18 young mothers, we discerned shared essential meanings reconstructed around two major domains: (a) grounded ethnicity, a firm desire to remain true to and share their heritage culture, and (b) authentic mothering, strong relationality to their infants. We found that young mothers embraced their Mexican heritage mothering approaches, such as fostering familismo, valuing family above other obligations. The adolescents in this study sensed their young motherhood as an opportunity to protect and improve qualities of traditional familial cultural heritage, while absorbing elements of American culture to enhance the future for themselves and their infants. We discuss how providers can help reduce stigmatization and promote self-efficacy by respecting and partnering with young mothers to provide culturally congruent services.

9.
BMC Public Health ; 18(1): 950, 2018 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-30071866

RESUMO

BACKGROUND: Scaling-up evidence-based behavior change interventions can make a major contribution to meeting the UNAIDS goal of no new HIV infections by 2030. We developed an evidence-based peer group intervention for HIV prevention and testing in Malawi that is ready for wider dissemination. Our innovative approach turns over ownership of implementation to rural communities. We adapted a 3-Step Implementation Model (prepare, roll-out and sustain) for communities to use. Using a hybrid design, we simultaneously evaluate community implementation processes and program effectiveness. METHODS: Three communities in southern Malawi begin implementation in randomly-assigned order using a stepped wedge design. Our evaluation sample size of 144 adults and 144 youth per community provides sufficient power to examine primary outcomes of condom use and HIV testing. Prior to any implementation, the first participants in all three communities are recruited and complete the Wave 1 baseline survey. Waves 2-4 surveys occur after each community completes roll-out. Each community follows the model's three steps. During Prepare, the community develops a plan and trains peer group leaders. During Roll-Out, peer leaders offer the program. During Sustain, the community makes and carries out plans to continue and expand the program and ultimately obtain local funding. We evaluate degree of implementation success (Aim 1) using the community's benchmark scores (e.g, # of peer groups held). We assess implementation process and factors related to success (Aim 2) using repeated interviews and observations, benchmarks from Aim 1 and fidelity assessments. We assess effectiveness of the peer group intervention when delivered by communities (Aim 3) using multi-level regression models to analyze data from repeated surveys. Finally, we use mixed methods analyses of all data to assess feasibility, acceptability and sustainability (Aim 4). DISCUSSION: The project is underway, and thus far the first communities have enthusiastically begun implementation. We have had to make several modifications along the way, such as moving from rapid-tests of STIs to symptoms screening by a nurse due to problems with test reliability and availability. If successful, results will provide a replicable evidence-based model for future community implementation of this and other health interventions. TRIAL REGISTRATION: Clinical Trials.gov NCT02765659 Registered May 6, 2016.


Assuntos
Infecções por HIV/prevenção & controle , Educação em Saúde/organização & administração , População Rural , Sexo Seguro/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Adolescente , Adulto , Agentes Comunitários de Saúde/educação , Feminino , Humanos , Capacitação em Serviço/organização & administração , Malaui/epidemiologia , Masculino , Grupo Associado , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Reprodutibilidade dos Testes , Projetos de Pesquisa , Comportamento Social , Adulto Jovem
10.
Early Hum Dev ; 121: 21-26, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29730131

RESUMO

BACKGROUND: The quality of mother-preterm infant interaction has been identified as a key factor in influencing the infant's later development and language acquisition. The relationship between mother-infant responsiveness and later development may be evident early in infancy, a time period which has been understudied. AIM: Describe the relationship between mother-infant mutual dyadic responsiveness and premature infant development. DESIGN: This study employed a secondary analysis of data from the 6-week corrected age (CA) follow-up visit of the Hospital-Home Transition: Optimizing Prematures' Environment (H-HOPE) study, a randomized clinical trial testing the efficacy of a mother- and infant- focused intervention for improving outcomes among premature infants. SUBJECTS: Premature infants born between 29 and 34 weeks gestational age and their mothers who had social-environmental risks. OUTCOME MEASURES: At 6-weeks corrected age, a play session was coded for the quality of mutual responsiveness (Dyadic Mutuality Code). Development was assessed via the Bayley Scales of Infant and Toddler Development, 3rd edition. RESULTS: Of 137 mother-infant dyads, high, medium and low mutual responsiveness was observed for 35.8%, 34.3% and 29.9%, respectively. Overall motor, language and cognitive scores were 115.8 (SD = 8.2), 108.0 (7.7) and 109.3 (7.9). Multivariable linear models showed infants in dyads with high versus low mutual responsiveness had higher scores on the motor (ß = 3.07, p = 0.06) and language (ß = 4.47, p = 0.006) scales. CONCLUSION: High mutual responsiveness in mother-premature infant dyads is associated with significantly better language development and marginally better motor development.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Relações Mãe-Filho , Adulto , Deficiências do Desenvolvimento/psicologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/psicologia , Masculino , Habilidades Sociais
12.
J Assoc Nurses AIDS Care ; 29(2): 241-253, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29276150

