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Rev. cuba. inform. méd ; 12(2): e354, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144466


Introducción: El desarrollo de la eSalud y el uso de las aplicaciones móviles han contribuido a la transición a un nuevo paradigma en el sector, logrando que tanto las personas como el equipo médico interactúen en otra dimensión. Se sabe que para los adolescentes y los jóvenes el móvil es parte indispensable para su vida y que lo usan más que nadie y seguramente mejor que nadie. Objetivo: Esta investigación se propone construir una aplicación móvil dirigida a adolescentes con información sobre las infecciones de trasmisión sexual y otros elementos clave para mantener la salud sexual y reproductiva. Método: Xebra fue construida sobre Python versión 2.7.8, lenguaje de programación de código abierto. La aplicación estuvo sujeta a varias pruebas de software tales como: funcionamiento de la interfaz de usuario, consistencia de la interfaz, pruebas de acciones del usuario, pruebas de recursos de bajo nivel y pruebas de caja blanca con el objetivo de garantizar la funcionalidad optima del producto. Igualmente los contenidos fueron revisados por expertos en la temática de la salud sexual en adolescente. Resultados: XEBRA contiene cuatro bloques principales para la interacción con los usuarios. Secciones de juegos, información básica, estadísticas y autoevaluación. Conclusiones: Se obtuvo una aplicación para móviles con sistema operativo Android, de distribución gratuita, destinada a promover contenidos relacionados con la salud sexual, que se encuentra a disposición de los adolescentes cubanos(AU)

Introduction: development of eHealth and the use of mobile applications have contributed to the transition to a new paradigm in the sector, making both people and the medical team, interact in another dimension. It is known that for adolescents and young people, the mobile is an essential part of their lives and that they use it more and surely better than anyone. Objective: To build a mobile application aimed at adolescents with information on sexually transmitted infections and other key elements to maintain sexual and reproductive health. Method: Xebra was built on Python version 2.7.8, an open source programming language. The application was subjected to various software tests such as: operation of the user interface, consistency of the interface, tests of user actions, tests of low-level resources and white box tests in order to guarantee the optimal functionality of the product. Likewise, the contents were reviewed by experts on the subject of adolescent sexual health. Results: XEBRA contains four main blocks for interaction with users: Games sections, Basic information, Statistics and Self-evaluation. Conclusions: A free mobile application with Android operating system was obtained, aimed at promoting content related to sexual health, which is available to Cuban adolescents(AU)

Humanos , Masculino , Feminino , Adolescente , Aplicações da Informática Médica , Linguagens de Programação , Doenças Sexualmente Transmissíveis/prevenção & controle , Telemedicina , Saúde Sexual , Aplicativos Móveis
Artigo em Inglês | MEDLINE | ID: mdl-33138073


Intimate partner violence is a recognized public health and development issue that is consistently and comparatively measured through women's experience of physical and/or sexual acts by their partner. While physical intimate partner violence is covered by a wide range of behaviors, sexual intimate partner violence (SIPV) is often only measured through attempted or completed forced sex, ignoring less obvious forms of sexual intimate partner violence. We explored women's conceptualizations of SIPV by conducting in-depth interviews with 18 Tanzanian women. Using a thematic approach, we identified key features of women's sexual intimate relationships and their perceptions of them. The women clearly defined acts of positive sexual relationships that occurred with mutual consent and seduction and SIPV that included acts of forced sex and sex under the threat of violence. They also identified several acts that were crossing the line, whereby a discrepancy of views existed whether they constituted SIPV, such as having sex when out of the mood, sex being the duty of the wife, sex during the menses, requests for anal sex, having sex to not lose the husband, husband refusing sex and husband having other partners. Women in this study felt violated by a far wider range of sexual acts in their relationships. Future studies need to improve the measurement of sexual intimate partner violence to allow the collection of encompassing, yet comparable, data on this harmful phenomenon.

Violência por Parceiro Íntimo , Parceiros Sexuais/psicologia , Adulto , Formação de Conceito , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Comportamento Sexual , Saúde Sexual , Tanzânia
BMC Public Health ; 20(1): 1771, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33228642


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.

