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1.
Cochrane Database Syst Rev ; 8: CD013680, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32779730

RESUMO

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.


Assuntos
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
2.
Int J Equity Health ; 19(1): 111, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32635915

RESUMO

This paper addresses a critical concern in realizing sexual and reproductive health and rights through policies and programs - the relationship between power and accountability. We examine accountability strategies for sexual and reproductive health and rights through the lens of power so that we might better understand and assess their actual working. Power often derives from deep structural inequalities, but also seeps into norms and beliefs, into what we 'know' as truth, and what we believe about the world and about ourselves within it. Power legitimizes hierarchy and authority, and manufactures consent. Its capillary action causes it to spread into every corner and social extremity, but also sets up the possibility of challenge and contestation.Using illustrative examples, we show that in some contexts accountability strategies may confront and transform adverse power relationships. In other contexts, power relations may be more resistant to change, giving rise to contestation, accommodation, negotiation or even subversion of the goals of accountability strategies. This raises an important question about measurement. How is one to assess the achievements of accountability strategies, given the shifting sands on which they are implemented?We argue that power-focused realist evaluations are needed that address four sets of questions about: i) the dimensions and sources of power that an accountability strategy confronts; ii) how power is built into the artefacts of the strategy - its objectives, rules, procedures, financing methods inter alia; iii) what incentives, disincentives and norms for behavior are set up by the interplay of the above; and iv) their consequences for the outcomes of the accountability strategy. We illustrate this approach through examples of performance, social and legal accountability strategies.


Assuntos
Equidade em Saúde/ética , Equidade em Saúde/normas , Saúde Reprodutiva/ética , Saúde Reprodutiva/normas , Saúde Sexual/ética , Saúde Sexual/normas , Responsabilidade Social , Adulto , Feminino , Equidade em Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Reprodutiva/legislação & jurisprudência , Saúde Sexual/legislação & jurisprudência , Adulto Jovem
4.
Sex Reprod Health Matters ; 28(2): 1781583, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32543338

RESUMO

The COVID-19 pandemic is not just a health crisis - it is a full-blown economic and social crisis that is impacting the lives and livelihoods of billions of people. This commentary examines the mutually dependent relationship between health security and universal health coverage (UHC), and how the longstanding underinvestment in both renders us all vulnerable. It also discusses the vulnerability of services for sexual and reproductive health and rights (SRHR) in times of crisis, which is compounded when these services are not included and well integrated into national UHC packages. It concludes with a call for stronger political leadership for UHC and SRHR as the global community strives to "build back better" after COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Nível de Saúde , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde/organização & administração , Betacoronavirus , Acesso aos Serviços de Saúde/normas , Humanos , Pandemias , Política , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Saúde Sexual/normas
5.
Arch Sex Behav ; 49(6): 1863-1873, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32424802

RESUMO

Sexually transmitted infections (STIs) have been explored in various sexual subgroups. While excellent, these analyses have primarily occurred from uniquely biologic, epidemiologic, or sociologic perspectives. Missing from these discussions has been in-depth presentations of the dynamics of STI transmission from all three viewpoints simultaneously. In this paper, I present information about STI transmission for each STI, including considerations of prevalence, and then review the STI research and of the concept of risk. I then apply these three considerations to a fictitious case study to show their importance and utility. I close by arguing that this information could strengthen future sociologic reviews of STIs and sexual health by helping such researchers include more nuanced understandings about STIs.


Assuntos
Saúde Sexual/normas , Doenças Sexualmente Transmissíveis/epidemiologia , Feminino , Humanos , Masculino , Projetos de Pesquisa
6.
BMC Public Health ; 20(1): 791, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460806

