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1.
Epidemiol Serv Saude ; 29(4): e2020407, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32997069

RESUMO

OBJECTIVE: To describe lifestyle changes with regard to consumption of tobacco and alcohol, food intake and physical activity, in the period of social restriction resulting from the COVID-19 pandemic. METHODS: This is a cross-sectional study conducted in Brazil with data from the ConVid online health behavior survey. The data were collected via an online questionnaire answered by the survey participants. Post-stratification procedures were used to calculate prevalence rates and 95% confidence intervals. RESULTS: 45,161 individuals aged 18 years or more participated. During the period of social restriction participants reported a decrease in practicing physical activity and an increase in time spent using computers or tablets or watching TV, intake of ultra-processed foods, number of cigarettes smoked and alcoholic beverage consumption. Differences were observed according to sex and age group. CONCLUSION: The results indicate a worsening of lifestyles and an increase in health risk behaviors.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estilo de Vida , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Exercício Físico , Fast Foods/estatística & dados numéricos , Feminino , Qualidade dos Alimentos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Comportamento Sedentário , Fatores Sexuais , Fumar/epidemiologia , Lanches , Adulto Jovem
3.
Epidemiol Serv Saude ; 29(4): e2020427, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32844918

RESUMO

OBJECTIVE: To analyze the frequency of sadness, nervousness, and sleep disorders during the COVID-19 pandemic in Brazil, identifying the most affected demographic segments. METHODS: This was a cross-sectional study using an online questionnaire answered by adults and elderly people to collect information on living conditions, health and health-related behaviors. Prevalence rates and prevalence ratios adjusted for age and sex were estimated. RESULTS: The data on 45,161 Brazilian respondents showed that during the pandemic 40.4% (95%CI 39.0;41.8) frequently felt sad or depressed and 52.6% (95%CI 51.2;54.1) frequently felt anxious or nervous; 43.5% (95%CI 41.8;45.3) reported the onset of sleep problems and 48.0% (95%CI 45.6;50.5) had a prior sleep problem that had become worse. Frequent sadness and nervousness, as well as change in sleep patterns were higher in young adults, women and those with a history of depression. CONCLUSION: The high prevalence found indicates the need to guarantee the provision of services for mental health and quality of sleep that are adapted to the pandemic context.


Assuntos
Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Pneumonia Viral/psicologia , Tristeza , Transtornos do Sono-Vigília/epidemiologia , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Intervalos de Confiança , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Adulto Jovem
4.
PLoS One ; 15(8): e0237147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760116

RESUMO

INTRODUCTION: Maternal anemia is a worldwide public health problem especially in developing countries including Ethiopia. The burden of anemia among lactating mothers in Ethiopia was higher than those who were neither pregnant nor breastfeeding. To date, there is limited evidence on spatiotemporal patterns of anemia among lactating mothers in the country. Exploring the spatial patterns of maternal anemia is vital to design and monitor effective intervention programs. Therefore this study aimed to explore spatiotemporal patterns of anemia among lactating mothers in Ethiopia over the past one and half-decades. METHODS: A total of 11,989 lactating mothers were included from the three consecutive Ethiopian Demographic and Health Surveys(2005, 2011, and 2016). The trend of anemia over the three surveys was showed. Furthermore, spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographically risk areas of anemia among lactating mothers in Ethiopia. Finally, the most anemia risk areas were detected consistently by different spatial analytic methods in each survey. RESULTS: Anemia during lactation had an increasing trend from 2011 to 2016 in all regions of Ethiopia. It was also spatially clustered over three survey periods (Moran's I: 0.102-0.256, P<0.01).The hotspot areas were detected in Afar, Somali, Gambela, Dire Dawa, and Oromia regions during the last fifteen years. In 2005 and 2011, a total of 100 most likely clusters (Loglikelihood Ratio(LLR) = 8.8, P<0.05, and LLR = 45.94, P<0.001, respectively) were identified in the Afar region. However, in the 2016 survey period, primary clusters were shifted to the Somali region where 57 clusters (LLR = 72.73, P<0.001) were detected in the entire region. Besides, the risk prediction map showed that the eastern part of the country was at a higher risk of anemia during lactation. CONCLUSION: Anemia during lactation was spatially clustered in Ethiopia. High-risk areas were detected in the eastern part of Ethiopia prominently in the Afar and Somali regions. Therefore, public health intervention activities designed in a targeted approach to impact high-risk populations in those hot spot areas wound be helpful to reduce anemia in Ethiopia.