RESUMO

Bel-Air College of Nursing in India promotes nondiscriminatory care of persons living with HIV throughout its programs, albeit with no specific intervention. We examined whether nursing students' stigmatizing attitudes were related to number of years at Bel-Air. At the start of the 2015 and 2016 academic years, 310 Bachelor's (BScN; 4-year program) and 119 Auxiliary Nurse Midwife (ANM; 2-year program) students completed the Zelaya and colleagues (2008) Stigma Scale (24 Likert-type items). Three subscales (Fear, Blame, Personal Discrimination) measured Overall Personal Stigma. The fourth subscale measured Perceived Community Discrimination. BScN students' mean Overall Personal Stigma and subscales scores declined and Perceived Community Discrimination scores increased from Year 1 to 4. For ANM students, Overall Personal Stigma, Fear, and Personal Discrimination scores were lower for Year 2 than Year 1 students. Bel-Air emphasizes effective and nondiscriminatory care throughout the entire curriculum, providing a model for reducing student nurses' stigmatizing attitudes.


Assuntos
Educação em Enfermagem/métodos , Medo , Infecções por HIV/psicologia , Estigma Social , Estudantes de Enfermagem/psicologia , Adulto , Estudos Transversais , Currículo , Feminino , Grupos Focais , Infecções por HIV/enfermagem , Humanos , Índia , Masculino , Pesquisa Qualitativa , Escolas de Enfermagem , Estereotipagem , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários
13.
BMC Res Notes ; 10(1): 742, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258564

RESUMO

BACKGROUND: Chlorhexidine topical cord application is recommended to prevent umbilical cord infections in newborns delivered at home in low-resource settings. A community campaign introducing chlorhexidine for the first time in Haiti was developed. Traditional birth attendants (TBAs) were identified as implementers since they typically cut newborns' cords. TBAs were trained to apply chlorhexidine to the cord and demonstrate this procedure to the mother. Concurrently TBAs explained reasons for using chlorhexidine exclusively instead of traditional cord care practices. The campaign's effectiveness was evaluated 7-10 days post-delivery using a survey administered by community health workers (CHWs) to 198 mothers. RESULTS: Nearly all mothers heard about chlorhexidine use and applied it as instructed. Most mothers did not initially report using traditional cord care practices. With further probing, the majority reported covering the cord but few applied an unhygienic substance. No serious cord infections were reported. CONCLUSION: The campaign was highly successful in reaching mothers and achieving chlorhexidine use. In this study, the concomitant use of traditional cloth coverings or bindings of the cord did not appear harmful; however more research is needed in this area. This campaign provides a model for implementing chlorhexidine use, especially where trained TBAs and CHWs are present.


Assuntos
Infecções Bacterianas/prevenção & controle , Clorexidina/uso terapêutico , Saúde da População Rural/estatística & dados numéricos , Cordão Umbilical/microbiologia , Adulto , Anti-Infecciosos Locais/uso terapêutico , Agentes Comunitários de Saúde , Feminino , Haiti , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Recém-Nascido , Tocologia/estatística & dados numéricos , Mães , Gravidez , Resultado do Tratamento
14.
BMC Pregnancy Childbirth ; 17(Suppl 2): 336, 2017 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-29143624

