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1.
Medicine (Baltimore) ; 98(44): e17737, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689820

RESUMO

The World Health Organization and United Nations Children's Fund's Baby-Friendly Hospital Initiative is aimed at the global promotion, protection and support of breastfeeding. In this study, we compared breastfeeding-related information received, knowledge and behaviours among postpartum women in Baby-Friendly Hospital Initiative accredited and non-accredited hospitals. We selected 10 hospitals: 9 non-accredited hospitals in the Campania region in southern Italy and one accredited hospital in the Piedmont region in northern Italy. In total, 786 women (580 (73.8%) in Campania and 206 (26.2%) in Piedmont) in the hospitals' maternity wards completed a questionnaire comprising 5 sections within 24 to 72hours after giving birth. The questionnaire investigated breastfeeding activities in the days immediately following childbirth, as well as the information provided by health personnel, knowledge about breastfeeding before and during hospitalisation, and participation in antenatal classes. To evaluate the comparison between the 2 regions, we performed at first a bivariate analysis and then a multinomial and a multivariate logistic regression. Compared with Piedmont, in Campania hospitals there was a rate of breastfeeding of 44.3% vs 89.3%, a skin-to-skin contact between mother and child of 74.5% vs 90.7% and first milk feed within 2hours of 15.0% vs 87.2%. The Campania group had fewer problems with child latching. The Campania group reported receiving less information about breastfeeding in general compared with the Piedmont group. In general, both groups showed good basic knowledge about different aspects of breastfeeding. In both regions, about 90% reported that the information received during the antenatal classes simplified the breastfeeding experience. Our study confirms the importance of systematic promotion of breastfeeding and subsequent delivery of adequate support to maternity departments, in accordance with international guidelines.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Promoção da Saúde/normas , Mães/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Adulto , Aleitamento Materno/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Humanos , Recém-Nascido , Itália , Modelos Logísticos , Mães/psicologia , Análise Multivariada , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Gravidez , Avaliação de Programas e Projetos de Saúde , Nações Unidas , Organização Mundial da Saúde
2.
Rev Lat Am Enfermagem ; 27: e3186, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618386

RESUMO

OBJECTIVE: to identify in the scientific literature the technologies developed to promote health education for the community elderly. METHOD: integrative review that included original articles indexed by Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Science Direct, and Cochrane databases, without restriction of time and language. Results were analyzed descriptively, in five analytical categories. RESULTS: Fifteen articles published on national and international journals were selected, with predominance of experimental studies that tested the effects of such technologies. The types of educational technology developed were printed materials, software and video, as well as mock-up and telephone support. Falls in the elderly were the most discussed theme. The studies have shown that the types of technology found are feasible to promote health education for the community elderly. CONCLUSION: The technologies developed to promote health education for the elderly were multiple and proved effective for use in community interventions.


Assuntos
Tecnologia Educacional/métodos , Educação em Saúde/métodos , Promoção da Saúde/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Recursos Audiovisuais , Humanos , Educação de Pacientes como Assunto/métodos , Software
3.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190010, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576986

RESUMO

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/terapia , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Hepatite C/terapia , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Sífilis Congênita/terapia , Brasil , Infecções por HIV/epidemiologia , Promoção da Saúde/métodos , Promoção da Saúde/estatística & dados numéricos , Hepatite C/epidemiologia , Humanos , Programas Nacionais de Saúde , Inquéritos e Questionários , Sífilis Congênita/epidemiologia
4.
Pan Afr Med J ; 33: 85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489063