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
J Pastoral Care Counsel ; 74(4): 265-268, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33228495


Abortion care requires supporting a patient through the decision to end a pregnancy, the process of having an abortion, and how to care for themselves after the decision is made. This process is nuanced in the best of times and has been exacerbated by the COVID-19 pandemic. This article provides a foundation for clergy and mental health providers on some of the issues that patients will experience accessing abortion care, specifically during the pandemic.

Aborto Induzido/psicologia , Aborto Induzido/reabilitação , Assistência Religiosa/métodos , Feminino , Humanos , Gravidez , Saúde Sexual , Isolamento Social/psicologia
Lancet HIV ; 7(10): e711-e720, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33010243


Despite a large and growing body of literature on sexual and reproductive health (SRH) and HIV integration, the drivers of integration of SRH and HIV services, from a health systems perspective, are not well understood. These drivers include complex so-called hardware (structural and resource) and software (values and norms, and human relations and interactions) factors. Two groups of software factors emerge as essential enablers of effective integration of SRH and HIV services that often interact with systems hardware: (1) leadership, management, and governance processes and (2) provider motivation, agency, and relationships. Evidence suggests the potential for software elements that are essential enablers to overcome some of the obstacles posed by the non-integration of health system hardware elements (eg, financing, guidelines, and commodity supplies). These enabling factors include flexible decision making, inclusive management, and support in motivating frontline staff who can work with agency as a team. Improved software, even within constrained hardware (especially in low-income and middle-income countries), can directly contribute to improved SRH and HIV service delivery.

Prestação Integrada de Cuidados de Saúde , Infecções por HIV/epidemiologia , Serviços de Saúde Reprodutiva , Saúde Sexual , África ao Sul do Saara/epidemiologia , Tomada de Decisões , Análise Fatorial , Pessoal de Saúde , Humanos , Vigilância em Saúde Pública , Responsabilidade Social
Artigo em Inglês | MEDLINE | ID: mdl-33007804


INTRODUCTION: Coronavirus disease (COVID-19), announced as a pandemic by the World Health Organization, recently has dominated people's lifestyle. The impact of COVID-19 seems to be relevant to the sexual health as well. METHODS: This prospective study was conducted on two occasions involving 764 female patients between March and April 2020-before and during the time of social quarantine. The sexual function was assessed using the Polish version of the Female Sexual Function Index (FSFI). Every patient filled out the survey concerning socio-demographic characteristics as well as the influence of SARS-CoV-2 pandemic on their lives. RESULTS: The overall FSFI score before the pandemic was 30.1 ± 4.4 and changed to 25.8 ± 9.7 during it. Scores of every domain: desire, arousal, lubrication, orgasm, satisfaction and pain decreased as well (p < 0.001). There was statistically significant association between the workplace and the change of FSFI scores before and during COVID-19 pandemic (p < 0.01). We noticed the biggest decrease in FSFI score in the group of women who did not work at all (5.2 ± 9.9). Religion had a statistically important impact on level of anxiety (p < 0.01). CONCLUSION: The main finding of our study was the influence of COVID-19 pandemic on the quality of sexual lifestyle and frequency of intercourse among Polish women.

Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Saúde Sexual , Ansiedade , Betacoronavirus , Infecções por Coronavirus/psicologia , Feminino , Humanos , Pandemias , Pneumonia Viral/psicologia , Polônia , Estudos Prospectivos , Local de Trabalho
An. psicol ; 36(3): 512-520, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195668


En las últimas décadas se han llevado a cabo varios estudios que evidencian la relevancia de la actividad sexual para la salud, el bienestar y la calidad de vida de las personas mayores. En este contexto se ubica esta investigación, que tiene por objeto conocer los factores que potencialmente pueden explicar la inactividad sexual en las poblaciones mayores. Además de los factores sociodemográficos, que tradicionalmente se han asociado a la actividad sexual, exploramos el potencial explicativo y la sensibilidad en la estimación de la inactividad sexual en el último año de las percepciones de salud y las actitudes hacia la sexualidad en una muestra de 200 sujetos de entre 62 y 91 años (M=71.30; SD=5.48). Los resultados obtenidos sugieren importantes porcentajes de varianza explica de la inactivad sexual por el modelo de regresión donde se incorporan variables sociodemográficas (R2 = .295). Nuestros resultados apuntan también, a que tanto la percepción y preocupación por la salud sexual como las consideraciones en torno a las relaciones sexuales antes del matrimonio o al sexo sin amor, explicarían la inactividad sexual de las personas mayores. Estos resultados permiten sugerir el potencial de la intervención centrada en los estereotipos y actitudes hacia la sexualidad