Assuntos
Anemia Ferropriva/epidemiologia , Lactação , Etiópia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Mães/estatística & dados numéricos
5.
PLoS One ; 15(8): e0237720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834011

RESUMO

BACKGROUND: Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS: This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS: Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION: Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.


Assuntos
Necessidades e Demandas de Serviços de Saúde/organização & administração , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Magreza/epidemiologia , Adolescente , Adulto , Estudos Transversais , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Sobrepeso/fisiopatologia , Sobrepeso/prevenção & controle , Prevalência , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Reprodução/fisiologia , Fatores de Risco , Fatores Socioeconômicos , Tanzânia/epidemiologia , Magreza/fisiopatologia , Magreza/prevenção & controle , Adulto Jovem
6.
Am J Gastroenterol ; 115(10): 1707-1715, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32852340

RESUMO

INTRODUCTION: Proton pump inhibitors (PPIs) increase the risk for enteric infections that is likely related to PPI-induced hypochlorhydria. Although the impact of acid suppression on severe acute respiratory syndrome coronavirus 2 is unknown thus far, previous data revealed that pH ≤3 impairs the infectivity of the similar severe acute respiratory syndrome coronavirus 1. Thus, we aimed to determine whether use of PPIs increases the odds for acquiring coronavirus disease 2019 (COVID-19) among community-dwelling Americans. METHODS: From May 3 to June 24, 2020, we performed an online survey described to participating adults as a "national health survey." A multivariable logistic regression was performed on reporting a positive COVID-19 test to adjust for a wide range of confounding factors and to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: Of 53,130 participants, 3,386 (6.4%) reported a positive COVID-19 test. In regression analysis, individuals using PPIs up to once daily (aOR 2.15; 95% CI, 1.90-2.44) or twice daily (aOR 3.67; 95% CI, 2.93-4.60) had significantly increased odds for reporting a positive COVID-19 test when compared with those not taking PPIs. Individuals taking histamine-2 receptor antagonists were not at elevated risk. DISCUSSION: We found evidence of an independent, dose-response relationship between the use of antisecretory medications and COVID-19 positivity; individuals taking PPIs twice daily have higher odds for reporting a positive test when compared with those using lower-dose PPIs up to once daily, and those taking the less potent histamine-2 receptor antagonists are not at increased risk. These findings emphasize good clinical practice that PPIs should only be used when indicated at the lowest effective dose, such as the approved once-daily label dosage of over-the-counter and prescription PPIs. Further studies examining the association between PPIs and COVID-19 are needed.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Ácido Gástrico/metabolismo , Inquéritos Epidemiológicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Adolescente , Adulto , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/estatística & dados numéricos , Fatores de Confusão Epidemiológicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/metabolismo , Refluxo Gastroesofágico/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Microbioma Gastrointestinal/fisiologia , Azia/tratamento farmacológico , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Adulto Jovem
7.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753371

RESUMO

BACKGROUND AND OBJECTIVES: Although clinical settings are increasingly screening for social determinants of health, essential questions about optimal screening remain. We aimed to assess primary care contexts of individuals choosing not to answer questions about health-related social needs and to compare screening question response with subsequent use of resource information. METHODS: We compared caregiver responses to an electronic survey administered during a child's emergency department visit and through telephone follow-up 2 weeks later by responses to questions about health-related social needs (no social needs endorsed, ≥1 endorsed, none endorsed but ≥1 question not answered). RESULTS: Of 146 respondents, 42 (29%) endorsed ≥1 health-related social need. Additionally, 19 (13%) endorsed no social needs but did not answer ≥1 question. Compared with those denying all social needs and those endorsing ≥1 social need, respondents who did not answer social needs screening questions reported longer duration since their child's last primary care visit, lower perceptions of primary care, and less social support. For the 61 respondents participating in the 2-week follow-up survey, reported use of a community resource packet was 37% among those who had reported a social need, 26% among those who had denied all social needs, and 0% among those who had not answered ≥1 social needs questions. CONCLUSIONS: Clinicians and systems implementing screening for health-related social risks should plan for individuals who choose not to respond to specific items and may also wish to consider strategies that do not rely on screening and disclosure, particularly in communities known to have high prevalence of social needs.