RESUMO

BACKGROUND: The links between empowerment and a number of health-related outcomes in sub-Saharan Africa have been documented, but empowerment related to pregnancy is under-investigated. Antenatal care (ANC) is the entry point into the healthcare system for most women, so it is important to understand how ANC affects aspects of women's sense of control over their pregnancy. We compare pregnancy-related empowerment for women randomly assigned to the standard of care versus CenteringPregnancy-based group ANC (intervention) in two sub-Saharan countries, Malawi and Tanzania. METHODS: Pregnant women in Malawi (n = 112) and Tanzania (n = 110) were recruited into a pilot study and randomized to individual ANC or group ANC. Retention at late pregnancy was 81% in Malawi and 95% in Tanzania. In both countries, individual ANC, termed focused antenatal care (FANC), is the standard of care. FANC recommends four ANC visits plus a 6-week post-birth visit and is implemented following the country's standard of care. In group ANC, each contact included self- and midwife-assessments in group space and 90 minutes of interactive health promotion. The number of contacts was the same for both study conditions. We measured pregnancy-related empowerment in late pregnancy using the Pregnancy-Related Empowerment Scale (PRES). Independent samples t-tests and multiple linear regressions were employed to assess whether group ANC led to higher PRES scores than individual ANC and to investigate other sociodemographic factors related to pregnancy-related empowerment. RESULTS: In Malawi, women in group ANC had higher PRES scores than those in individual ANC. Type of care was a significant predictor of PRES and explained 67% of the variation. This was not so in Tanzania; PRES scores were similar for both types of care. Predictive models including sociodemographic variables showed religion as a potential moderator of treatment effect in Tanzania. Muslim women in group ANC had a higher mean PRES score than those in individual ANC; a difference not observed among Christian women. CONCLUSIONS: Group ANC empowers pregnant women in some contexts. More research is needed to identify the ways that models of ANC can affect pregnancy-related empowerment in addition to perinatal outcomes globally.


Assuntos
Processos Grupais , Poder Psicológico , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Adulto , Cristianismo/psicologia , Demografia , Feminino , Humanos , Islamismo/psicologia , Malaui , Projetos Piloto , Gravidez , Fatores Sociológicos , Tanzânia , Adulto Jovem
15.
J Pediatr Nurs ; 36: 1-6, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28888488

RESUMO

PURPOSE: Childhood obesity is a growing health concern for Korean-Americans (KA). The purpose of this study was to develop a culturally appropriate Korean-language version of the Family Nutrition Physical Activity (FNPA) instrument and evaluate its comprehensibility and cultural appropriateness of the FNPA for KAs. DESIGN AND METHODS: The FNPA was translated into Korean and cognitive interviews were conducted with 19 KA mothers in the Chicago metropolitan area. RESULTS: Overall, participants reported that the FNPA is easy to understand and said they had no difficulty answering items using a 4-point Likert scale. Six out of 20 items had minor revisions due to: items that were not specific enough, had confusing wording, or led to incorrect interpretations. CONCLUSIONS: Cognitive interviews confirmed the cultural appropriateness of the translated FNPA in the KA context. It is crucial that child's age and cultural aspects of a child's household routines should be taken into consideration when the original FNPA is being used with culturally diverse populations. PRACTICE IMPLICATIONS: Health care professionals may use the FNPA when assessing family environment in their efforts to prevent and control childhood obesity among KAs.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Exercício Físico/fisiologia , Educação em Saúde/métodos , Avaliação Nutricional , Obesidade/prevenção & controle , Adulto , Pré-Escolar , Cognição , Estudos de Avaliação como Assunto , Família , Feminino , Humanos , Entrevistas como Assunto , Obesidade/etnologia , Estados Unidos
16.
Int J Gynaecol Obstet ; 139(3): 290-296, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28905377

RESUMO

OBJECTIVE: To identify implementation challenges associated with conducting a randomized controlled trial (RCT) of group prenatal care (PNC) and report outcomes of the pilot. METHODS: A multi-site randomized pilot was conducted in Malawi and Tanzania between July 31, 2014, and June 30, 2015. Women aged at least 16 years with a pregnancy of 20-24 weeks were randomly assigned using sealed envelopes (1:1) to individual or group PNC. Structured interviews were conducted at baseline, in the third trimester and 6-8 weeks after delivery. The primary outcomes were attendance at four PNC visits and attendance at the 6-week postnatal visit. RESULTS: The pilot showed that an RCT with individual randomization can be conducted in these two low-resource settings. Significantly more women in group PNC than in individual PNC completed at least four PNC visits (96/102 [94.1%] vs 53/91 [58.2%]) and attended the postnatal visit (76/102 [74.5%] vs 45/90 [50.0%]; both P<0.001). CONCLUSION: Group PNC was feasible and associated with an increase in healthcare utilization and improved outcomes in Malawi and Tanzania. Lessons learned should be considered when designing large RCTs to determine efficacy. ClinicalTrials.gov: NCT02999334.