Extensive studies carried out in recent decades have noted the relevance of sexual activity to the health, well-being and quality of life of older people. In this context, we propose this research work that aims to know the factors that can potentially explain sexual inactivity in older populations. In addition to the sociodemographic factors that have traditionally been associated with sexual activity, we explored the explanatory potential and the sensitivity in the estimation of sexual inactivity in the last year of health perceptions and attitudes towards sexuality in a sample of 200 subjects between 62 and 91 years old (M = 71.30, SD = 5.48). The results obtained suggest important percentages of variance explained by the regression model where variables such as the existence of a partner, age and place of origin are incorporated (R2 = .295). Our results also point to the fact that, both the perception and concern for sexual health and the considerations regarding sexual relations before marriage or sex without love, would explain the sexual inactivity of the elderly. These results allow us to suggest the potential of the intervention centered on stereotypes and attitudes towards sexuality

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Comportamento Sexual/estatística & dados numéricos , Saúde Sexual/estatística & dados numéricos , Fatores Socioeconômicos , Fatores Sexuais , Estudos Transversais , Inquéritos e Questionários , Assexualidade , Qualidade de Vida
Pan Afr Med J ; 37: 1, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32983319


Introduction: despite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective. Methods: we implemented a descriptive cross-sectional quantitative study sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding. Results: a total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (<19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The "overall satisfaction" rate was more frequent in both groups, being answered by 93.8% of youth and adults (>= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p <0.05). Conclusion: while most users are satisfied with the services there was, however, some sharp criticism. Health professionals' practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.

Serviços de Planejamento Familiar/organização & administração , Gravidez na Adolescência/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Criança , Estudos Transversais , Serviços de Planejamento Familiar/normas , Feminino , Humanos , Masculino , Moçambique , Satisfação do Paciente/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Atenção Primária à Saúde/normas , Saúde Sexual , Inquéritos e Questionários , Adulto Jovem
Aust N Z J Public Health ; 44(5): 363-368, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32865864


OBJECTIVES: Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men (MSM) in Melbourne, Australia. METHODS: We conducted a retrospective, cross-sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare-eligible and Medicare-ineligible MSM. RESULTS: We included 5,085 Medicare-eligible and 2,786 Medicare-ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare-eligible compared to Medicare-ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare-eligible and Medicare-ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare-ineligible MSM were more likely to have anorectal chlamydia compared to Medicare-eligible MSM (10.6% vs. 8.5%; p=0.004). CONCLUSIONS: Medicare-ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high-risk behaviour. Implications for public health: Scaling up access to HIV and STI testings for Medicare-ineligible MSM is essential.

Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Homossexualidade Masculina/psicologia , Programas de Rastreamento/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Estudos Transversais , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas Nacionais de Saúde , Estudos Retrospectivos , Saúde Sexual
BMC Womens Health ; 20(1): 160, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738885


BACKGROUND: This study offers voice to young adolescent women with cerebral palsy (CP) in Bangladesh as they describe their menstrual experiences and needs, and their mothers providing menstrual support. METHOD: Semi-structured focus groups with adolescents with CP, and separately their mother. Data was analysed using a material discursive framework and drawing on feminist disability theory. Participants were recruited from the Bangladesh CP Register (BCPR); a population-based surveillance of children and adolescents with CP in rural Bangladesh. RESULTS: Participants were 45 women including 12 female adolescents with CP and 33 female caregivers. Participants reported a wide range of experiences and needs; menarche acted as a gateway to menstrual information although for some a discourse of silence prevailed due to exclusion from peer and familial networks. Menstruation was discursively constructed as a sign of 'female maturation' marked by an expectation of 'independence', required for acceptance into socially valued adult roles, and was positioned alongside increased vulnerability to sexual abuse. Young adolescent women with CP were expected to 'quietly endure' the material aspects of menstruation although unmanaged pain and distress were described. Mothers reported an imperative for meeting their adolescent's menstrual needs however this role was discursively positioned as 'painful', 'irritating' and 'shameful', in part due to an absence of affordable, functional menstrual resources. CONCLUSION: The findings of the present study provide motivation for disability services in Bangladesh to account for the menstrual needs of young adolescent women with CP within service delivery through strategies such as providing menstrual education and by embedding value in constructs such as 'interdependence'. Moreover, interventions focused on alleviating menstrual pain among young adolescent women with CP as well as those targeted to alleviate distress among mothers providing menstrual care are required. Finally, policy responses are required to ensure that 'inclusive development' considers the needs of menstruating women with disability.