RESUMO

BACKGROUND: Statistics from South Africa show the world's highest HIV prevalence with an estimated seven million people living with the virus. Several studies have pointed to communication about sexuality between parents/caregivers and children as a protective factor. However, communication between generations has been described as problematic, especially due to discomfort in discussing sexual matters. The aim of this study was to explore how caregivers in a poor, rural part of South Africa talked about young people in general, their sexuality, and their lifestyle practices. A particular interest was directed towards central discourses in the caregivers' narratives and how these discourses were of importance for the caregivers to function as conversation partners for young people. METHODS: In this qualitative study convenience sampling was used to select and invite participants. Information was collected from nine one-on-one interviews conducted with caregivers from rural areas within South Africa. The interview guide included nine main questions and optional probing questions. Each interview took place in an uninterrupted setting of choice associated with the caregivers' home environment. The interviews were transcribed and analyzed using discourse analysis. RESULTS: Interview narratives were characterized by three central discourses - demoralized youths in a changing society, prevailing risks and modernity and a generation gap. The youths were discursively constructed as a problematic group relating to specific prevailing risks such as early pregnancies, modern technologies, STI/HIV and contraceptives. The interview narratives illustrated that caregivers tried to impose their views of a respectable lifestyle in young people. At the same time caregivers expressed a morality of despair mirroring a generation gap which counteracted their ability to communicate with their children and grandchildren. CONCLUSIONS: The findings add to the body of earlier research illustrating that rural South African caregivers and their children/grandchildren hold different moral standards. The interview material reflected a 'clash' between generations relating to their differing perceptions of a desirable lifestyle. To overcome the generational gap, we recommend further research about how a well-founded national and community collaboration linked to school-based programs can support family participation in order to empower adults in their communication with young people.


Assuntos
Cuidadores/estatística & dados numéricos , Relação entre Gerações , População Rural/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Saúde Sexual/normas , Adolescente , Adulto , Cuidadores/psicologia , Criança , Feminino , Humanos , Estilo de Vida , Masculino , Pais , Pesquisa Qualitativa , Saúde Reprodutiva , Comportamento Sexual/psicologia , Percepção Social , África do Sul/epidemiologia
7.
J Endocrinol Invest ; 43(8): 1153-1157, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32462316

RESUMO

PURPOSE: The recent pandemic of severe acute respiratory syndrome (SARS) due to coronavirus (CoV) 2 (SARS-CoV-2) has raised several concerns in reproductive medicine. The aim of this review is to summarize available evidence providing an official position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) METHODS: A comprehensive Pubmed, Web of Science, Embase, Medline and Cochrane library search was performed. Due to the limited evidence and the lack of studies, it was not possible to formulate recommendations according to the Oxford 2011 Levels of Evidence criteria. RESULTS: Several molecular characteristics of the SARS-CoV-2 can justify the presence of virus within the testis and possible alterations of spermatogenesis and endocrine function. Orchitis has been reported as a possible complication of SARS-CoV infection, but similar findings have not been reported for SARS-CoV-2. Alternatively, the orchitis could be the result of a vasculitis as COVID-19 has been associated with abnormalities in coagulation and the segmental vascularization of the testis could account for an orchitis-like syndrome. Finally, available data do not support the presence of SARS-CoV-2 in plasma seminal fluid of infected subjects. CONCLUSION: Data derived from other SARS-CoV infections suggest that in patients recovered from COVID-19, especially for those in reproductive age, andrological consultation and evaluation of gonadal function including semen analysis should be suggested. Studies in larger cohorts of currently infected subjects are warranted to confirm (or exclude) the presence of risks for male gametes that are destined either for cryopreservation in liquid nitrogen or for assisted reproduction techniques.


Assuntos
Andrologia/normas , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Criopreservação/normas , Preservação da Fertilidade/normas , Pneumonia Viral/epidemiologia , Espermatozoides/fisiologia , Andrologia/tendências , Infecções por Coronavirus/terapia , Criopreservação/tendências , Preservação da Fertilidade/tendências , Humanos , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/terapia , Análise do Sêmen/normas , Análise do Sêmen/tendências , Saúde Sexual/normas , Sociedades Médicas/normas
10.
Int J Gynaecol Obstet ; 149(1): 113-119, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32012258

RESUMO

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings.


Assuntos
Refugiados , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Migrantes , Adolescente , Adulto , Criança , Feminino , Saúde Global , Ginecologia/normas , Humanos , Cooperação Internacional , Obstetrícia/normas , Saúde Sexual/normas , Desenvolvimento Sustentável , Saúde da Mulher
11.
Reprod Health ; 17(1): 1, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915022

RESUMO

INTRODUCTION: Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents. METHODS: This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention-Context-Actors-Mechanism-Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. RESULTS: We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages. CONCLUSION: The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform 'ordinary' community-based health systems into systems that are responsive to adolescents.


Assuntos
Pesquisa Participativa Baseada na Comunidade/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Reprodutiva/organização & administração , Comportamento Sexual/psicologia , Saúde Sexual/normas , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Reprodutiva , População Rural , Adulto Jovem , Zâmbia
12.
Reprod Health ; 17(1): 13, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973748

RESUMO

BACKGROUND: Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls' reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls. METHODS: The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members. DISCUSSION: Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/normas , Serviços de Saúde Reprodutiva/organização & administração , Saúde Reprodutiva/normas , Comportamento Sexual/psicologia , Saúde Sexual/normas , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Criança , Feminino , Humanos , Gravidez , Gravidez não Desejada , Pesquisa Qualitativa , Adulto Jovem
13.
BMJ Sex Reprod Health ; 46(3): 184-191, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31754063

RESUMO

BACKGROUND: The study aimed to examine the impact of household composition and satisfaction with family life on sexual behaviours among high school male and female students (aged 11-22 years) in Hong Kong. METHOD: High schools were randomly selected, and the final sample comprised 25 schools. Students were divided into two groups ('living with both biological parents' vs 'not living with both biological parents'). Students were asked to rate their satisfaction with family life on a five-point Likert scale in a self-administered questionnaire. Dependent variables were sexual experience, sexual harassment, sexting and nude chats. Multiple logistic regression was used to analyse the results. RESULTS: 3907 students were included in the analysis. 202 students (5.2%) were sexually active. 505 students had ever (13.0%) sexually harassed others and 303 students (7.8%) had ever been sexually harassed by others. 58 students (1.5%) had ever had nude chats. 1005 students (25.8%) had sexted in the last 12 months. Students who lived with both biological parents were less like to be sexually active, to sext and to have nude chats than those who did not. Students who had higher family life satisfaction were less likely to be sexually active, to sexually harass others, to be sexually harassed by others, to sext and to have nude chats than students who had lower satisfaction with their family life. CONCLUSIONS: Sexual health programmes and interventions should consider family functioning. Students who have low family satisfaction and those who do not live with both their biological parents should be targeted for sexual health interventions.


Assuntos
Características da Família , Relações Familiares/psicologia , Saúde Sexual/normas , Adolescente , Criança , Feminino , Hong Kong , Humanos , Masculino , Satisfação Pessoal , Autorrelato , Saúde Sexual/estatística & dados numéricos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
14.
J Cancer Surviv ; 14(1): 26-30, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31482477

RESUMO

PURPOSE: Each year, thousands of young breast cancer (BC) patients confront the difficult decision to medically suppress ovarian function and undergo abrupt, premature menopause to reduce risk of cancer recurrence. Unlike natural menopause, young women undergoing ovarian suppression (OS) face severe and disruptive side effects. Profound sexual dysfunction is one of the most prevalent, distressing side effects of OS treatment. Unmanaged sexual dysfunction is also a primary predictor of non-adherence to this potentially life-saving treatment. We developed and tested a brief, psychosexual intervention targeted to manage sexual dysfunction and psychological distress after OS in young BC survivors. METHODS: Twenty young BC survivors with sexual dysfunction received a single 4-h group intervention that included sexual health rehabilitation, body awareness exercises, and mindfulness-based cognitive therapy (MBCT) skills followed by a single tailored booster telephone call 1-month later. Assessment of female sexual function and psychological distress was completed at baseline and 2 months post-intervention. RESULTS: Analyses examined changes pre- to post-intervention. Female sexual health improved significantly from baseline to follow-up (n = 19, p < 0.02). Anxiety was also significantly improved at the 2-month (p < 0.000) timepoint, compared with baseline 1. Moderate-to-large effect sizes were observed regarding changes in sexual function and psychological distress. CONCLUSIONS: Significant improvements in sexual functioning and psychological distress were observed 2 months post-intervention. IMPLICATIONS FOR CANCER SURVIVORS: These results demonstrate that delivery of a targeted intervention in brief, low-intensity group setting is a promising model for reducing distressing sexual dysfunction in young BC survivors on OS treatment.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Ovário/efeitos dos fármacos , Saúde Sexual/normas , Adulto , Neoplasias da Mama/terapia , Feminino , Humanos , Disfunções Sexuais Psicogênicas/psicologia
15.
Arch Sex Behav ; 49(3): 1039-1052, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31243616

RESUMO

International travel is popular worldwide, yet its implications for sexual and reproductive health are not fully understood. Few studies have examined the contextual factors that shape women's sexual and contraceptive behaviors-and thus, their risk of unintended pregnancy and sexually transmitted infections (STIs)-while traveling outside their home country. In this qualitative study, female university students with recent (n = 25) or upcoming (n = 19) travel outside the U.S. completed semi-structured interviews from October 2015 to March 2017. Transcripts were analyzed for themes related to contraceptive and sexual behaviors: (1) participants' pre-travel expectations of sex; (2) the circumstances surrounding sexual encounters with men while traveling; (3) negotiation about condom and contraception use with partners; and (4) factors affecting contraceptive adherence. Participants generally expected to be abstinent during travel, citing myriad rationales that included personal values, no perceived opportunities for sex, and the nature of the trip. Some travelers had unexpected sexual encounters, involving health-protecting behaviors and risk-taking (e.g., unprotected sex, substance use). New sexual partnerships were fueled by increased attention from men, situational disinhibition, and perceived heightened intimacy. International travel brought many contraceptive considerations (adequacy of supplies, access to refrigeration, time zone differences, etc.) as well as obstacles that triggered contraceptive lapses and discontinuation. Pill users described the most challenges, while travelers using intrauterine devices expressed appreciation for their maintenance-free contraception. This study suggests complex associations between international travel and young women's sexual and reproductive health. Some travelers were more vulnerable to situational risk factors, while others may have been more insulated. We identify potential intervention opportunities via clinical services, education, and policy to reduce young women's risk of adverse sexual and reproductive health outcomes while traveling abroad. We urge greater recognition of and conversations about contraceptive lapse and unintended pregnancy as potential health risks for female travelers of reproductive age, just as clinical guidelines acknowledge travel-associated STI.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/métodos , Comportamento Sexual/fisiologia , Saúde Sexual/normas , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pesquisa Qualitativa , Viagem , Adulto Jovem
16.
Support Care Cancer ; 28(2): 599-605, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31104133

RESUMO

OBJECTIVE: To assess the impact of a screening tool, the Brief Sexual Symptom Checklist for Women, on referral rates to physiotherapists, sexual counselors, and psychologists for sexual issues among patients attending the practices of two gynecological oncologists. METHODS: A prospective observational cohort study. A retrospective cohort of consecutive patients matched for age, diagnosis, and stage was used as a control group. RESULTS: Seventy-eight women were recruited to the intervention group. Diagnoses were endometrial carcinoma (38%), ovarian carcinoma (33%), and cervical carcinoma (24%). Sixty percent had completed adjuvant treatment, and 89% were married or in a de facto relationship. More than half of participants reported at least one sexual difficulty and were not satisfied with their sexual function. The most commonly reported sexual issue was decreased sexual desire. Twelve of 77 (15%) women screened in the intervention group were referred to a sexual counselor and/or a physiotherapist for a sexual issue. Twelve percent of women in the intervention group were referred to a sexual counselor, compared with 5% in the control group (p = 0.072). There was no difference in the proportion of women referred to a pelvic floor physiotherapist between the two groups (8% of women in the intervention group vs. 8% in the control group; p = 1.000). CONCLUSIONS: In the current study, the Brief Sexual Symptom Checklist for Women identified sexual health concerns in over half of gynecological cancer survivors and resulted in a non-significant trend to more referrals for sexual counseling.


Assuntos
Neoplasias dos Genitais Femininos/complicações , Saúde Sexual/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Sobreviventes de Câncer , Estudos de Coortes , Detecção Precoce de Câncer , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Acad Med ; 95(1): 77-82, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31348064

RESUMO

PROBLEM: In 2014, medical students at the Florida International University Herbert Wertheim College of Medicine (FIU HWCOM) first drew attention to perceived gaps in the sexual health curriculum. The authors used Kern and colleagues' model for curriculum development to review and update the existing curriculum. APPROACH: To develop longitudinal sexual health curricular objectives for undergraduate medical education (UME), the authors reviewed existing specialty- and organization-specific objectives. Then, an iterative process guided by clear criteria was used to develop feasible objectives, which were refined through stakeholder feedback. As these objectives were being finalized in 2017, UME sexual health competencies were first published; the authors mapped their objectives to these, as possible. The medical school's course activities and assessments were mapped to the authors' sexual health objectives to identify curricular gaps and unplanned redundancies. OUTCOMES: This process resulted in 12 sexual health curricular objectives that are adaptable by other institutions. In mapping the FIU HWCOM curriculum to these objectives, specific gaps and assessment weaknesses emerged. With stakeholder support obtained through a strong curricular management structure, the work of modifying content to address gaps has begun. NEXT STEPS: New assessments specific to these sexual health objectives are needed, especially within the clinical curriculum. Assessment of these objectives may be strengthened through the development of new sexual-health-related entrustable professional activities (EPAs) nested within the broader Core EPAs for Entering Residency being piloted. When data on learning outcomes are available, the process of targeting curricular improvement will begin.


Assuntos
Educação Baseada em Competências/métodos , Currículo/normas , Educação de Graduação em Medicina/métodos , Saúde Sexual/normas , Currículo/tendências , Feminino , Florida/epidemiologia , Humanos , Internato e Residência/métodos , Aprendizagem/fisiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Faculdades de Medicina/organização & administração , Estudantes de Medicina/estatística & dados numéricos
18.
Arch Sex Behav ; 49(1): 217-232, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31691076

RESUMO

The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.


Assuntos
Pesquisa Biomédica/métodos , Bissexualidade/psicologia , Infecções por HIV/prevenção & controle , Comportamento Sexual/psicologia , Saúde Sexual/normas , Minorias Sexuais e de Gênero/psicologia , Adulto , Humanos , Masculino , Prevalência
19.
J Cancer Surviv ; 13(6): 932-942, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31741248

RESUMO

PURPOSE: Breast cancer survivor (BCS)-provider communication about sexual health (SH) is often absent or inadequate. Patients report wanting providers to broach the topic, but providers cite barriers to initiating discussions. While the health care community works to address barriers, it is unrealistic to rely solely on provider initiation of SH conversations. This research investigates willingness to communicate about sexual health (WTCSH) to better understand what may interfere with survivors' ability to self-advocate and receive care for these concerns. METHODS: (N = 305) BCSs completed online surveys. Hierarchical multiple regression determined the relationship between Sexual Quality of Life-Female (SQOL-F), which measures psychological and social dimensions of SH and WTCSH. Interviews were then conducted with forty BCSs. The constant comparative method was used to thematically analyze the transcripts. RESULTS: The mean SQOL score was 53.4 out of 100. No statistically significant differences in SQOL or WTCSH were found by age or survivorship length. The positive relationship between WTCSH and SQOL was significant, F (6,266) = 4.92, p < .000, adj. R2 = .080). Five themes illustrated factors that shape WTCSH: (1) comfort discussing SH; (2) perception of demographic similarity/discordance; (3) patient-centered communication; (4) belief that SH is (un)treatable, and (5) ability to access timely/coordinated care. CONCLUSIONS: Findings establish the significance of SH concerns and provide an in-depth understanding of intrapersonal, interpersonal, and organizational issues informing WTCSH. IMPLICATIONS FOR CANCER SURVIVORS: Age and gender dynamics, perceptions of provider SQOL messaging, and futility influence survivor openness. Addressing these areas may encourage disclosure among women who would otherwise continue to suffer in silence.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Pessoal de Saúde/psicologia , Qualidade de Vida/psicologia , Comportamento Sexual/psicologia , Saúde Sexual/normas , Sobrevivência , Adulto , Idoso , Neoplasias da Mama/mortalidade , Comunicação , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
J Pediatr Rehabil Med ; 12(3): 317-324, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476181

RESUMO

PURPOSE: Assessing provider adherence to preventative sexual and reproductive healthcare guidelines in adolescents and young adults (AYA) patients with physical and intellectual disabilities (PWD). METHODS: Records of PWD (N= 42) age 12-26 receiving health maintenance between 01/01/11-12/31/16 were reviewed for: (1) initiation and completion of human papilloma virus (HPV) vaccination series, (2) initiation and completion of meningococcal vaccination, (3) screening for human immunodeficiency virus (HIV), and documentation of (4) sexual, (5) menstrual, and (6) pregnancy histories. Unaffected age and gender-matched patients provided comparison data (Comparison Cohort, CC). RESULTS: The mean age of both groups was 17.3 years ± 3.8 and 40.5% were female. There was no significant difference between groups regarding the completion of HPV or meningococcal vaccine series. Among those 15+ years of age, 7.1% of PWD and 28.6% of CC were screened for HIV (p= 0.04). Sexual history was documented in 19.0% of PWD versus 73.8% of CC (p< 0.001). Among females, menstrual regularity was recorded in 11.8% of PWD versus 47.1% of CC (p= 0.02) and pregnancy history in 0.0% of PWD versus 29.4% of CC (p= 0.04). CONCLUSIONS: Adherence to sexual health guidelines was suboptimal, and lower among PWD. Vaccination rates did not differ between the two groups.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Serviços de Saúde para Pessoas com Deficiência/normas , Atenção Primária à Saúde/normas , Serviços de Saúde Reprodutiva/normas , Saúde Sexual/normas , Adolescente , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
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