Assuntos
Implementação de Plano de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Psicoterapia de Grupo/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Humanos , Malaui , Projetos Piloto , Cuidado Pós-Natal/métodos , Gravidez , Tanzânia , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 17(1): 113, 2017 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-28399825

RESUMO

BACKGROUND: Parental obesity is highly predictive of child obesity, and preterm infants are at greater risk of obesity, but little is known about obese and non-obese mothers' responsiveness to preterm infant cues during feeding. The relationship between maternal weight status and response to preterm infant behavioral cues during feeding at 6-weeks corrected age was examined. METHODS: This secondary analysis used data from a randomized clinical trial. Maternal weight was coded during a play session. Mother-infant interaction during feeding was coded using the Nursing Child Assessment Satellite Training Feeding Scale (NCAST). We used multivariate linear regressions to examine NCAST scores and multivariate logistic regressions for the two individual items, satiation cues and termination of feeding. RESULTS: Of the 139 mothers, 56 (40.3%) were obese, two underweight women were excluded. Obese mothers did not differ from overweight/normal weight mothers for overall NCAST scores, but they had higher scores on response to infant's distress subscale (mean = 10.2 vs. 9.6, p = 0.01). The proportion of infants who exhibited satiation cues did not differ by maternal weight. Obese mothers were more likely than overweight/normal weight mothers to terminate the feeding when the infant showed satiation cues (82.1% vs. 66.3%, p = 0.04, adjusted OR = 2.31, 95% CI = 0.97, 5.48). CONCLUSIONS: Limitations include lack of BMI measures and small sample size. Additional research is needed about maternal weight status and whether it influences responsiveness to preterm infant satiation cues. Results highlight the need for educating all mothers of preterm infants regarding preterm infant cues. TRIAL REGISTRATION: NCT02041923 . Feeding and Transition to Home for Preterms at Social Risk (H-HOPE). Registered 15 January 2014.


Assuntos
Comportamento Alimentar/psicologia , Cuidado do Lactente/psicologia , Recém-Nascido Prematuro/psicologia , Mães/psicologia , Obesidade/psicologia , Adolescente , Adulto , Peso Corporal , Sinais (Psicologia) , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Relações Mãe-Filho , Adulto Jovem
18.
J Assoc Nurses AIDS Care ; 28(2): 250-265, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26264258

RESUMO

Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed.


Assuntos
Infecções por HIV/prevenção & controle , Assunção de Riscos , Comportamento Sexual/psicologia , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Preservativos/estatística & dados numéricos , Infecções por HIV/transmissão , Humanos , Entrevistas como Assunto , Malaui , Masculino , Estado Civil , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Adulto Jovem
19.
Rev. panam. salud pública ; 40(5): 363-370, Nov. 2016. tab
Artigo em Inglês | LILACS | ID: biblio-845657

RESUMO

ABSTRACT Objective This study identified the personal characteristics that affect Chilean health care providers’ readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence-based practice (EBP). Methods Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. Results Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean “readiness to implement ORT” score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Conclusion The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers’ readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile’s capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.