RESUMO

Introduction: Testicular self-examination (TSE) is a screening technique that involves inspection of the appearance and palpation of the testes to detect any changes from the normal. Globally, the incidence of cancer has increased among which is testicular cancer (TC). Data on this topic among male secondary school adolescents in Uganda is limited therefore this study sought to assess the knowledge and practice of testicular self-examination among secondary students at Ntare School, Mbarara District in south western Uganda. The objective of the study is to assess the knowledge and practice of testicular self-examination among secondary students at Ntare School in Mbarara district, south western Uganda. Methods: We conducted a descriptive cross-sectional quantitative study among 165 students. Recruitment was made using simple random sampling technique. Respondents were selected among advanced level (A' level) male students studying at Ntare School in Mbarara district, south western Uganda. Structured self-administered questionnaires were used for data collection. Results: Of the male students, 41.8% reported to have knowledge about TSE and only 23.6% practiced TSE. Most students rated their knowledge of TSE to be below 5 (from 1-10). Of the 39 students who admitted performing TSE, only 16 did so as recommended (monthly). Conclusion: The knowledge and practice of TSE were low among adolescent secondary school boys in Ntare School in Mbarara District, south western Uganda. This suggests that these students are unaware of the value of this personal health promotion tool which is fundamental in early diagnosis of testicular cancer.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Autoexame/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Neoplasias Testiculares/diagnóstico , Adolescente , Adulto , Estudos Transversais , Educação em Saúde/métodos , Promoção da Saúde/métodos , Humanos , Masculino , Instituições Acadêmicas , Inquéritos e Questionários , Uganda , Adulto Jovem
5.
Ann Agric Environ Med ; 26(3): 445-449, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559801

RESUMO

INTRODUCTION: An analysis of the impact of health promotion efforts as part of the Polish Universal Neonatal Hearing Screening Program demonstrated diagnostic efficacy. The health promotion efforts had been efficiently implemented via a proper execution of this long-term Program by the Great Orchestra for Christmas Charity (WOSP) foundation. OBJECTIVE: The aim of the study was to demonstrate the impact of health promotion efforts by public benefit organizations by analyzing the WOSP foundation's involvement in the Program in Poland during 2003-2015. MATERIAL AND METHODS: Statistical data for 2003-2015 were obtained from the database of the Department of Otolaryngology and Laryngeal Oncology at Poznan University of Medical Sciences. The analyzed data included the rates of hearing-impairment detection (phase 1), diagnosis (phase 2), and treatment (phase 3) in the newborns included in the Program, as well as the documentation of expenditures based on WOSP's foundation annual financial reports. RESULTS: A total of 4,672,704 newborns were screened from 2003-2015, which amounted to approximately 360,000 screened patients per year. During the analyzed 12 years of the Program, the mean proportion of children who underwent screening was 96.1%, with an observable, gradual increase in the number of children undergoing diagnostic assessments (phase 2) for a suspected hearing impairment, with the largest amount of money having been allocated to the Program implementation and expended in its early stages. The total cost of financing the Program by the year 2015 was 51,841,712 PLN. CONCLUSIONS: The Polish Universal Neonatal Hearing Screening Program resulted in an improvement in the quality in the screening test, ensured more thorough diagnostics, and shortened the time needed to implement the appropriate treatment.


Assuntos
Promoção da Saúde/métodos , Perda Auditiva/diagnóstico , Programas de Rastreamento/métodos , Feminino , Promoção da Saúde/economia , Perda Auditiva/economia , Perda Auditiva/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/economia , Polônia
6.
Metas enferm ; 22(7): 24-32, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-2572

RESUMO

Objetivo: evaluar la efectividad de una intervención de promoción de la salud para personas de edad avanzada, con el objetivo de promover la adopción de hábitos saludables y de mejorar la calidad de vida relacionada con la salud (CVRS), la salud mental y el apoyo social. Método: se llevó a cabo un estudio de evaluación con diseño pre/post, no-experimental. Se trataba de captar a mayores de 65 años, residentes en la comunidad, de dos barrios de nivel socioeconómico desfavorecido de la ciudad de Barcelona. La intervención consistió en un taller estructurado en ocho sesiones cuyo objetivo era la adopción de hábitos saludables. Se obtuvo información sobre la actividad física, CVRS, hábitos dietéticos, salud mental y apoyo social a partir de cuestionarios validados (IPAQ, SF-36, PREDIMED, GHQ-12, MOS y NSHAP, respectivamente). Se analizaron diferencias antes y después de la intervención mediante los test de McNemar, t de Student y de Wilcoxon para datos apareados según correspondiese. Resultados: la muestra se compuso de 22 adultos. Tras la intervención, la mediana de actividad física se incrementó en 842,5 MET/semana. La CVRS también mejoró: las puntuaciones para dimensión mental se incrementaron en un 30% y las de la dimensión física un 22%. No se observaron cambios en la dieta o en la salud mental. Conclusiones: las intervenciones de promoción de la salud, orientadas a personas mayores pueden jugar un papel clave en la mejora de la calidad de vida y el bienestar