Assuntos
Acesso à Informação , Cuidadores/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Distribuição de Qui-Quadrado , Pré-Escolar , Feminino , Seguimentos , Abastecimento de Alimentos/estatística & dados numéricos , Recursos em Saúde/organização & administração , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Apoio Social , Transportes/estatística & dados numéricos , Adulto Jovem
8.
PLoS One ; 15(8): e0236955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764770

RESUMO

BACKGROUND: Childhood vaccination plays a key role in reducing morbidity and mortality from vaccine-preventable diseases. Numerous studies have assessed the influence of demographic and socioeconomic factors on child immunization around the world. There are few such studies in Afghanistan, however. Therefore, this study aimed to identify factors influencing vaccination status among children age 12-23 months in Afghanistan. MATERIALS AND METHODS: Nationally representative data from the 2015 Afghanistan Demographic and Health Survey were used for this study. A sample of 5,708 children age 12-23 months with a vaccine card and immunization history was analyzed. Multinomial logistic regression was used to identify significant relationships between cofactors and vaccination status. RESULTS: In the study, 51% the subjects were boys, 48% were born at home, and 76% were residents of rural areas. Background characteristics positively associated with vaccination status included delivery in a health facility (RRR = 2.5, 95% CI = 1.9-3.3), maternal age of 30-39 years (RRR = 2.2, 95% CI = 1.2-4.1), attending at least four visits for antenatal care (RRR = 2.7, 95% CI = 1.7-4.5), health facility visit in the past 12 months (RRR = 1.9, 95% CI = 1.4-2.5), paternal professional occupation (RRR = 4.9, 95% CI = 2.0-12.3), family with richer wealth index (RRR = 2.4, 95% CI = 1.4-4.1), and living in the northeast region (RRR = 2.2, 95% CI = 1.2-3.9)were positively associated with vaccination status. Living in the southern region (RRR = 0.3, 95% CI = 0.2-0.5) was negatively associated with vaccination status. CONCLUSION: This study identified maternal age, ANC visits, place of delivery, health facility visits in past 12 months, paternal occupation, wealth quintile, and geographic region as the factors influencing child's vaccination status in Afghanistan.


Assuntos
Cobertura Vacinal/estatística & dados numéricos , Adulto , Afeganistão , Estudos Transversais , Demografia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Fatores Socioeconômicos , Vacinação/estatística & dados numéricos , Adulto Jovem
9.
PLoS One ; 15(8): e0237349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776957

RESUMO

BACKGROUND: Dimensions of social location such as socioeconomic position or sex/gender are often associated with low response rates in epidemiological studies. We applied an intersectionality-informed approach to analyze non-response among population strata defined by combinations of multiple dimensions of social location and subjective health in a health survey in Germany. METHODS: We used data from the cross-sectional sample of the German Health Interview and Examination Survey for Adults (DEGS1) conducted between 2008 and 2011. Information about non-responders was available from a mailed non-responder questionnaire. Intersectional strata were constructed by combining all categories of age, sex/gender, marital status, and level of education in scenario 1. Subjective health was additionally used to construct intersectional strata in scenario 2. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to calculate measures of discriminatory accuracy, proportions of non-responders among intersectional strata, as well as stratum-specific total interaction effects (intersectional effects). Markov chain Monte Carlo methods were used to estimate multilevel logistic regression models. RESULTS: Data was available for 6,534 individuals of whom 36% were non-responders. In scenario 2, we found weak discriminatory accuracy (variance partition coefficient = 3.6%) of intersectional strata, while predicted proportions of non-response ranged from 20.6% (95% credible interval (CI) 17.0%-24.9%) to 57.5% (95% CI 48.8%-66.5%) among intersectional strata. No evidence for intersectional effects was found. These results did not differ substantially between scenarios 1 and 2. CONCLUSIONS: MAIHDA revealed that proportions of non-response varied widely between intersectional strata. However, poor discriminatory accuracy of intersectional strata and no evidence for intersectional effects indicate that there is no justification to exclusively target specific intersectional strata in order to increase response, but that a combination of targeted and population-based measures might be appropriate to achieve more equal representation.