Paralisia Cerebral/complicações , Conhecimentos, Atitudes e Prática em Saúde , Menstruação/fisiologia , Mães , Apoio Social , Adolescente , Bangladesh , Criança , Feminino , Grupos Focais , Humanos , Menstruação/psicologia , Pesquisa Qualitativa , Saúde Reprodutiva , Saúde Sexual
J Sex Med ; 17(10): 2108-2112, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773345


BACKGROUND: In the last decade, many novel minimally invasive surgical techniques within benign prostatic hyperplasia (BPH) surgery were developed to reduce postoperative complications that often discourage patients from pursuing BPH surgery. AIM: To assess perspective of future and past international BPH surgery patients regarding their postoperative complications, namely erectile and ejaculatory function. METHODS: A survey was distributed randomly to 2 groups of BPH patients: one with 149 patients having undergone surgery in the last 2 years (group A), and the other cohort of 151 men seriously considering BPH surgery in the next year (group B). This survey consisted of 20 questions that assessed patients' motivating factors for undergoing elective BPH surgery and their perspectives regarding the potential postoperative complications attributed to BPH surgery. OUTCOMES: The perspective of future and past international BPH surgical patients towards the preservation of their erectile and ejaculatory functions was assessed with the help of a survey. RESULTS: Results indicated that in general BPH surgery patients considered the maintenance of erectile (95%, n = 284) and ejaculatory function (92%, n = 276) to be important preoperative considerations, regardless of their age. Patients aged 50-59 years were most concerned with the permanent impact on sexual function and patients aged >60 years were most concerned with urinary incontinence. In patients aged >70 years, 66% (n = 43) and 62% (n = 40) of the respondents indicated that maintaining erectile and ejaculatory function was important, respectively. CLINICAL IMPLICATIONS: Patient-centered care needs to be implemented in order to address the importance that past and future BPH surgery patients hold toward the maintenance of their postoperative sexual function. STRENGTHS & LIMITATIONS: In the group of patients having previously undergone BPH surgery, the possibility of recall bias should be taken into account when interpreting the study's findings. However, maintaining sexual function was also important for the group of patients seriously considering surgery in the next year suggesting that these considerations are not solely due to recall bias. Additionally, the results were limited by the small sample size of participants in groups A (n = 149) and B (n = 151). CONCLUSION: It was found that past and future BPH surgery patients attribute a significant importance toward the maintenance of their sexual function. Although novel approaches with better sexual outcomes such as Rezum and UroLift for prostates <80 mL, and Aquablation for any size prostate are available, more research is needed to investigate their long-term effects on sexual function before they can be recommended to patients. Bouhadana D, Nguyen D-D, Zorn KC, et al. Patient Perspectives on Benign Prostatic Hyperplasia Surgery: A Focus on Sexual Health. J Sex Med 2020;17:2108-2112.

Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Saúde Sexual , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Hiperplasia Prostática/cirurgia , Resultado do Tratamento
Cochrane Database Syst Rev ; 8: CD013680, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32779730


