Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.653
Filtrar
1.
Adv Exp Med Biol ; 1300: 3-19, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33523427

RESUMO

In this Chapter, we systematically and comprehensively described various environmental harmful factors. They were classified into four aspects: physical factors, chemical factors, biological factors, and physiological and psychological stress factors. Their classification, modes of presence, toxicity and carcinogenicity, routes of exposure to human and toxic effects on the female reproductive health were introduced. It is expected that the exposure routes could be controlled and eliminated, and the pathogenic mechanism of environmental harmful factors should be investigated and explained to protect female reproductive health.


Assuntos
Exposição Ambiental , Saúde Reprodutiva , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Reprodução , Saúde da Mulher
2.
Adv Exp Med Biol ; 1300: 205-229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33523436

RESUMO

Environmental endocrine-disrupting chemicals (EDCs) are xenobiotic compounds that are frequently contacted in daily life. With the species and quantity of substances created and utilized by human beings significantly surpassing the self-purification capacity of nature, a large number of hazardous substances are enriched in the human body through the respiratory tract, digestive tract, and skin. Some of these compounds cause many problems endangering female reproductive health by simulating/antagonizing endogenous hormones or affecting the synthesis, metabolism, and bioavailability of endogenous hormones, including reproductive disorders, fetal birth defects, fetal developmental abnormalities, endocrine and metabolic disorders, and even gynecological malignancies. Therefore, the study of the relationship between environmental EDCs and female reproductive diseases and related mechanisms is of considerable significance to women, children health care, and improve the quality of the population.


Assuntos
Disruptores Endócrinos , Poluentes Ambientais , Criança , Disruptores Endócrinos/toxicidade , Sistema Endócrino , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/toxicidade , Feminino , Hormônios/farmacologia , Humanos , Reprodução , Saúde Reprodutiva
3.
Artigo em Russo | MEDLINE | ID: mdl-33591663

RESUMO

The young generation aged 16-24 years is the main demographic national reserve for coming decades. Hence, the purpose of the study is to investigate attitude of modern youth exemplified by students of medical university to establishing family, marriage and birth of children, and also their awareness about issues of reproductive health and training of couple to birth of healthy progeny considering modern approaches of personalized "4P Medicine". The survey of medical students was carried out on the basis of sampling of 193 students in November 2019 to February 2020. The survey data was processed using software SPSS 21. The indices of descriptive and analytical statistics were calculated to analyze study results. The low awareness of medical students on issues of pregravid training and modern approaches of personalized «4P Medicine¼ was established. Despite the fact that significant number of students understand importance of improving their awareness of reproductive health and pregravid training from positions of "4P Medicine", about quarter of all respondents never pondered about these issues. The majority of respondents lead healthy life-style and understand its importance for their health, including reproductive health. The students have positive attitudes to establishment of family and birth of children. It is necessary to improve awareness of medical students of reproductive health, pregravid training and main principles of personalized "4P Medicine".


Assuntos
Medicina , Estudantes de Medicina , Adolescente , Adulto , Criança , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Saúde Reprodutiva , Inquéritos e Questionários , Universidades , Adulto Jovem
5.
Open Biol ; 11(1): 200347, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33465325

RESUMO

Coronavirus disease 2019 (COVID-19) has emerged as a new public health crisis, threatening almost all aspects of human life. Originating in bats, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted to humans through unknown intermediate hosts, where it is primarily known to cause pneumonia-like complications in the respiratory system. Organ-to-organ transmission has not been ruled out, thereby raising the possibility of the impact of SARS-CoV-2 infection on multiple organ systems. The male reproductive system has been hypothesized to be a potential target of SARS-CoV-2 infection, which is supported by some preliminary evidence. This may pose a global threat to male fertility potential, as men are more prone to SARS-CoV-2 infection than women, especially those of reproductive age. Preliminary reports have also indicated the possibility of sexual transmission of SARS-CoV-2. It may cause severe complications in infected couples. This review focuses on the pathophysiology of potential SARS-CoV-2 infection in the reproductive organs of males along with their invasion mechanisms. The risks of COVID-19 on male fertility as well as the differences in vulnerability to SARS-CoV-2 infection compared with females have also been highlighted.