Assuntos
Inquéritos Epidemiológicos/estatística & dados numéricos , Recusa de Participação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Escolaridade , Feminino , Alemanha , Nível de Saúde , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multinível , Fatores Sexuais , Adulto Jovem
11.
PLoS One ; 15(7): e0233029, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658927

RESUMO

BACKGROUND: Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. METHODS: Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. RESULTS: Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. CONCLUSIONS: Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.


Assuntos
Abastecimento de Alimentos/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Renda , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
12.
PLoS One ; 15(7): e0236451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697789

RESUMO

BACKGROUND: Lifestyle habits associate with metabolic health in overall populations. Whether such association is similar among subjects with a different nutritional status has been less studied. We aimed to (i) determine the prevalence of metabolic phenotypes in Chile, and (ii) determine the association between lifestyle habits and metabolic health according to the nutritional status. METHODS: The National Health Survey of Chile 2016-2017 was analyzed. A metabolically unhealthy phenotype was defined as manifesting ≥3 of the following risk factors: elevated blood pressure, elevated triglycerides, elevated glucose, elevated waist circumference, or reduced high-density lipoprotein cholesterol. Individuals manifesting <2 risk factors were considered as healthy. The nutritional status was defined as normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2) or obesity (≥30 kg/m2). Questionnaires were used to estimate smoking habits, alcohol intake, sedentary behavior, moderate-vigorous physical activity, fruits/vegetables consumption, and fish/seafood consumption. The association (odds ratio [95%CI]) between lifestyle habits and metabolic health was determined within each nutritional status, adjusting for age, sex, BMI (in kg/m2), and education. RESULTS: The prevalence of a metabolically unhealthy phenotype was 36% in the overall sample. Such a prevalence was 7%, 33% and 58% among subjects with normal weight, overweight and obesity, respectively. In subjects with normal weight, the highest quartile of fruits/vegetables consumption was associated with reduced odds of having a metabolically unhealthy phenotype (0.09 [0.01-0.48]). In subjects with obesity, the highest quartile of moderate-vigorous physical activity was associated with reduced odds of having a metabolically unhealthy phenotype (0.29 [0.09-0.91]). CONCLUSION: One third of the Chilean population manifests an unhealthy phenotype. We identified associations between lifestyle habits and metabolic health that are specific to the nutritional status. Thus, emphasizing fruits/vegetables consumption in subjects with normal weight, and physical activity in subjects with obesity, may maximize the benefits of public health interventions.


Assuntos
Hábitos , Estilo de Vida , Síndrome Metabólica/epidemiologia , Estado Nutricional/fisiologia , Adolescente , Adulto , Idoso , Glicemia/análise , Chile/epidemiologia , HDL-Colesterol/sangue , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Hipertensão/metabolismo , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/metabolismo , Sobrepeso/sangue , Sobrepeso/epidemiologia , Sobrepeso/metabolismo , Prevalência , Fatores de Risco , Circunferência da Cintura/fisiologia , Adulto Jovem
13.
PLoS One ; 15(6): e0234474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525935

RESUMO

INTRODUCTION: Ethiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children. METHODS: We used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance. RESULTS: Contraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0-55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use. CONCLUSION: Contraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Necessidades e Demandas de Serviços de Saúde , Gravidez não Planejada , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Estudos Transversais , Etiópia , Características da Família , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Islamismo/psicologia , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
14.
PLoS One ; 15(6): e0234483, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520940

RESUMO

BACKGROUND: Substantial inequality in neonatal mortality rates (NMR) remains in low- and middle-income countries to the detriment of disadvantaged subpopulations. In Ethiopia, there is a dearth of evidence on the extent and trends of disparity in NMR. This study assessed the socioeconomic, residence and sex-based inequalities in NMR, as well as examined its change over a sixteen year period in Ethiopia. METHODS: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Ethiopia Demographic and Health Surveys (EDHS) were analyzed between 2000 and 2016. NMR was disaggregated by four equity stratifiers: education, wealth, residence and sex. In addition, absolute and relative inequality measures, namely Difference, Population Attributable Risk (PAR), Ratio, Relative Concentration Index (RCI) and Slope Index of Inequality (SII) were calculated to understand inequalities from different perspectives. Corresponding 95% Uncertainty Intervals (UIs) were computed to measure statistical significance. FINDINGS: Large educational inequalities in NMR were found in 2000, 2005, and 2011, while wealth-driven inequality occurred in 2011. Sex disparity was noted in all the surveys, and urban-rural differentials remained in all the surveys except in 2016. While socioeconomic and area-related inequalities decreased over time, sex related inequality did not change during the period of study. CONCLUSIONS: NMR appeared to be concentrated among male newborns, neonates born to illiterate and poor women and those living in rural settings. However, the inequality narrowed over time. Interventions appropriate for different subpopulations need to be designed.