BACKGROUND: The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low- and middle-income countries. Targeted client communication (TCC) delivered via mobile devices (MD) (TCCMD) may improve the health behaviours and service use important for sexual and reproductive health. OBJECTIVES: To assess the effects of TCC via MD on adolescents' knowledge, and on adolescents' and adults' sexual and reproductive health behaviour, health service use, and health and well-being. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials of TCC via MD to improve sexual and reproductive health behaviour, health service use, and health and well-being. Eligible comparators were standard care or no intervention, non-digital TCC, and digital non-targeted communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. We have presented results separately for adult and adolescent populations, and for each comparison. MAIN RESULTS: We included 40 trials (27 among adult populations and 13 among adolescent populations) with a total of 26,854 participants. All but one of the trials among adolescent populations were conducted in high-income countries. Trials among adult populations were conducted in a range of high- to low-income countries. Among adolescents, nine interventions were delivered solely through text messages; four interventions tested text messages in combination with another communication channel, such as emails, multimedia messaging, or voice calls; and one intervention used voice calls alone. Among adults, 20 interventions were delivered through text messages; two through a combination of text messages and voice calls; and the rest were delivered through other channels such as voice calls, multimedia messaging, interactive voice response, and instant messaging services. Adolescent populations TCCMD versus standard care TCCMD may increase sexual health knowledge (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.23 to 1.71; low-certainty evidence). TCCMD may modestly increase contraception use (RR 1.19, 95% CI 1.05 to 1.35; low-certainty evidence). The effects on condom use, antiretroviral therapy (ART) adherence, and health service use are uncertain due to very low-certainty evidence. The effects on abortion and STI rates are unknown due to lack of studies. TCCMD versus non-digital TCC (e.g. pamphlets) The effects of TCCMD on behaviour (contraception use, condom use, ART adherence), service use, health and wellbeing (abortion and STI rates) are unknown due to lack of studies for this comparison. TCCMD versus digital non-targeted communication The effects on sexual health knowledge, condom and contraceptive use are uncertain due to very low-certainty evidence. Interventions may increase health service use (attendance for STI/HIV testing, RR 1.61, 95% CI 1.08 to 2.40; low-certainty evidence). The intervention may be beneficial for reducing STI rates (RR 0.61, 95% CI 0.28 to 1.33; low-certainty evidence), but the confidence interval encompasses both benefit and harm. The effects on abortion rates and on ART adherence are unknown due to lack of studies. We are uncertain whether TCCMD results in unintended consequences due to lack of evidence. Adult populations TCCMD versus standard care For health behaviours, TCCMD may modestly increase contraception use at 12 months (RR 1.17, 95% CI 0.92 to 1.48) and may reduce repeat abortion (RR 0.68 95% CI 0.28 to 1.66), though the confidence interval encompasses benefit and harm (low-certainty evidence). The effect on condom use is uncertain. No study measured the impact of this intervention on STI rates. TCCMD may modestly increase ART adherence (RR 1.13, 95% CI 0.97 to 1.32, low-certainty evidence, and standardised mean difference 0.44, 95% CI -0.14 to 1.02, low-certainty evidence). TCCMD may modestly increase health service utilisation (RR 1.17, 95% CI 1.04 to 1.31; low-certainty evidence), but there was substantial heterogeneity (I2 = 85%), with mixed results according to type of service utilisation (i.e. attendance for STI testing; HIV treatment; voluntary male medical circumcision (VMMC); VMMC post-operative visit; post-abortion care). For health and well-being outcomes, there may be little or no effect on CD4 count (mean difference 13.99, 95% CI -8.65 to 36.63; low-certainty evidence) and a slight reduction in virological failure (RR 0.86, 95% CI 0.73 to 1.01; low-certainty evidence). TCCMD versus non-digital TCC No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may modestly increase in service attendance overall (RR: 1.12, 95% CI 0.92-1.35, low certainty evidence), however the confidence interval encompasses benefit and harm. TCCMD versus digital non-targeted communication No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may increase service utilisation overall (RR: 1.71, 95% CI 0.67-4.38, low certainty evidence), however the confidence interval encompasses benefit and harm and there was considerable heterogeneity (I2 = 72%), with mixed results according to type of service utilisation (STI/HIV testing, and VMMC). Few studies reported on unintended consequences. One study reported that a participant withdrew from the intervention as they felt it compromised their undisclosed HIV status. AUTHORS' CONCLUSIONS: TCCMD may improve some outcomes but the evidence is of low certainty. The effect on most outcomes is uncertain/unknown due to very low certainty evidence or lack of evidence. High quality, adequately powered trials and cost effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCC delivered by mobile devices. Given the sensitivity and stigma associated with sexual and reproductive health future studies should measure unintended consequences, such as partner violence or breaches of confidentiality.