Objective: to assess the efficacy of a health promotion intervention for persons of advanced age, with the objective of promoting the adoption of healthy habits and improving health-related quality of life (HRQoL), mental health, and social support. Methods: an evaluation study was conducted with pre/post, non-experimental design. The objective was to recruit >65-year-old persons living in the community, from two areas in the city of Barcelona with underprivileged socioeconomic levels. The intervention consisted in a workshop structured into eight sessions, with the objective of adopting healthy habits. Information was collected about physical activity, HRQoL, diet habits, mental health, and social support, through validated questionnaires (IPAQ, SF-36, PREDIMED, GHQ-12, MOS and NSHAP, respectively). Any differences before and after the intervention were analyzed through the McNemar, Student's t and Wilcoxon tests for paired data, as relevant. Results: the sample included 22 adults. After the intervention, there was an increase in the median physical activity of 842.5 MET/week. There was also an improvement in HRQoL: the scores for the mental dimension increased by 30% and the physical dimension by 22%. No changes were observed in diet or mental health. Conclusions: health promotion interventions, oriented to elderly persons, can play a key role in the improvement of QoL and wellbeing


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Avaliação de Resultado de Intervenções Terapêuticas , Promoção da Saúde/métodos , Idoso Fragilizado/estatística & dados numéricos , Resultado do Tratamento , Atividade Motora/fisiologia , Comportamento Alimentar , Qualidade de Vida , Populações Vulneráveis , Apoio Social , Inquéritos e Questionários , Saúde do Idoso
7.
Cochrane Database Syst Rev ; 9: CD012099, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529625

RESUMO

BACKGROUND: Exclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant.Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long-term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities. OBJECTIVES: To assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese. SEARCH METHODS: On 23 January 2019 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are overweight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group. DATA COLLECTION AND ANALYSIS: We assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We found no trials comparing one type of support versus another. We included seven RCTs (including one cluster-RCT) involving 831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high-income countries: USA (5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias.Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump)Very low-certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41 to 1.03). The trial did not report other important outcomes of interest in this review: non-initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum.Multiple methods of breastfeeding support versus usual care Six trials (involving 792 women) used multiple methods of support including education and social support through telephone or face-to-face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest.We are unclear about the effects of the intervention because we identified very low-certainty evidence for all of the important outcomes in this review: rate of non-initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks (average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); rate of exclusive breastfeeding at six months postpartum (RR 7.23, 95% CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2 trials, 223 women).The included trials under the above comparisons also reported on some of this review's secondary outcomes but very low-certainty evidence means that we are unclear about the effects of the intervention on those outcomes. AUTHORS' CONCLUSIONS: There is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low-certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups.Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions.


Assuntos
Aleitamento Materno/psicologia , Promoção da Saúde/métodos , Mães/psicologia , Obesidade , Sobrepeso , Feminino , Humanos , Lactente , Mães/educação , Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Período Pós-Parto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
8.
Cochrane Database Syst Rev ; 9: CD010905, 2019 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-31560414