Assuntos
Mortalidade Infantil/tendências , Escolaridade , Etiópia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Características de Residência/estatística & dados numéricos , Fatores Sexuais
16.
BMC Med Res Methodol ; 20(1): 159, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32539726

RESUMO

BACKGROUND: We aimed to assess the feasibility of using multiple technologies to recruit and conduct cognitive interviews among young people across the United States to test items measuring sexual and reproductive empowerment. We sought to understand whether these methods could achieve a diverse sample of participants. With more researchers turning to approaches that maintain social distancing in the context of COVID-19, it has become more pressing to refine these remote research methods. METHODS: We used several online sites to recruit for and conduct cognitive testing of survey items. To recruit potential participants we advertised the study on the free online bulletin board, Craigslist, and the free online social network, Reddit. Interested participants completed an online Qualtrics screening form. To maximize diversity, we purposefully selected individuals to invite for participation. We used the video meeting platform, Zoom, to conduct the cognitive interviews. The interviewer opened a document with the items to be tested, shared the screen with the participant, and gave them control of the mouse and keyboard. After the participant self-administered the survey, the interviewer asked about interpretation and comprehension. After completion of the interviews we sent participants a follow-up survey about their impressions of the research methods and technologies used. We describe the processes, the advantages and disadvantages, and offer recommendations for researchers. RESULTS: We recruited and interviewed 30 young people from a range of regions, gender identities, sexual orientations, ages, education, and experiences with sexual activity. These methods allowed us to recruit a purposefully selected diverse sample in terms of race/ethnicity and region. It also may have offered potential participants a feeling of safety and anonymity leading to greater participation from gay, lesbian, and transgender people who would not have agreed to participate in-person. Conducting the interviews using video chat may also have facilitated the inclusion of individuals who would not volunteer for in-person meetings. Disadvantages of video interviewing included participant challenges to finding a private space for the interview and problems with electronic devices. CONCLUSIONS: Online technologies can be used to achieve a diverse sample of research participants, contributing to research findings that better respond to young people's unique identities and situations.


Assuntos
Cognição/fisiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Entrevistas como Assunto/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos de Viabilidade , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Internet , Entrevistas como Assunto/métodos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Psicometria/métodos , Reprodutibilidade dos Testes , Estados Unidos/epidemiologia , Adulto Jovem
17.
PLoS One ; 15(6): e0234980, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32598371

RESUMO

INTRODUCTION: Modern contraceptive use provides opportunities for women and couples to achieve optimal child spacing, achieve desired family size and reduce unsafe abortions. Despite these facts, modern contraceptive prevalence rate (mCPR) in Tanzania remains as low as 32%. This study aimed to determine trends and factors associated with changes in modern contraceptive use among women of reproductive age in Tanzania from 2004-2016. METHODOLOGY: This was a cross-sectional study utilizing data from Tanzania Demographic and Health Surveys of 2004-2005, 2010 and 2015-2016. Data analysis was performed using Stata version 14. Analysis considered the complex survey design through application of weights, clustering and strata. Multivariable Poisson decomposition analysis was used to assess factors associated with changes in modern contraceptive use. Results were presented in the form of decomposition coefficients and percentages. RESULTS: Modern contraceptive use increased from 23.0% in 2004 to 34.3% in 2016. Differences in women's characteristics contributed 12.5% of the increase in mCPR. These characteristics include partner's education levels, recent sexual activity and being visited by a family planning worker. The difference in coefficients contributed 87.5% increase in mCPR. The most increase in modern contraceptive use was attributed to rural population (44.1%) and women who experienced a termination of pregnancy (7.1%). CONCLUSION: Modern contraceptive use has steadily increased in Tanzania. Health policies and interventions need to target sexually active women, rural residents as well as less educated women and men to maintain and further accelerate the trends in mCPR. Interventions focusing on women who experienced a termination of pregnancy may also serve as an entry point to promote use of modern contraceptive methods.