Assuntos
/patologia , Saúde Reprodutiva , /patogenicidade , /imunologia , Citocinas/metabolismo , Fragmentação do DNA , Humanos , Linfócitos/metabolismo , Linfócitos/virologia , Masculino , Estresse Oxidativo , Espermatozoides/fisiologia , Espermatozoides/virologia
6.
Ecotoxicol Environ Saf ; 208: 111632, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33396152

RESUMO

Titanium (Ti) is commonly used in additives in the form of titanium dioxide (TiO2). However, our understanding of the effect of Ti on reproductive health remains limited. This nested case-control study, performed in a Ti mining exposure field, investigated the association between maternal blood Ti concentration and the risk of low birth weight (LBW), as well as the potential biological mechanism. A total of 45 women who delivered LBW infants (cases) and 352 women with normal birth weight infants (controls) were included. We collected maternal peripheral blood samples in the first or early second trimester to measure Ti concentration in serum (Tisr) and blood cells (Tibc), as well as inflammatory, lipid, and oxidative stress biomarkers thereof. The demographic characteristics of the women included in the study were also obtained. The results showed that the median total blood Ti concentration (Titb) in the case group was significantly higher than that in the control group (134 vs. 129 ng/mL, P = 0.039). A higher Titb level was associated with a greater risk of LBW [odds ratio = 2.62; 95% confidence interval (CI): 1.16-5.90], but no such association was observed for Tisr or Tibc after adjusting for potential confounders. The serum lipid biomarkers TC, TG, and total lipids (TL) were all negatively associated with Tisr and Titb. Serum 8-OHdG was positively associated with Tibc. We concluded that a high Titb during early pregnancy may increase the risk of LBW. Lipid metabolism and oxidative stress may play an important role in the adverse health effects associated with Ti exposure. Thus, our results merit more attention to the probable adverse effects of titanium exposure during pregnancy.


Assuntos
Recém-Nascido de Baixo Peso , Exposição Materna/efeitos adversos , Saúde Reprodutiva , Titânio/toxicidade , Adulto , Estudos de Casos e Controles , China , Feminino , Humanos , Recém-Nascido , Metabolismo dos Lipídeos/efeitos dos fármacos , Razão de Chances , Estresse Oxidativo/efeitos dos fármacos , Gravidez , Titânio/sangue
8.
Washington, D.C.; OPS; 2020-12-10. (OPS/FPL/HL/20-0019).
Não convencional em Espanhol | PAHO-IRIS | ID: phr-53134

RESUMO

El embarazo en la adolescencia afecta profundamente la trayectoria de vida de las niñas. Además de afectar su desarrollo psicosocial, lleva a resultados precarios en materia de salud para las niñas y sus hijos, repercute de manera negativa en sus oportunidades educativas y de empleo, y contribuye a la perpetuación de los ciclos intergeneracionales de salud precaria y de pobreza. A pesar del crecimiento socioeconómico registrado en años recientes en América Latina y el Caribe, la tasa de fecundidad en adolescentes en la región (la segunda más alta del mundo) continúa siendo inaceptablemente alta, con grandes inequidades entre los países y al interior de ellos.


Assuntos
Mulheres , Saúde da Mulher , Gravidez , Gravidez na Adolescência , Infecções por Coronavirus , Recém-Nascido , Criança , Saúde Materna , Saúde Reprodutiva , Saúde Sexual e Reprodutiva , Saúde do Adulto , Educação , Emprego , Pobreza , Iniquidade Social , Iniquidade de Gênero , Pandemias , Coronavirus , Infecções por Coronavirus
9.
Washington, D.C.; PAHO; 2020-12-10. (PAHO/FPL/HL/20-0019).
Não convencional em Inglês | PAHO-IRIS | ID: phr-53133

RESUMO

Adolescent pregnancy profoundly affects girls’ life trajectories. It hampers their psychosocial development, contributes to poor health outcomes for the girls and their offspring, negatively affects their educational and employment opportunities, and contributes to the perpetuation of intergenerational cycles of poor health and poverty. Despite recent socioeconomic growth in Latin America and the Caribbean (LAC), adolescent fertility rates in the region remain unacceptably high—the second highest in the world—with major inequities between and within countries.


Assuntos
Mulheres , Saúde da Mulher , Gravidez , Gravidez na Adolescência , Infecções por Coronavirus , Recém-Nascido , Criança , Saúde Materna , Saúde Reprodutiva , Saúde Sexual e Reprodutiva , Saúde do Adulto , Educação , Emprego , Pobreza , Iniquidade Social , Iniquidade de Gênero , Pandemias , Infecções por Coronavirus , Coronavirus
10.
Zhonghua Nan Ke Xue ; 26(1): 3-16, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33345471

RESUMO

Reproductive health is a key aim of the population health strategy, and male reproductive health constitutes an important part of reproductive health. This article systematically analyzes the applications to and grants from the National Natural Science Foundation of China (NSFC) and some related scientific problems in the field of male reproductive health in the past 30 years. It also discusses the development of the basic researches on male reproductive health in China and the facilitating role of NSFC in this field.