RESUMO

BACKGROUND: Many workers suffer from work-related stress and are at increased risk of work-related cardiovascular, musculoskeletal, or mental disorders. In the European Union the prevalence of work-related stress was estimated at about 22%. There is consensus that stress, absenteeism, and well-being of employees can be influenced by leadership behaviour. Existing reviews predominantly included cross-sectional and non-experimental studies, which have limited informative value in deducing causal relationships between leadership interventions and health outcomes. OBJECTIVES: To assess the effect of four types of human resource management (HRM) training for supervisors on employees' psychomental stress, absenteeism, and well-being. We included training aimed at improving supervisor-employee interaction, either off-the-job or on-the-job training, and training aimed at improving supervisors' capability of designing the work environment, either off-the-job or on-the-job training. SEARCH METHODS: In May 2019 we searched CENTRAL, MEDLINE, four other databases, and most relevant trials registers (ICTRP, TroPHI, ClinicalTrials.gov). We did not impose any language restrictions on the searches. SELECTION CRITERIA: We included randomised controlled trials (RCT), cluster-randomised controlled trials (cRCT), and controlled before-after studies (CBA) with at least two intervention and control sites, which examined the effects of supervisor training on psychomental stress, absenteeism, and well-being of employees within natural settings of organisations by means of validated measures. DATA COLLECTION AND ANALYSIS: At least two authors independently screened abstracts and full texts, extracted data and assessed the risk of bias of included studies. We analysed study data from intervention and control groups with respect to different comparisons, outcomes, follow-up time, study designs, and intervention types. We pooled study results by use of standardised mean differences (SMD) with 95% confidence intervals when possible. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS: We included 25 studies of which 4 are awaiting assessment. The 21 studies that could be analysed were 1 RCT, 14 cRCTs and 6 CBAs with a total of at least 3479 employees in intervention and control groups. We judged 12 studies to have an unclear risk of bias and the remaining nine studies to have a high risk of bias. Sixteen studies focused on improving supervisor-employee interaction, whereas five studies aimed at improving the design of working environments by means of supervisor training.Training versus no interventionWe found very low-quality evidence that supervisor training does not reduce employees' stress levels (6 studies) or absenteeism (1 study) when compared to no intervention, regardless of intervention type or follow-up. We found inconsistent, very low-quality evidence that supervisor training aimed at employee interaction may (2 studies) or may not (7 studies) improve employees' well-being when compared to no intervention. Effects from two studies were not estimable due to missing data.Training versus placeboWe found moderate-quality evidence (2 studies) that supervisor training off the job aimed at employee interaction does not reduce employees' stress levels more than a placebo training at mid-term follow-up. We found low-quality evidence in one study that supervisor training on the job aimed at employee interaction does not reduce employees' absenteeism more than placebo training at long-term follow-up. Effects from one study were not estimable due to insufficient data.Training versus other trainingOne study compared the effects of supervisor training off the job aimed at employee interaction on employees' stress levels to training off the job aimed at working conditions at long-term follow-up but due to insufficient data, effects were not estimable. AUTHORS' CONCLUSIONS: Based on a small and heterogeneous sample of controlled intervention studies and in contrast to prevailing consensus that supervisor behaviour influences employees' health and well-being, we found inconsistent evidence that supervisor training may or may not improve employees' well-being when compared to no intervention. For all other types of interventions and outcomes, there was no evidence of a considerable effect. However, due to the very low- to moderate-quality of the evidence base, clear conclusions are currently unwarranted. Well-designed studies are needed to clarify effects of supervisor training on employees' stress, absenteeism, and well-being.


Assuntos
Esgotamento Profissional , Liderança , Saúde do Trabalhador , Administração de Recursos Humanos , Estresse Psicológico , Absenteísmo , Promoção da Saúde/métodos , Humanos , Transtornos Mentais , Ensaios Clínicos Controlados Aleatórios como Assunto , Recursos Humanos , Local de Trabalho
10.
BMC Public Health ; 19(1): 1084, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399029