Assuntos
Comportamento Contraceptivo/tendências , Serviços de Planejamento Familiar/tendências , População Rural/tendências , Fatores Socioeconômicos , Aborto Induzido/estatística & dados numéricos , Aborto Induzido/tendências , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Política de Saúde , Necessidades e Demandas de Serviços de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Gravidez , População Rural/estatística & dados numéricos , Tanzânia , Adulto Jovem
18.
PLoS One ; 15(6): e0235164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574206

RESUMO

Inappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34-2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34-4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36-11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.


Assuntos
Antibacterianos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Amoxicilina/uso terapêutico , Pré-Escolar , Tosse/complicações , Tosse/diagnóstico , Tosse/tratamento farmacológico , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Metronidazol/uso terapêutico , Análise Multivariada , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Fatores de Risco , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Uganda/epidemiologia
19.
PLoS One ; 15(6): e0235088, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574228

RESUMO

Understanding health beliefs is important to facilitate health promotion and disease prevention as they influence health behaviors, outcomes, and disease management. Given the rise of hypertension-related diseases in the Dominican Republic, the purpose of our study was to identify hypertension-related health beliefs of Dominicans in order to inform the development of culturally appropriate interventions for hypertension prevention, care, and treatment. Semi-structured interviews were conducted with 20 Dominicans, 15 of whom were receiving treatment for hypertension. Operating within the interpretative paradigmatic framework, we conducted thematic analyses of interview data to identify hypertension-related health beliefs and practices. Iterative data analysis revealed the following themes: 1) Negative emotions are a primary cause of hypertension, 2) Medication is the best treatment but adherence is challenging, 3) Systemic barriers impede treatment access, 4) Hypertension negatively impacts mental and physical well-being, and 5) Lifestyle changes, relaxation, and social support help manage hypertension. Data gathered from member checking validated these findings. This study enhances understanding of the beliefs and experiences of Dominicans and emphasize the importance of implementing culturally competent health programming and care.


Assuntos
Cultura , Comportamentos Relacionados com a Saúde/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Inquéritos Epidemiológicos/métodos , Hipertensão/prevenção & controle , Hipertensão/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , República Dominicana , Emoções/fisiologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Hipertensão/psicologia , Entrevistas como Assunto/métodos , Entrevistas como Assunto/estatística & dados numéricos , Estilo de Vida , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Apoio Social
20.
PLoS One ; 15(6): e0235055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579574

RESUMO

BACKGROUND: Early supported discharge (ESD) models of care for stroke survivors coordinate inpatient and community services, with the aim of reducing length of stay. While there is an established evidence base around the clinical outcomes of ESD), less is known about the implementation of this approach into existing stroke care service. The aim of this case study was to describe staff perceptions of the implementation of an ESD model of care for stroke survivors at a large metropolitan public hospital in Australia. METHODS: This case study utilised a mixed methods design, which was designed in explicit alignment with the Consolidated Framework for Implementation Research (CFIR). Participants included staff that referred patients for ESD, and staff involved in the planning, implementation or delivery of ESD. Survey data was collected at three time points (ESD commencement, 3 months and 6 months), and focus groups were undertaken at the conclusion of the study. All quantitative data was analysed descriptive, while qualitative data was evaluated using thematic analysis. RESULTS: Results from both sources of data identified changes in staff perceptions of ESD implementation over time. While very few changes were statistically significant, they were diverse patterns of change across the CFIR constructs over time. The characteristics of individuals and ESD characteristics attracted consistently positive perceptions, while patient needs and resources was the most prevalent theme within the data. While perceptions of factors related to the inner setting were mixed, there was a steady improvement in perceptions about the process across the later stages of implementation. CONCLUSIONS: The sophistication of knowledge translation and implementation in modern complex healthcare environments is highlighted by the multiple interactions between the CFIR domains and constructs. While the implementation process described was generally positive and effective, using the CFIR as a framework confirmed that it also entailed some challenges and unanticipated outcomes.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Sobreviventes , Austrália , Cidades , Assistência à Saúde/métodos , Assistência à Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/normas , Inquéritos Epidemiológicos/estatística & dados numéricos , Hospitais Públicos , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente/normas , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa/normas , Projetos de Pesquisa/estatística & dados numéricos
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