Assuntos
Pesquisa Biomédica/tendências , Saúde Reprodutiva , China , Fundações , Humanos , Masculino
11.
Artigo em Inglês | MEDLINE | ID: mdl-33379287

RESUMO

Sarcopenia is defined as an age-related loss of skeletal muscle and is associated with several health disorders. Causes of sarcopenia, which included physical inactivity, alcohol, dietary habits, and smoking, have been researched. The present study was undertaken to examine the association between reproductive span and sarcopenia in Korean women. Data obtained from 2008 to 2011 Korea National Health and Nutrition Examination Surveys (KNHANES) were analyzed. We defined sarcopenia based on the cut-off values of the Foundation for the National Institutes of Health (FNIH) sarcopenia project criteria: ASM/BMI < 0.512 for women. Reproductive span was defined as years from menarche to menopause, and we divided the 3970 study subjects into three groups by reproductive span tertile. Multivariate logistic regression analysis was used to determine adjusted ORs for the relation between reproductive span and sarcopenia. The prevalence of sarcopenia in the study was 17.7% (704 of 3970). Multiple logistic regression analysis was performed using weighted populations. After adjusting for covariates, reproductive span was found to be inversely associated with the risk of sarcopenia [Tertile 1 = 1 (reference); Tertile 2, odds ratio (OR) = 0.927, 95% confidence interval (CI) = 0.863-0.995; Tertile 3, OR = 0.854, 95% CI = 0.793-0.915].


Assuntos
Saúde Reprodutiva , Sarcopenia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Razão de Chances , República da Coreia/epidemiologia , Fatores de Risco , Sarcopenia/epidemiologia , Sarcopenia/patologia , Adulto Jovem
12.
Sci Data ; 7(1): 438, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33335102

RESUMO

A cross-sectional survey of adolescents and heads of households was done in six urban and rural local government areas in Ebonyi state, Nigeria in August 2018. Modified cluster sampling technique was used to select households from which eligible adolescent boys and girls were recruited. This data article describes two datasets that, for the first time, expansively describe adolescents' sexual and reproductive behaviors in Nigeria. The datasets include variables on adolescents' demographic and socioeconomic characteristics; family relationships; sexual behaviors; awareness and use of contraceptives; access to sexual and reproductive health information and services; gender norms and ideology about adolescent sexuality; and potential strategies for reducing unwanted teenage pregnancies and unsafe abortions. This dataset would be useful to public health researchers and social scientists investigating drivers of adolescent sexual and reproductive behaviour, as well as programme managers seeking potential strategies for improving adolescent health outcomes. The datasets also provide a template that could be replicated for national or regional surveys on adolescent sexual and reproductive behaviours.


Assuntos
Saúde Reprodutiva , Saúde Sexual , Adolescente , Anticoncepcionais , Família , Humanos , Governo Local , Nigéria , População Rural , Comportamento Sexual , População Urbana
13.
JAMA Netw Open ; 3(12): e2027928, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33346844