Telefone Celular , Comunicação , Saúde Reprodutiva/normas , Saúde Sexual/normas , Aborto Legal/estatística & dados numéricos , Adolescente , Anticoncepção/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Sexualmente Transmissíveis , Envio de Mensagens de Texto , Incerteza , Adulto Jovem
J Med Internet Res ; 22(7): e15378, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32735217


BACKGROUND: The World Health Organization recommends the development of participatory sexuality education. In health promotion, web-based participatory interventions have great potential in view of the internet's popularity among young people. OBJECTIVE: The aim of this review is to describe existing published studies on online participatory intervention methods used to promote the sexual health of adolescents and young adults. METHODS: We conducted a systematic review based on international scientific and grey literature. We used the PubMed search engine and Aurore database for the search. Articles were included if they reported studies on participatory intervention, included the theme of sexual health, were conducted on the internet (website, social media, online gaming system), targeted populations aged between 10 and 24 years, and had design, implementation, and evaluation methods available. We analyzed the intervention content, study implementation, and evaluation methods for all selected articles. RESULTS: A total of 60 articles were included, which described 37 interventions; several articles were published about the same intervention. Process results were published in many articles (n=40), in contrast to effectiveness results (n=23). Many of the 37 interventions were developed on websites (n=20). The second most used medium is online social networks (n=13), with Facebook dominating this group (n=8). Online peer interaction is the most common participatory component promoted by interventions (n=23), followed by interaction with a professional (n=16). Another participatory component is game-type activity (n=10). Videos were broadcast for more than half of the interventions (n=20). In total, 43% (n=16) of the interventions were based on a theoretical model, with many using the Information-Motivation-Behavioral Skills model (n=7). Less than half of the interventions have been evaluated for effectiveness (n=17), while one-third (n=12) reported plans to do so and one-fifth (n=8) did not indicate any plan for effectiveness evaluation. The randomized controlled trial is the most widely used study design (n=16). Among the outcomes (evaluated or planned for evaluation), sexual behaviors are the most evaluated (n=14), followed by condom use (n=11), and sexual health knowledge (n=8). CONCLUSIONS: Participatory online interventions for young people's sexual health have shown their feasibility, practical interest, and attractiveness, but their effectiveness has not yet been sufficiently evaluated. Online peer interaction, the major participatory component, is not sufficiently conceptualized and defined as a determinant of change or theoretical model component. One potential development would be to build a conceptual model integrating online peer interaction and support as a component.

Promoção da Saúde/métodos , Educação Sexual/métodos , Saúde Sexual/normas , Adolescente , Adulto , Feminino , Humanos , Internet , Masculino , Adulto Jovem
Int J Equity Health ; 19(1): 130, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736634


While economic inequalities have been a key focus of attention through the COVID 19 pandemic, gendered relations of power at every level have undermined health rights of women, girls and gender diverse individuals. Sexual and reproductive health rights (SRHR) have always been sites of power contestations within families, societies, cultures, and politics; these struggles are exacerbated by economic, racial, religious, caste, citizenship status, and other social inequities, especially in times of crisis such as these. Policy responses to the COVID pandemic such as lockdown, quarantine, contact tracing and similar measures are premised on the existence of a social contract between the government and the people and among people, with the health sector playing a key role in preventive and curative care.We propose the use of an intersectional lens to explore the impact of the COVID-19 pandemic on the social contract, drawing on our field experiences from different continents particularly as related to SRHR. Along with documenting the ways in which the pandemic hinders access to services, we note that it is essential to interrogate state-society relations in the context of vulnerable and marginalized groups, in order to understand implications for SRHR. Intersectional analysis takes on greater importance now than in non-pandemic times as the state exercises more police or other powers and deploys myriad ways of 'othering'.We conclude that an intersectional analysis should not limit itself to the cumulative disadvantages and injustices posed by the pandemic for specific social groups, but also examine the historical inequalities, structural drivers, and damaged social contract that underlie state-society relationships. At the same time, the pandemic has questioned the status quo and in doing so it has provided opportunities for disruption; for re-imagining a social contract that reaches across sectors, and builds community resilience and solidarities while upholding human rights and gender justice. This must find place in future organizing and advocacy around SRHR.

Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Política , Direitos Sexuais e Reprodutivos , Infecções por Coronavirus/epidemiologia , Feminino , Saúde Global , Acesso aos Serviços de Saúde , Humanos , Pneumonia Viral/epidemiologia , Saúde Reprodutiva , Serviços de Saúde Reprodutiva , Saúde Sexual
Rev. colomb. enferm ; 19(2)ago. 2020.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1121795


Objetivo: recopilar, resumir y analizar la producción científica actual sobre la violencia sexual infantil (VSI) en niños y adolescentes varones en el mundo entre el 2014 y el 2019. Método: se realizó una revisión integrativa de literatura mediante una búsqueda sistemática de estudios publicados entre el 2014 y el 2019 en PubMed, LILACS e IBECS. Resultados: se identificaron 990 referencias, de las cuales se seleccionaron 31 artículos para la revisión. La mayoría se realizaron en EE. UU. (n = 18) y otros países desarrollados; solo cinco provienen de países en desarrollo (Brasil, China, India, Jamaica y Suráfrica). Dieciocho estudios usaron metodologías cuantitativas; quince, de tipo transversal. Dos trabajos abordaron menores de 16 años como su población objetivo. Respecto a los objetivos y hallazgos principales, se identificaron cuatro temas recurrentes: caracterización de la VSI, efectos en salud de la VSI (salud mental, salud sexual, comportamientos de riesgo y violencia), revelación de la VSI y análisis de intervenciones terapéuticas. Entre los hallazgos más sobresalientes se refirió que la divulgación del evento constituye un factor protector en el fortalecimiento de la resiliencia frente al abuso. Conclusiones: la VSI genera un impacto negativo en diferentes dimensiones de la salud de la víctima, que trascienden a lo largo de su vida y se profundizan en la medida en que se prolonga el momento de la revelación de los hechos. Más investigaciones son necesarias, principalmente en regiones y países en vías de desarrollo.

Objective: Collect, summarize, and analyze current scientific publications on Child Sexual Violence (CSV) in male children and adolescents worldwide between 2014 and 2019. Method: An integrative review was conducted using a systematic search of studies published between 2014 and 2019 in PubMed, LILACS, and IBECS. Results: Nine hundred and ninety references were identified, from which thirty-one articles were selected for the review. Most of the studies were conducted in the USA (n=18) and other developed countries; only five were conducted in developing countries (Brazil, China, India, Jamaica, and South Africa). Eighteen studies used quantitative methodologies; fifteen were cross-sectional. In two articles, children under 16 years were chosen as the target population. Regarding the main objectives and findings, four recurrent themes were identified: CSV characteristics, effects of CSV on health (mental health, sexual health, risk behaviors, and violence), CSV disclosure, and analysis of therapeutic interventions. Among the findings, the most outstanding was that the disclosure of the event is a protective factor for strengthening resilience against abuse. Conclusions: CSV has a negative impact on different dimensions of the victim's health that transcends throughout his life, and it deepens as the moment of disclosure is delayed. Further research is needed, especially in regions of developing countries.

Objetivo: coletar, resumir e analisar a produção científica atual sobre violência sexual infantil (VSI) em crianças e adolescentes do sexo masculino no mundo entre 2014 e 2019. Método: foi realizada uma revisão integrativa da literatura por meio de uma busca sistemática de estudos publicados entre 2014 e 2019 no PubMed, LILACS e IBECS. Resultados: foram identificadas 990 referências, das quais 31 artigos foram selecionados para a revisão. A maioria foi conduzida nos Estados Unidos (n = 18) e em outros países desenvolvidos; apenas cinco provém de países em desenvolvimento (Brasil, China, Índia, Jamaica e África do Sul). Dezoito estudos utilizaram metodologias quantitativas; quinze, tipo transversal. Dois estudos abordaram crianças menores de 16 anos como população-alvo. Em relação aos objetivos e principais achados foram identificados quatro temas recorrentes: caracterização da VSI, efeitos da VSI na saúde (saúde mental, saúde sexual, comportamentos de risco e violência), revelação da VSI e análise das intervenções terapêuticas. Entre os achados mais destacados, foi colocado que a divulgação do evento constitui um fator de proteção no fortalecimento da resiliência contra o abuso. Conclusões: a VSI gera impacto negativo em diferentes dimensões da saúde da vítima, que transcendem ao longo de sua vida e se aprofundam à medida que se prolonga o momento da revelação dos fatos. Mais pesquisas são necessárias, principalmente em países e regiões em desenvolvimento

Delitos Sexuais , Violência , Saúde Mental , Menores de Idade , Saúde Sexual