RESUMO

The rising global burden of noncommunicable diseases (NCDs) among people with low socioeconomic status (SES) has heightened awareness of the need for primary prevention programs in low-SES neighborhoods. Social inequity in health is apparent in mental, social and physical aspects of health among people living in low-SES neighborhoods. Viewing this problem from a life course perspective and adopting a vulnerable population approach points to the importance of inducing sustainable health behavior changes in children and young people living in low-SES neighborhoods. One important factor in lowering the risk of many NCDs while improving mental health is the promotion of physical activity (PA). In this paper, we argue that lowering the risk of many NCDs and improving mental health is best achieved through setting-based programs that facilitate long-term PA behavior changes in children and adolescents living in marginalized neighborhoods. Empirical evidence indicates that extrinsic motives for participating in physical activities, such as improving health, are insufficient when long-term participation is the goal. Therefore, we argue that interventions with the aim of affecting long-term PA in low-SES neighborhoods and thereby reducing social inequities in health should include activities that aim to create more intrinsic and autonomous motivations by building on more broad and positive understandings of health and participation. Here, we advocate that sports-based recreation (SR) holds several advantages. If implemented well, SR has the potential to be a health-promoting activity that is meaningful and motivating in itself and that involves physiological health-promoting aspects (e.g., PA), a social aspect (e.g., positive relations with others), and a psychological aspect (e.g., positive experiences of oneself). Further, we suggest four practicalities that should be considered when conducting interventions: the cost of participating, the location, the facilities required, and the suitability of the SR activities.


Assuntos
Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Doenças não Transmissíveis/prevenção & controle , Áreas de Pobreza , Determinantes Sociais da Saúde , Esportes , Adolescente , Criança , Feminino , Humanos , Masculino
11.
BMC Public Health ; 19(1): 1086, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399071

RESUMO

BACKGROUND: Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men's exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men's health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men's co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. METHODS: This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline. DISCUSSION: Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men's depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men. TRIAL REGISTRATION: Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069 .


Assuntos
Promoção da Saúde/métodos , Saúde Mental , Saúde Sexual , Minorias Sexuais e de Gênero/psicologia , Adolescente , Adulto , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto Jovem
12.
BMC Public Health ; 19(1): 1039, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375074

RESUMO

BACKGROUND: Interventions in India to improve menstrual health and hygiene management (MHHM) have been implemented at the national, state, district and school level. However, evaluations of these interventions have been scarce. The objective of the study was to determine if a social and behavioral change communication (SBCC) intervention (GARIMA) had a relationship with knowledge, attitudes, interpersonal communication, restrictions and MHHM using a comparison group post-test only design among 2206 adolescent girls. METHODS: Intervention villages and adolescent girls were selected through stratified random sampling based on where GARIMA was implemented. Villages and adolescent girls in comparison villages were matched socio-demographically to intervention villages and adolescent girls. Multi-level logistic regressions assessed the relationship between the encoded exposure, mediators and MHHM. RESULTS: The results showed that the encoded exposure predicted all behaviors corresponding to MHHM. Additionally, adolescent girls in the high encoded exposure group had significantly higher knowledge about puberty and reproductive parts (AOR: 2.03 (95% CI: 1.31 - 3.15)), positive attitudes towards gender (AOR: 1.48 (95% CI: 1.02 - 2.16)) and higher levels of some discussion and dialogue (AOR: 1.41 (95% CI: 1.04 - 1.92)). CONCLUSIONS: Future programs should use SBCC to improve MHHM behavior but involve families, peers and community members to a greater extent in order to improve attitudes towards menstruation, attitudes towards restrictions, attitudes towards absorbent use and reduce restrictions within the community.


Assuntos
Comunicação , Promoção da Saúde/métodos , Higiene/normas , Menstruação/psicologia , Mudança Social , Adolescente , Criança , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
13.
BMC Public Health ; 19(1): 1162, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438908

RESUMO

BACKGROUND: The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake. METHODS: We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS - yes or no) × 4 (letter - national template control, open-ended, time-limited, social norm) × 2 (reminder SMS - yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC. RESULTS: Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder (Uptake 30%; Adjusted Odds Ratio AOR 1.86; 95% CI 1.45-2.83; p < 0.00); 10 percentage points for the open-ended letter with reminder (Uptake 27%; AOR 1.68; 95% CI 1.31-2.17; p < 0.00) and a 9 percentage point increase using the time-limited letter with reminder (Uptake 27%; AOR 1.61; 95% CI 1.25-2.10; p < 0.00). The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect. CONCLUSIONS: This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance. TRIAL REGISTRATION: Retrospectively Registered (24/01/2014) ISRCTN36027094 .


Assuntos
Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde/métodos , Sistemas de Alerta , Medicina Estatal/estatística & dados numéricos , Mensagem de Texto , Adulto , Método Duplo-Cego , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores de Tempo
14.
Rev Esp Salud Publica ; 932019 Aug 02.
Artigo em Espanhol | MEDLINE | ID: mdl-31368457

RESUMO

OBJECTIVE: Increasing breastfeeding rates is a desirable goal for improving maternal and child health. Pediatricians have a main role in this subject. The objective was to document breastfeeding knwoledge in Pediatric residents, and its relationship with the BFHI (Baby Friendly Hospital Initiative) status of their hospitals. METHODS: Transversal study with a validated online survey (ECoLa). Polietapic sampling of Pediatric residentes in Spain by strata (BFHI degree) and clusters (hospitals). Estimated sample size was 142 residents. 312 surveys were sent to 21 hospitals. Main variable was the percentage of correct answers to survey questions, it was analyzed with non parametric techniques. RESULTS: 189 answers (response rate 60%). Global median (Me) of correct answers was 76.9% (95% Confidence Interval [95CI] 74.2-79.6). There was no difference among first and second year residents (Me=76.9%) and third and fourth year residents (Me=73.1%) (p=0.541). Residents from BFHI hospitals (Me=84.6%) achieved better results than those from non-BFHI hospitals (Me=73.1%) (p=0.002). Variability at non-BFHI hospitals was considerable, where some hospitals showed unacceptable scores. Prevalence of courses was greater at BFHI hospitals (95% vs 52%). CONCLUSIONS: There are some deficiencies in Pediatric residents' breastfeeding training. There are hospitals whose residents have an insufficient breastfeeding knowledge. No low scores were found in residents from BFHI hospitals. We consider neccesary to systematize and universalize breastfeeding training during Pediatric Residency.


Assuntos
Atitude Frente a Saúde , Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde/métodos , Hospitais/estatística & dados numéricos , Pediatria/normas , Adulto , Estudos Transversais , Feminino , Humanos , Internato e Residência , Masculino , Mães , Prevalência , Espanha/epidemiologia , Inquéritos e Questionários , Adulto Jovem
15.
Rev Esp Salud Publica ; 932019 Aug 12.
Artigo em Espanhol | MEDLINE | ID: mdl-31406103

RESUMO

OBJECTIVE: Acquiring the habit of doing regular physical activity in adolescents has shown positive effects in the prevention of diseases and the maintenance of physical and psychological health. The objective was to explore the topics related to physical activity of a group of adolescents, to identify the barriers and motivators of regular physical activity practice. METHODS: Qualitative research of phenomenological explanatory design. The information was obtained through four Discussion Groups conducted with: a) expert professionals (6 participants); b) adolescents of both sexes (10 participants); c) female adolescents (6 participants); d) male adolescents (9 participants). RESULTS: Perceived barriers and motivations were detected in all groups of adolescents, contributing a total of 104 units of analysis. The group of experts emphasized the need to involve the family, the school, and the agents that surround the teenagers. The adolescents showed barriers related to incompatibilities due to lack of time, participation in leisure activities and demotivation due to routine and imposed activities (37; 35.5%). Motivation was related to participation in team sports and the positive influence of friends (28; 28%). The girls also showed concern about their body image and diet (39; 37.5%). CONCLUSIONS: Barriers were identified in relation to the close environment of the adolescents in three main areas: family, friends and school. Motivators were linked to social and multicultural components. Priority actions in this group are to promote activities that include team sports as a mean to enhance social support.