RESUMO

Importance: Menstrual cycle dysfunction is associated with insulin resistance, a key feature early in the pathogenesis of type 2 diabetes. However, the evidence linking irregular and long menstrual cycles with type 2 diabetes is scarce and inconsistent. Objectives: To evaluate the associations between menstrual cycle characteristics at different points throughout a woman's reproductive life span and risk of type 2 diabetes and the extent to which this association is modified by lifestyle factors. Design, Setting, and Participants: This prospective cohort study included 75 546 premenopausal US female nurses participating in the Nurses' Health Study II from 1993 to June 30, 2017. Data analysis was performed from February 1 to December 30, 2019. Exposures: Self-reported usual length and regularity of menstrual cycles at the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years. Main Outcomes and Measures: Incident type 2 diabetes identified through self-report and confirmed by validated supplemental questionnaires. Results: Among the 75 546 women in the study at baseline, the mean (SD) age was 37.9 (4.6) years (range, 29.0-46.0 years). A total of 5608 participants (7.4%) had documented new cases of type 2 diabetes during 1 639 485 person-years of follow-up. After adjustment for potential confounders, women reporting always having irregular menstrual cycles between the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years were, respectively, 32% (95% CI, 22%-44%), 41% (95% CI, 23%-62%), and 66% (95% CI, 49%-84%) more likely to develop type 2 diabetes than women reporting very regular cycles (within 3-4 days of expected period) in the same age range. Similarly, women reporting a usual cycle length of 40 days or more between the age ranges of 18 to 22 years and 29 to 46 years were, respectively, 37% (95% CI, 19%-57%) and 50% (95% CI, 36%-65%) more likely to develop type 2 diabetes during follow-up compared with women reporting a usual cycle length of 26 to 31 days in the same age ranges. These associations appeared to be stronger among women with overweight or obesity, a low-quality diet, and low levels of physical activity. The relative excess risk of type 2 diabetes due to the interaction between irregular and long menstrual cycles and the overall unhealthy lifestyle score was 0.73 (95% CI, 0.57-0.89) and 0.68 (95% CI, 0.54-0.83), respectively. Conclusions and Relevance: In this cohort study of US female nurses participating in the Nurses' Health Study II, irregular and long menstrual cycles throughout life were associated with a greater risk of type 2 diabetes, particularly among women with overweight or obesity, a low-quality diet, and low levels of physical activity.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Ciclo Menstrual , Distúrbios Menstruais/complicações , Adolescente , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Dieta/efeitos adversos , Feminino , Humanos , Incidência , Estilo de Vida , Distúrbios Menstruais/epidemiologia , Distúrbios Menstruais/fisiopatologia , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Obesidade/complicações , Obesidade/fisiopatologia , Sobrepeso/complicações , Sobrepeso/fisiopatologia , Estudos Prospectivos , Saúde Reprodutiva , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
14.
PLoS One ; 15(12): e0242046, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347460

RESUMO

INTRODUCTION: Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. DATA AND METHODS: We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Refugiados/psicologia , Serviços de Saúde Reprodutiva/organização & administração , Saúde da Mulher , Adolescente , Adulto , Criança , República Democrática do Congo , Feminino , Humanos , Pessoa de Meia-Idade , Saúde Reprodutiva , Saúde Sexual , Adulto Jovem
15.
Zhonghua Nan Ke Xue ; 26(3): 195-199, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33346955

RESUMO

In December 2019, the novel coronavirus pneumonia broke out in Wuhan, Hubei, and then spread across China and the world, which posed a threat to public health and safety.The symptoms caused by the novel coronavirus (SARS-CoV-2) mainly involve the respiratory system, but no literature has been reported whether it can induce pathological changes in the male reproductive system. According to the fact that SARS-CoV-2 can infect the cells expressing angiotensin-converting enzyme 2 (ACE2), which can be distributed in the corpus cavernosum, testis and other male reproductive organs and may also participate in erectile function, spermatogenesis, sperm motility and androgen metabolism through the ACE2-Ang-(1-7)-Mas axis in the renin-angiotensin system(RAS), it can be deduced that SARS-CoV-2 may affect these physiological processes of male reproduction.


Assuntos
/fisiopatologia , Saúde Reprodutiva , Humanos , Masculino , Sistema Renina-Angiotensina , Motilidade Espermática
16.
BMC Public Health ; 20(1): 1771, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33228642

RESUMO

BACKGROUND: Guaranteeing the sexual and reproductive health and rights (SRHR) of populations living in fragile and humanitarian settings is essential and constitutes a basic human right. Compounded by the inherent vulnerabilities of women in crises, substantial complications are directly associated with increased risks of poor SRHR outcomes for displaced populations. The migration of Venezuelans, displaced due to current economic circumstances, is one of the largest in Latin America's history. This study aims to provide an overview of the sexual and reproductive health (SRH) issues affecting migrant Venezuelan women in the state of Roraima, Brazil. METHODS: Face-to-face interviews were conducted from 24 to 30 November 2019. Data collection covered various issues involving access to and use of SRH services by 405 migrant Venezuelan women aged 18-49 years. The Minimum Initial Service Package readiness assessment tools, available from the Inter-Agency Working Group on Reproductive Health in Crises, were used in the data collection. RESULTS: Most commonly, the women reported unmet family planning needs. Of these, a significant proportion reported being unable to obtain contraceptive methods, particularly long-acting reversible contraceptives, either due to the woman's inability to access them or their unavailability at healthcare centres. Although a significant proportion of women were largely satisfied with the attention received at the maternity hospital, both before and during childbirth, 24.0% of pregnant or postpartum women failed to receive any prenatal or postnatal care. CONCLUSION: Meeting the essential SRHR needs of migrant Venezuelan women in Roraima, Brazil is a challenge that has yet to be fully addressed. Given the size of this migrant population, the Brazilian healthcare system has failed to adapt sufficiently to meet their needs; however, problems with healthcare provision are similar for migrants and Brazilian citizens. Efforts need to be encouraged not only in governmental health sectors, but also with academic, non-governmental and international organisations, including a coordinated approach to ensure a comprehensive SRHR response. Given the current high risks associated with the SARS-CoV-2 pandemic, meeting the SRHR needs of migrant populations has become more critical than ever.