RESUMEN Objetivo En este estudio se determinaron las características personales que influyen sobre la disposición de los prestadores de atención de salud a adoptar la prueba oral rápida de detección del VIH en Chile como una nueva práctica clínica basada en la evidencia. Métodos Con un diseño de investigación transversal, en el estudio se realizó un muestreo de 150 enfermeros, parteras y médicos que trabajaban en cuatro centros de la Red de Salud de la Pontifícia Universidad Católica de Chile, en Santiago. Los participantes llenaron una encuesta autoadministrada en la que se preguntaba sus características demográficas, actitudes y experiencia en relación con la práctica clínica basada en la evidencia, creencias personales respecto del VIH, importancia de las pruebas de detección del VIH y sensación de comodidad respecto de realizar una prueba oral rápida de detección del VIH. Resultados El 90% de los participantes afirmó que creía que la incorporación de la prueba oral rápida significaría un cambio positivo en su práctica y que estaría dispuesto a adoptar la nueva tecnología por ese motivo. No obstante, de acuerdo con las respuestas, la "disposición a utilizar la prueba oral rápida" obtuvo una media de puntuación de 15,1 de un posible valor de 20, lo que sugiere solo una disposición autopercibida moderada a adoptar esta práctica basada en la evidencia. La educación, las creencias acerca de la práctica basada en la evidencia, la sensación de comodidad al realizar la prueba oral rápida y la percepción de la importancia de las pruebas de detección del VIH explican el 43,6% de la varianza de la disposición a adoptar la prueba oral rápida. Conclusiones Los resultados de este estudio previo a la introducción de la prueba oral rápida de detección del VIH en Chile pueden ser útiles para orientar a los responsables de las políticas y a las partes interesadas en cuanto a la preparación de los prestadores de atención primaria de la salud para que aumente su disposición a adoptar con éxito esta tecnología basada en la evidencia. La adopción satisfactoria de la prueba oral rápida podría aumentar la capacidad de Chile para llegar a los chilenos vulnerables a la infección por el VIH para que se realicen la prueba y sean derivados para recibir atención si tienen un resultado positivo y, de este modo, podría contribuir a detener la transmisión del virus y reducir las complicaciones médicas.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/diagnóstico , Estudos Transversais Seriados , Técnicas Microbiológicas , Pesquisas sobre Serviços de Saúde , Chile
20.
Rev Panam Salud Publica ; 40(5), nov. 2016
Artigo em Inglês | PAHO-IRIS | ID: phr-31379

RESUMO

Objective. This study identified the personal characteristics that affect Chilean health care providers’ readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence- based practice (EBP). Methods. Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. Results. Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean “readiness to implement ORT” score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Conclusion. The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers’ readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile’s capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.


Objetivo. En este estudio se determinaron las características personales que influyen sobre la disposición de los prestadores de atención de salud a adoptar la prueba oral rápida de detección del VIH en Chile como una nueva práctica clínica basada en la evidencia. Métodos. Con un diseño de investigación transversal, en el estudio se realizó un muestreo de 150 enfermeros, parteras y médicos que trabajaban en cuatro centros de la Red de Salud de la Pontifícia Universidad Católica de Chile, en Santiago. Los participantes llenaron una encuesta autoadministrada en la que se preguntaba sus características demográficas, actitudes y experiencia en relación con la práctica clínica basada en la evidencia, creencias personales respecto del VIH, importancia de las pruebas de detección del VIH y sensación de comodidad respecto de realizar una prueba oral rápida de detección del VIH. Resultados. El 90% de los participantes afirmó que creía que la incorporación de la prueba oral rápida significaría un cambio positivo en su práctica y que estaría dispuesto a adoptar la nueva tecnología por ese motivo. No obstante, de acuerdo con las respuestas, la "disposición a utilizar la prueba oral rápida" obtuvo una media de puntuación de 15,1 de un posible valor de 20, lo que sugiere solo una disposición autopercibida moderada a adoptar esta práctica basada en la evidencia. La educación, las creencias acerca de la práctica basada en la evidencia, la sensación de comodidad al realizar la prueba oral rápida y la percepción de la importancia de las pruebas de detección del VIH explican el 43,6% de la varianza de la disposición a adoptar la prueba oral rápida. Conclusiones. Los resultados de este estudio previo a la introducción de la prueba oral rápida de detección del VIH en Chile pueden ser útiles para orientar a los responsables de las políticas y a las partes interesadas en cuanto a la preparación de los prestadores de atención primaria de la salud para que aumente su disposición a adoptar con éxito esta tecnología basada en la evidencia. La adopción satisfactoria de la prueba oral rápida podría aumentar la capacidad de Chile para llegar a los chilenos vulnerables a la infección por el VIH para que se realicen la prueba y sean derivados para recibir atención si tienen un resultado positivo y, de este modo, podría contribuir a detener la transmisión del virus y reducir las complicaciones médicas.


Assuntos
HIV , Prevenção de Doenças , Chile , HIV , Atenção à Saúde , Variação Contingente Negativa , Prevenção de Doenças , Atenção à Saúde
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