Assuntos
Comportamento do Adolescente/psicologia , Exercício/psicologia , Promoção da Saúde/métodos , Atividades de Lazer , Apoio Social , Adolescente , Atitude Frente a Saúde , Feminino , Hábitos , Humanos , Masculino , Motivação , Pesquisa Qualitativa , Instituições Acadêmicas , Espanha
16.
BMC Public Health ; 19(1): 1136, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426776

RESUMO

BACKGROUND: Worldwide, HIV remains a major public health challenge, especially in Sub-Saharan Africa. Literature indicates that men's involvement in HIV testing, care, and treatment services is lower compared to women, therefore novel approaches are required to engage men in the cascade of HIV care. This study aimed to explore men's perception on the provision of HIV testing services in venues where English Premier League football games are televised. METHODS: An exploratory qualitative study was conducted between February and May 2018. Six focus group discussions were conducted with 50 conveniently selected men aged 18 years and older using a pre-tested discussion guide. All focus group discussions were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Overall, HIV testing at venues telecasting English Premier League football games was acceptable to men. There was a very strong preference for health workers providing testing and counseling services be external or unknown in the local community. Possible motivators for testing services provided in these settings include subsidizing or eliminating entrance fee to venues telecasting games, integrating testing and counseling with health promotion or screening for other diseases, use of local football games as mobilization tools and use of expert clients as role models. CONCLUSIONS: This study suggests that HIV testing services at venues where EPL football games are televised is generally acceptable to men. In implementing such services, consideration should be given to preferences for external or unknown health workers and the motivating factors contributing to the use of these services. Given that HIV testing is currently not conducted in these settings, further research should be conducted to evaluate the feasibility of this approach as a means of enhancing HIV testing among Ugandan men.


Assuntos
Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Programas de Rastreamento/psicologia , Homens/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Futebol , Adulto , Idoso , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Uganda , Adulto Jovem
17.
BMC Public Health ; 19(1): 1097, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409381

RESUMO

BACKGROUND: This study aimed to describe the design and present the baseline characteristics of a web-based lifestyle intervention program, which comprises of sequentially and simultaneously delivered intervention modules targeting physical activity (PA) and fruit and vegetable consumption (FVC) in Chinese college students. METHODS: The study adopted a randomized placebo-controlled trial, using the Health Action Process Approach (HAPA) and the Compensatory Carry-Over Action Model (CCAM) as the theoretical backdrops. 556 Chinese college students participated in the 8-week web-based lifestyle intervention program. All eligible participants were randomly assigned to one of four groups: 1) the PA-first arm which received a 4-week intervention addressing PA followed by a 4-week intervention addressing FVC; 2) the FVC-first arm which received a 4-week intervention addressing FVC followed by a 4-week intervention addressing PA; 3) the PA + FVC simultaneous arm that received an 8-week intervention addressing both PA and FVC at the same time; and 4) the placebo-control arm that received 8 weeks of general health information, which is not relevant for changing actual PA and FVC behaviors. Data collection includes four time-points: at the beginning and end of the intervention, and a 3-month and 12-month follow-up after the intervention. RESULTS: At baseline, 41.7% of participants were male and 58.3% were female. 41.0% of the participants did not meet the standard PA-recommendations, while 69.6% did not adhere to the standard FVC-recommendations. In total, only 19.6% of participants met both PA and FVC recommendations. Baseline characteristics across the four groups had no significant differences (all P = .17-.99), indicating successful randomization. CONCLUSIONS: The preliminary results indicate a high prevalence of unhealthy lifestyles in college students in China, which further supports the need for web-based health intervention programs. This is also the first study that examines the comparative effectiveness of simultaneously and sequentially delivered lifestyle interventions in the Chinese population. These findings may contribute to the creation of future web-based health behavior change interventions. TRIAL REGISTRATION: ClinicalTrails.gov: NCT03627949 , 14 August, 2018.


Assuntos
Promoção da Saúde/métodos , Internet , Estilo de Vida , Estudantes/psicologia , Adolescente , China , Dieta/psicologia , Dieta/estatística & dados numéricos , Exercício/psicologia , Feminino , Frutas , Humanos , Masculino , Projetos de Pesquisa , Estudantes/estatística & dados numéricos , Universidades , Verduras , Adulto Jovem
18.
BMC Public Health ; 19(1): 1126, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420033

RESUMO

BACKGROUND: The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers. METHODS: The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD = 10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation - Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention. RESULTS: Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Motivation was highlighted as a core target for intervention, both reflective Motivation, such as beliefs about capability and intention and automatic in terms of overcoming habit through reinforcement. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace. CONCLUSIONS: The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease sitting in the workplace. Intervention designers should consider the identified BCW factors and BCTs when developing interventions to reduce and break up workplace sitting.


Assuntos
Promoção da Saúde/métodos , Saúde do Trabalhador , Postura Sentada , Local de Trabalho/psicologia , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Cultura Organizacional , Pesquisa Qualitativa , Fatores de Tempo , Local de Trabalho/organização & administração
19.
Enferm. clín. (Ed. impr.) ; 29(4): 254-256, jul.-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-182921

RESUMO

Propósitos y objetivos: Revisar la bibliografía identificando los factores de riesgo asociados con el debut sexual temprano y coaccionado, con el propósito de facilitar la planificación de los profesionales sanitarios en los correspondientes servicios de salud en la provisión de estrategias de intervención comunitarias para retrasar el debut sexual precoz coaccionado o debut sexual forzado (DSC/DSF). Antecedentes: Identificar los factores de riesgo asociados con la coacción a la primera relación sexual, es crucial para profundizar en el conocimiento de la salud sexual y reproductiva, y para la promoción de la salud. Sin embargo, el conocimiento actual acerca de los factores de riesgo asociados con la coacción, debut sexual (DS) y retraso de DS entre la población joven es limitado. Los programas de educación para la salud son importantes durante la adolescencia, cuando la gente joven se encuentra desarrollando sus valores y creencias acerca de la actividad sexual y las normas sexuales. Sin embargo, poco se conoce acerca de estos factores de riesgo en la iniciación precoz del debut sexual para planificar intervenciones relevantes que puedan retrasar el DS y prevenir el DSC/DSF en esta población. Diseño: Revisión sistemática. Métodos: Revisión bibliográfica ampliada utilizando las bases de datos MEDLINE (PubMed), Nursing Journals (PubMed), Web of Science, PsychINFO y CINAHL. Resultados: La búsqueda obtuvo 39 estudios publicados que reunieron nuestros criterios de inclusión y exclusión. Treinta y dos artículos pasaron la evaluación de calidad y fueron seleccionados. Esta revisión identificó seis dominios de factores de riesgo, categorizados como:1 el dominio individual,2 el dominio familiar,3 el dominio compañero/par,4 el dominio escolar,5 el dominio de la comunidad y 6 el dominio cultural. Estos factores influyen en la toma de decisiones de adolescentes y personas jóvenes y el tiempo de su primera relación sexual. Conclusión: Es importante usar la categorización de factores de riesgo resultante de esta revisión, para facilitar a los trabajadores del cuidado de la salud la planificación de programas de salud sexual y reproductiva relevantes, así como más accesibles para los adolescentes, especialmente para mujeres jóvenes y sus padres. Esto es una necesidad para evaluar el impacto de estos programas que pueden retrasar el DS y prevenir el DSC/DSF en esta población. Relevancia para la práctica clínica: los resultados de este estudio pueden proporcionar una guía en la planificación de intervenciones efectivas para el retraso de un DSC/DSF precoz en las comunidades


No disponible


Assuntos
Humanos , Adolescente , Adulto Jovem , Fatores de Risco , Sexualidade , Comportamento Sexual/psicologia , Coito/psicologia , Coerção , Promoção da Saúde/métodos , Saúde Sexual
20.
AIDS Behav ; 23(9): 2253-2272, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31401741

RESUMO

A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.


Assuntos
Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Homossexualidade Masculina , Doenças Sexualmente Transmissíveis/prevenção & controle , Telemedicina , Adulto , Humanos , Masculino , Comportamento de Redução do Risco , Mensagem de Texto
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