Assuntos
Saúde Materna/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Brasil , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Gravidez , Saúde Reprodutiva , Direitos Sexuais e Reprodutivos , Saúde Sexual , Venezuela/etnologia
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(9): 578-585, nov. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-197339

RESUMO

INTRODUCTION: Diabetes is a worldwide problem with a greater impact in developing countries, where many people are unaware of their risk. In Mexico, women show the greatest risk for T2D. Current risk scores have been developed and validated in predominantly older European cohorts. They are not the best option in Mexican women. The development of a risk model/score in this population would be useful. OBJECTIVE: To develop and validate a risk model and score that incorporates the most relevant risk factors for T2D in Mexican women of reproductive age. METHODS: The study was carried out in two phases, with the first phase being the development of the predictive model and the second phase the validation of the model in a separate independent population. A cohort of Mexican patients of reproductive age ("Derivation Cohort") was used to create the predictive model. It included data on 3161 women. Risk factors for identification were assessed using Cox proportional hazards regression. Finally a score with a range of 0 to 19 points was developed to identify the 2.4 year probability of developing DM2 in Mexican women of reproductive age. RESULTS: 147 new cases of T2D (4.6%) were identified in the Derivation Cohort model, 97 of 925 participants (10.48%) in the validation cohort. The risk factor predictors of T2D were: history of gestational diabetes (HR 2.69, 95% CI 1.10-6.58), BMI (HR 1.03, 95% CI 1.01-1.06), hypertriglyceridemia (HR 1.54, 95% CI 1.11-2.14) and fasting blood glucose (HR 1.06, 95% CI 1.05-1.08), with an AUC of 0.75. The AUC in the validation cohort was 0.91 (95% CI 0.87-0.94). The score had a sensitivity of 73% and specificity of 67% at a cutoff of ≥15. CONCLUSIONS: A predictive model and risk score was developed to detect cases at risk for incident T2D. It was generated using the characteristics of Mexican women of reproductive age. This risk score is a step forward in attempting to address the generational legacy that diabetes in pregnancy could have on women and their children


INTRODUCCIÓN: La diabetes es un problema mundial con mayor impacto en los países en desarrollo, donde muchas personas desconocen su riesgo. En México las mujeres muestran un mayor riesgo de diabetes tipo 2 (DT2). Las escalas de riesgo actuales se han desarrollado y validado principalmente en cohortes europeas de edad avanzada y no representan la mejor opción para las mujeres mexicanas. El desarrollo de un modelo/puntaje de riesgo en esta población sería útil. OBJETIVO: Desarrollar y validar un modelo y escala de riesgo que incorpore los factores de riesgo de la DT2 más relevantes en las mujeres mexicanas en edad reproductiva. MÉTODOS: El estudio se realizó en 2 fases, en la primera se desarrolló el modelo predictivo en una cohorte de 3.161 mujeres mexicanas en edad reproductiva (cohorte de derivación) y en la segunda se validó en una población independiente. Se utilizó una regresión de riesgos proporcionales de Cox. Finalmente se desarrolló una escala de riesgo de 0 a 19, para identificar la probabilidad de desarrollar DT2 en 2,4 años en las mujeres mexicanas en edad reproductiva. El punto de corte fue ≥15, con una sensibilidad del 73% y una especificidad del 67%. RESULTADOS: Se identificaron 147 (4,6%) casos nuevos de DT2 en la cohorte de derivación del modelo y 97 de 925 (10,48%) en la cohorte de validación. Los factores de riesgo predictivos de DT2 fueron: historia de diabetes gestacional (HR: 2,69; IC 95%: 1,10-6,58), IMC (HR: 1,03; IC 95%: 1,01-1,06), hipertrigliceridemia (HR: 1,54; IC 95%: 1,11-2,14) y glucosa de ayuno (HR: 1,06; IC 95%: 1,05-1,08), con AUC de 0,75 y 0,91 (IC 95%: 0,87-0,95) en la cohorte de validación. CONCLUSIONES: Se desarrolló un modelo y score de riesgo para detectar casos en riesgo de diabetes incidente. Esta herramienta fue generada empleando las características de las mujeres mexicanas en edad reproductiva. El score de riesgo es un paso adelante al tratar de abordar el legado generacional que la diabetes en el embarazo podría tener sobre las mujeres y sus hijos


Assuntos
Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/diagnóstico , México/epidemiologia , Saúde Reprodutiva , Fatores de Risco , Valor Preditivo dos Testes , Modelos Lineares , Sensibilidade e Especificidade , Hipertrigliceridemia/diagnóstico , Inquéritos e Questionários
19.
Afr J AIDS Res ; 19(3): 231-241, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33119456

RESUMO

Research on adolescent sexuality, health and parenting has gained much attention in recent years. This growing body of research, however, has arguably limited qualitative outputs on HIV-positive adolescent mothers' sexual and reproductive health choices, needs, and rights in South Africa that could lead to informed policymaking. Through in-depth interviews conducted with a select group of ten HIV-positive adolescents and three key informants, the article explores the sexual, motherhood, risk discourses and reproductive health issues and rights of HIV-positive adolescent mothers as they come to terms with choices they have made and the challenges ahead. The findings highlight the dominant narratives on what are deemed to be the forces that shape these adolescent mothers' new social realities. With existing policies in place for adolescents, it is argued that a "one-size-fits-all" policy approach does not work, especially for HIV-positive adolescent mothers. Drawing on this identified gap and the tensions between individual needs, and the public welfare provision, the article highlights the need for tailored policy that will accommodate and promote the overall well-being of HIV-positive adolescent mothers and their children.


Assuntos
Infecções por HIV/psicologia , Mentores , Mães/psicologia , Grupo Associado , Adolescente/legislação & jurisprudência , Feminino , Infecções por HIV/epidemiologia , Humanos , Mentores/legislação & jurisprudência , Mães/legislação & jurisprudência , Narração , Formulação de Políticas , Saúde Reprodutiva , Comportamento Sexual , África do Sul/epidemiologia
20.
PLoS One ; 15(10): e0230849, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031399

RESUMO

INTRODUCTION: In South Africa, in 2013-2014, provision of antiretroviral treatment (ART) shifted in some areas from NGOs to public facilities. Tuberculosis (TB) management has also been integrated into public services. We aimed to explore the opinions and experiences of service managers and healthcare providers regarding integration of HIV and TB services into primary healthcare services. METHODS: The study sites included three clinics in one peri-urban/urban administrative region of Johannesburg. From March 2015 to August 2016, trained interviewers conducted semi-structured interviews with purposively selected participants. Participants were eligible if they were city/regional managers, clinic managers, or healthcare providers responsible for HIV, TB, non-communicable diseases, or sexual and reproductive health at the three study sites. We used a grounded theory approach for iterative, qualitative analysis, and produced descriptive statistics for quantitative data. RESULTS: We interviewed 19 individuals (nine city/regional managers, three clinic managers, and seven nurses). Theoretical definitions of integration varied, as did actual practice. Integration of HIV treatment had been anticipated, but only occurred when required due to shifts in funding for ART. The change was rapid, and some clinics felt unprepared. That said, nearly all respondents were in favor of integrated care. Perceived benefits included comprehensive case management, better client-nurse interactions, and reduced stigma. Barriers to integration included staff shortages, insufficient training and experience, and outdated clinic infrastructure. There were also concerns about the impact of integration on staff workloads and waiting times. Finally, there were concerns about TB integration due to infection control issues. DISCUSSION: Integration is multi-faceted and often contingent on local, if not site-specific, factors. In the future in South Africa and in other settings contending with health service reorganization, staff consultations prior to and throughout phase-in of services changes could contribute to improved understanding of operational requirements, including staff needs, and improved patient outcomes.


Assuntos
Antivirais/uso terapêutico , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Tuberculose/tratamento farmacológico , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto , Masculino , Médicos de Atenção Primária , Atenção Primária à Saúde , Pesquisa Qualitativa , Saúde Reprodutiva , África do Sul
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA