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1.
Matern Child Health J ; 27(3): 527-537, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36701099

RESUMO

OBJECTIVE: To explore the predictors of emergency department attendance and admission for mothers and their infants. METHODS: Self-reported emergency department (ED) attendance and admission, sociodemographic, mental health, and other measures were recorded at baseline and at 12 months at 4 sites in England between May 2017 and March 2020. RESULTS: Infants' gestational age (OR 0.73, 95% CI 0.61 to 0.88, p = 0.001), mothers' mental health (OR 2.40, 95% CI 1.30 to 4.41, p = 0.005) and mothers' attendance at ED (OR 2.34, 95% CI 1.13 to 4.84, p = 0.022) predicted infant ED attendance. Frequency of attendance was predicted by ED site (IRR 0.46, 95% CI 0.29 to 0.73, p = 0.001) and mothers' age (IRR 0.96, 95% CI 0.92 to 1.00, p = 0.028). Infant hospital admissions were predominantly for respiratory (40%) and other infectious diseases (21%) and were predicted by previous health problems (OR 3.25, 95% CI 1.76 to 6.01, p < 0.001). Mothers' ED attendance was predicted by mixed or multiple ethnic origin (OR 9.62, 95% CI 2.19 to 42.27, p = 0.003), having a male infant (OR 2.08, 95% CI 1.03 to 4.20, p = 0.042), and previous hospitalisation (OR 4.15, 95% CI 1.81 to 9.56, p = 0.001). Hospital admission was largely for reproductive health issues (61%) with frequency predicted by having attended the ED at least once (IRR 3.39, 95% CI 1.66 to 6.93, p = 0.001), and being anxious or depressed (IRR 3.10, 95% CI 1.14 to 8.45, p = 0.027). CONCLUSIONS FOR PRACTICE: Improving the reproductive and mental health of mothers may help to avoid poor maternal and infant health outcomes and reduce emergency service utilisation and hospitalisation.


Assuntos
Hospitalização , Mães , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Idade Materna , Serviço Hospitalar de Emergência
2.
Curr HIV/AIDS Rep ; 19(6): 455-470, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36308580

RESUMO

PURPOSE OF REVIEW: Pregnant people living with HIV (PLWH) are at especially high risk for progression from latent tuberculosis infection (LTBI) to active tuberculosis (TB) disease. Among pregnant PLWH, concurrent TB increases the risk of complications such as preeclampsia, intrauterine fetal-growth restriction, low birth weight, preterm-delivery, perinatal transmission of HIV, and admission to the neonatal intensive care unit. The grave impact of superimposed TB disease on maternal morbidity and mortality among PLWH necessitates clear guidelines for concomitant therapy and an understanding of the pharmacokinetics (PK) and potential drug-drug interactions (DDIs) between antitubercular (anti-TB) agents and antiretroviral therapy (ART) in pregnancy. RECENT FINDINGS: This review discusses the currently available evidence on the use of anti-TB agents in pregnant PLWH on ART. Pharmacokinetic and safety studies of anti-TB agents during pregnancy and postpartum are limited, and available data on second-line and newer anti-TB agents used in pregnancy suggest that several research gaps exist. DDIs between ART and anti-TB agents can decrease plasma concentration of ART, with the potential for perinatal transmission of HIV. Current recommendations for the treatment of LTBI, drug-susceptible TB, and multidrug-resistant TB (MDR-TB) are derived from observational studies and case reports in pregnant PLWH. While the use of isoniazid, rifamycins, and ethambutol in pregnancy and their DDIs with various ARTs are well-characterized, there is limited data on the use of pyrazinamide and several new and second-line antitubercular drugs in pregnant PLWH. Further research into treatment outcomes, PK, and safety data for anti-TB agent use during pregnancy and postpartum is urgently needed.


Assuntos
Infecções por HIV , Tuberculose Resistente a Múltiplos Medicamentos , Gravidez , Feminino , Recém-Nascido , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Pirazinamida/uso terapêutico
3.
J Urban Health ; 99(2): 334-343, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35277814

RESUMO

Pedal cycling is advocated for increasing physical activity and promoting health and wellbeing. However, whilst some countries have achieved zero cyclist deaths on their roads, this is not the case for Great Britain (GB). A retrospective cross-sectional analysis was conducted of STATS19 cyclist crash data, a dataset of all police-reported traffic crashes in GB. Information about crash location, casualty, driver and vehicles involved were included as predictors of casualty severity (fatal or severe vs. slight). Sixteen thousand one hundred seventy pedal cycle crashes were reported during 2018. Severe or fatal cyclist crash injury was associated with increasing age of the cyclist (35-39 years, OR 1.38, 95% CI 1.11 to 1.73; 55-59 years, OR 1.73, 95% CI 1.35 to 2.2; 70 years and over, OR 2.87, 95% CI 2.12 to 3.87), higher road speed limits (50 MPH OR 2.10, 95% CI 1.43 to 3.07; 70 MPH OR 4.12, 95% CI 2.12 to 8.03), the involvement of goods vehicles (OR 2.08, 95% CI 1.30 to 3.33) and the months of May and June (OR 1.34 to 1.36, 95% CI 1.06 to 1.73). Urban planning that includes physical separation of pedal cyclists from other road users, raising awareness around the risks from goods vehicles and reducing road speed should be the urgent focus of interventions to increase the benefits and safety of cycling.


Assuntos
Acidentes de Trânsito , Ciclismo , Adulto , Ciclismo/lesões , Estudos Transversais , Humanos , Estudos Retrospectivos , Reino Unido/epidemiologia
5.
AIDS Behav ; 20(9): 1821-40, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27142057

RESUMO

Young South Africans, especially women, are at high risk of HIV. We evaluated the effects of PREPARE, a multi-component, school-based HIV prevention intervention to delay sexual debut, increase condom use and decrease intimate partner violence (IPV) among young adolescents. We conducted a cluster RCT among Grade eights in 42 high schools. The intervention comprised education sessions, a school health service and a school sexual violence prevention programme. Participants completed questionnaires at baseline, 6 and 12 months. Regression was undertaken to provide ORs or coefficients adjusted for clustering. Of 6244 sampled adolescents, 55.3 % participated. At 12 months there were no differences between intervention and control arms in sexual risk behaviours. Participants in the intervention arm were less likely to report IPV victimisation (35.1 vs. 40.9 %; OR 0.77, 95 % CI 0.61-0.99; t(40) = 2.14) suggesting the intervention shaped intimate partnerships into safer ones, potentially lowering the risk for HIV.


Assuntos
Comportamento do Adolescente , Infecções por HIV/prevenção & controle , Violência por Parceiro Íntimo/prevenção & controle , Assunção de Riscos , Educação Sexual/métodos , Comportamento Sexual/psicologia , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Vítimas de Crime , Feminino , Humanos , Relações Interpessoais , Violência por Parceiro Íntimo/psicologia , Sexo Seguro , Serviços de Saúde Escolar , Instituições Acadêmicas , Delitos Sexuais , Parceiros Sexuais , Inquéritos e Questionários
6.
Cochrane Database Syst Rev ; 11: CD006417, 2016 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-27824221

RESUMO

BACKGROUND: School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs). OBJECTIVES: To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents. SEARCH METHODS: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers. SELECTION CRITERIA: We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland). Sexual and reproductive health educational programmesSix trials evaluated school-based educational interventions.In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; low certainty evidence), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; moderate certainty evidence; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; low certainty evidence). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; moderate certainty evidence). Material or monetary incentive-based programmes to promote school attendanceTwo trials evaluated incentive-based programmes to promote school attendance.In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; low certainty evidence). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; very low certainty evidence). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; very low certainty evidence). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; low certainty evidence). Combined educational and incentive-based programmesThe single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants; low certainty evidence), predominantly in young women, but no effect was detected for HIV or pregnancy (low certainty evidence). AUTHORS' CONCLUSIONS: There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.


Assuntos
Anticoncepção , Infecções por HIV/prevenção & controle , Herpes Genital/prevenção & controle , Gravidez na Adolescência , Serviços de Saúde Escolar , Sífilis/prevenção & controle , Adolescente , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Herpes Genital/epidemiologia , Herpes Genital/transmissão , Herpesvirus Humano 2 , Humanos , Masculino , Gravidez , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Recompensa , Educação Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Sífilis/epidemiologia
7.
Inj Prev ; 22(1): 3-18, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26635210

RESUMO

BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.


Assuntos
Efeitos Psicossociais da Doença , Saúde Global , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Criança , Pré-Escolar , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade , Adulto Jovem
8.
BMC Public Health ; 15: 608, 2015 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-26141155

RESUMO

BACKGROUND: Adolescents need access to effective sexual and reproductive health (SRH) interventions, but face barriers accessing them through traditional health systems. School-based approaches might provide accessible, complementary strategies. We investigated whether a 21-session after-school SRH education programme and school health service attracted adolescents most at risk for adverse SRH outcomes and explored motivators for and barriers to attendance. METHODS: Grade 8 adolescents (average age 13 years) from 20 schools in the intervention arm of an HIV prevention cluster randomised controlled trial in the Western Cape Province of South Africa, were invited to participate in an after-school SRH program and to attend school health services. Using a longitudinal design, we surveyed participants at baseline, measured their attendance at weekly after-school sessions for 6 months and surveyed them post-intervention. We examined factors associated with attendance using bivariate and multiple logistic and Poisson regression analyses, and through thematic analysis of qualitative data. RESULTS: The intervention was fully implemented in 18 schools with 1576 trial participants. The mean attendance of the 21-session SRH programme was 8.8 sessions (S.D. 7.5) among girls and 6.9 (S.D. 7.2) among boys. School health services were visited by 17.3 % (14.9 % of boys and 18.7 % of girls). Adolescents who had their sexual debut before baseline had a lower rate of session attendance compared with those who had not (6.3 vs 8.5, p < .001). Those who had been victims of sexual violence or intimate partner violence (IPV), and who had perpetrated IPV also had lower rates of attendance. Participants were motivated by a wish to receive new knowledge, life coaching and positive attitudes towards the intervention. The unavailability of safe transport and domestic responsibilities were the most common barriers to attendance. Only two participants cited negative attitudes about the intervention as the reason they did not attend. CONCLUSIONS: Reducing structural barriers to attendance, after-school interventions are likely to reach adolescents with proven-effective SRH interventions. However, special attention is required to reach vulnerable adolescents, through offering different delivery modalities, improving the school climate, and providing support for adolescents with mental health problems and neurodevelopmental academic problems. TRIAL REGISTRATION: Current Controlled Trials ISRCTN56270821 ; Registered 13 February 2013.


Assuntos
Promoção da Saúde/organização & administração , Área Carente de Assistência Médica , Serviços de Saúde Reprodutiva/organização & administração , Serviços de Saúde Escolar/organização & administração , Educação Sexual/organização & administração , Adolescente , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Motivação , Delitos Sexuais , África do Sul
9.
bioRxiv ; 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38895353

RESUMO

Intra-genomic conflict driven by selfish chromosomes is a powerful force that shapes the evolution of genomes and species. In the male germline, many selfish chromosomes bias transmission in their own favor by eliminating spermatids bearing the competing homologous chromosomes. However, the mechanisms of targeted gamete elimination remain mysterious. Here, we show that Overdrive (Ovd), a gene required for both segregation distortion and male sterility in Drosophila pseudoobscura hybrids, is broadly conserved in Dipteran insects but dispensable for viability and fertility. In D. melanogaster, Ovd is required for targeted Responder spermatid elimination after the histone-to-protamine transition in the classical Segregation Distorter system. We propose that Ovd functions as a general spermatid quality checkpoint that is hijacked by independent selfish chromosomes to eliminate competing gametes.

10.
J Child Adolesc Ment Health ; 25(1): 35-42, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-25860305

RESUMO

OBJECTIVE: To evaluate the effects of a high school peer educator training programme on the sexual behaviour and related psychosocial outcomes of peer educators. METHOD: A total of 728 students from 15 randomly selected public high schools in the Western Cape, South Africa, with a peer education programme and 15 matched comparison schools were recruited, comprising 295 students in the intervention group and 433 students in the comparison arms of the study respectively. Age of sexual debut, use of condom at last sex and psychosocial outcomes such as decision making, goal orientation, critical thinking and self-esteem were measured at baseline and follow-up 18 months later. RESULTS: At follow-up, there were no significant differences in the age of sexual debut, use of condom at last sex, goal orientation, critical thinking and self-esteem scores of the peer educators compared to students in the comparison group. Decision-making scores were significantly higher in the peer educators, compared to students in the comparison group (adjusted difference between means 0.14, 95% CI 0.02 to 0.26). CONCLUSION: Even a highly intensive peer education training programme had limited effects for the peer educators themselves. It is clear that community factors, gendered power relations and poverty need to be addressed to have a lasting impact.

11.
Am J Obstet Gynecol MFM ; 5(2S): 100731, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36028160

RESUMO

Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide, with uterine atony estimated to account for 70% to 80% of cases, thereby remaining the single most common cause. Pharmacotherapy remains the first-line preventative therapy for postpartum hemorrhage. These therapies may be single (oxytocin, carbetocin, methylergonovine, ergometrine, misoprostol, prostaglandin analogs, or tranexamic acid) or combination therapies, acting in an additive, infra-additive, or synergistic fashion to prevent postpartum hemorrhage. Evidence is strong for the use of oxytocin, the first-line uterotonic agent in the United States for prevention of postpartum hemorrhage. Although carbetocin, a long-acting analog of oxytocin, is not yet available for use in the United States, it is likely the most effective single pharmacologic therapy for prevention of postpartum hemorrhage and need for additional uterotonics. Use of second-line uterotonics such as methylergonovine, misoprostol, and carboprost in combination with oxytocin has an additive or synergistic effect and a greater risk reduction for postpartum hemorrhage prevention compared with oxytocin alone. Therefore, combined therapy rather than oxytocin alone should be advised for preventing postpartum hemorrhage. Tranexamic acid has been found to be both effective and safe for decreasing maternal mortality in women with postpartum hemorrhage, and prophylactic use of tranexamic acid may decrease the need for packed red blood cell transfusions and/or uterotonics. The WOMAN-2 Trial, designed to assess if tranexamic acid prevents postpartum hemorrhage in women with moderate to severe anemia undergoing vaginal delivery, is currently recruiting participants. The additive, infra-additive, or synergistic action of oxytocin in combination with other second-line therapies deserves further study.


Assuntos
Metilergonovina , Misoprostol , Ocitócicos , Hemorragia Pós-Parto , Ácido Tranexâmico , Gravidez , Feminino , Humanos , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/prevenção & controle , Metilergonovina/uso terapêutico , Ácido Tranexâmico/uso terapêutico
12.
Front Reprod Health ; 5: 1119407, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38111839

RESUMO

Background: The relationship between SRH and mental health among men is not well documented, especially in the 10-24 age group. This scoping review aimed to investigate what is known about the association between SRH and mental health among young men (10-24) in LMICs. Methods: Embase, APA PsycInfo, MEDLINE(R) ALL, ASSIA and the Cochrane Library of Database of Systematic Reviews were searched from the year of establishment up to August 2022. The review was reported using the PRISMA-ScR checklist. Results: A total of (n = 2636) studies were identified from the five databases. After the completion of screening, only ten studies (n = 8 cross-sectional, n = 1 mixed methods and n = 1 qualitative) met the eligibility criteria and were included in the review. The findings suggest that there is a reciprocal relationship between mental health and SRH. Sperm concentration and total sperm count were found to be lower in depressed men. Poor mental health was associated with early sexual debut, higher rates of sexual activity and an increased number of sexual partners. Poor mental health was also found among men who had sex with men (MSM). In addition, we found a relationship between sexual abuse, sexual coercion and poor mental health. Conclusion: The findings of this unique study indicate that poor mental health is associated with poor SRH outcomes and vice versa among young men (10-24) living in LMICs. However, further research will be needed to establish the temporal relationship between SRH and mental health outcomes.

13.
J Adolesc Health ; 73(6): 975-982, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37452795

RESUMO

PURPOSE: An overview of reviews was conducted to summarize the evidence and synthesize the results from systematic reviews. METHODS: The Cochrane and Preferred Reporting Items for Overviews of Reviews reporting guidelines were followed and the protocol was registered. Electronic and manual searches were conducted to identify systematic reviews, published between January 1990 and July 2022. Studies with outcomes relating to all areas of adolescent sexual and reproductive health (SRH) (changes in knowledge, attitudes, beliefs, skills, and practices) were considered. The ROBIS (Risk of Bias in Systematic Reviews) tool was used to assess quality. RESULTS: A total 1849 articles were retrieved, and eight reviews met the inclusion criteria. Three of the eight reviews included meta-analyses. All three of these reviews demonstrated a significant improvement in HIV knowledge. One reported improved attitudes toward people living with HIV but none found any statistically significant effect on condom use or other SRH behaviors. The remaining five reviews included reports of positive individual study outcomes related to knowledge and attitudes and provided narrative syntheses with regard to recruitment, training, support, and participation of peers. Five of the eight reviews were judged to have a low risk of bias. DISCUSSION: Our overview demonstrates that peer-based interventions can improve SRH knowledge and attitudes. Evidence of their effectiveness in promoting healthier SRH behaviors is less certain. Any future studies need to investigate which adolescent health outcomes peer-based programs could reasonably be expected to improve using robust methodologies. Additionally, peers need to be meaningfully engaged and acknowledged as experience-based experts.


Assuntos
Infecções por HIV , Saúde Reprodutiva , Humanos , Adolescente , Revisões Sistemáticas como Assunto , Comportamento Sexual , Sexo Seguro , Infecções por HIV/prevenção & controle
14.
Cochrane Database Syst Rev ; (9): CD005014, 2012 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-22972081

RESUMO

BACKGROUND: In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES: We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA: Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS: Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS: Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.


Assuntos
Acidentes Domésticos/prevenção & controle , Equipamentos de Proteção , Segurança , Prevenção de Acidentes/instrumentação , Prevenção de Acidentes/métodos , Acidentes por Quedas/prevenção & controle , Adolescente , Queimaduras/prevenção & controle , Queimaduras por Corrente Elétrica/prevenção & controle , Criança , Pré-Escolar , Afogamento/prevenção & controle , Humanos , Lactente , Recém-Nascido , Intoxicação/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
BMC Int Health Hum Rights ; 12: 3, 2012 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-22490444

RESUMO

BACKGROUND: The National Health Act, No 61, 2003 in South Africa is the first effort made by the government to protect health-related research participants under law. Implemented on March 1, 2012, the law mandates active consent from a parent or legal guardian for all research conducted with research participants under the age of 18 years. This paper focuses on the Act's implications for school-based adolescent sexual and reproductive health research. DISCUSSION: Although well intentioned, the added legal protections in the National Health Act may have the unintended consequence of reducing participation rates in school-based adolescent sexual and reproductive health research, thereby excluding the most at-risk students. The Act may also compromise adolescents' right to dignity and privacy, especially considering the personal nature of research on sex and sexuality. Devolved, discretionary decision-making, which empowers local human research ethics committees to permit a wider range of protective measures, including passive consent, independent adolescent consent or community consultation ought to be considered. The continued and direct involvement of young people in their sexual and reproductive health and well-being is an important principle to uphold. SUMMARY: This paper calls for a re-examination of section 71's ethical guidelines relating to informed consent in the National Health Act, No 61, 2003 in South Africa in order to better serve the interests of South African adolescents in sexual and reproductive health research.

16.
Expert Rev Anti Infect Ther ; 20(6): 837-848, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35196941

RESUMO

INTRODUCTION: The rate of spontaneous preterm-birth among pregnant women living with HIV on antiretroviral therapy (ART) is 3- to 4-fold higher when compared to HIV-negative women. The pathophysiology of preterm-birth related to HIV or ART remains unknown, especially as women living with HIV are often excluded from preterm birth studies. AREAS COVERED: This review discusses the currently available evidence on the prediction and prevention of preterm-birth in pregnant women living with HIV. A review of the literature was conducted of primary articles between 2005 and 2021 measuring the association or lack thereof between combination ART and preterm birth, as well as of other predisposing factors to preterm birth in women living with HIV, including cervical length, vaginal microbiome, and cervico-vaginal biomarkers. EXPERT OPINION: Further research into the effect of ART exposure on preterm-birth risk is critical, and development of preterm-birth predictive tools in this population should be a priority. Vaginal progesterone supplementation deserves further investigation as a therapeutic option to prevent recurrent preterm birth in pregnant women living with HIV. The ProSPAR study, a multicenter randomized controlled trial studying progesterone supplementation in pregnant women on protease inhibitor-based regimens, has been designed but is not yet recruiting patients.


Assuntos
Infecções por HIV , Nascimento Prematuro , Terapia Antirretroviral de Alta Atividade , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Recém-Nascido , Estudos Multicêntricos como Assunto , Gravidez , Gestantes , Nascimento Prematuro/tratamento farmacológico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Progesterona/uso terapêutico
17.
PLoS One ; 17(9): e0266758, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36129932

RESUMO

BACKGROUND: To understand the impact of COVID-19 on implementation of the peer education programme of the National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK); repurposing of the RKSK health workers and Peer Educators (PEs) in COVID-19 response activities and effect on adolescents´ health and development issues. METHODS: Virtual in-depth interviews were conducted with stakeholders (n = 31) (aged 15 to 54 years) engaged in the implementation of the RKSK and peer education programme at state, district, block, and village levels in Madhya Pradesh and Maharashtra (India). These interviews were thematically coded and analysed to address the research objectives. RESULTS: Despite most peer education programme activities being stopped, delayed, or disrupted during the pandemic and subsequent lockdown, some communication networks previously established, helped facilitate public health communication regarding COVID-19 and RKSK, between health workers, PEs, and adolescents. There was repurposing of RKSK health workers and PEs' role towards COVID-19 response-related activities. PEs, with support from health workers, were involved in disseminating COVID-19 information, maintaining migrant and quarantine records, conducting household surveys for recording COVID-19 active cases and providing essential items (grocery, sanitary napkins, etc.) to communities and adolescents. CONCLUSION: PEs with support from community health workers are able to play a crucial role in meeting the needs of the communities during a pandemic. There is a need to further engage, involve and build the skills of PEs to support the health system. PEs can be encouraged by granting more visibility and incorporating their role more formally by paying them within the public health system in India.


Assuntos
COVID-19 , Adolescente , Saúde do Adolescente , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Agentes Comunitários de Saúde , Humanos , Índia/epidemiologia , Pandemias
18.
AIDS Behav ; 15(8): 1605-11, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21809049

RESUMO

Peer education is popular both with governments and with young people. The purpose of this quasi-experimental study was to evaluate the effectiveness of a government-led peer education program on the self-reported sexual health behavior and related psychosocial outcomes of adolescent students in public high schools in the Western Cape of South Africa. Grade 10 students (n = 3934), at 30 public high schools (15 intervention, 15 comparison) were recruited to the study. In the intervention schools, peer educators were recruited and trained to provide information and support to their fellow students. Sexual health behaviors and related psychosocial outcomes of students were measured at baseline and at follow up 18 months later. Comparisons were made between those in the intervention and comparison group schools. We were unable to detect a significant difference in the age of sexual debut, use of condoms at last sex, goal orientation, decision-making or future orientation for students in the intervention group as compared to students in the comparison group. The findings suggest that the peer education program was not effective in reducing the age of sexual debut or condom use. Issues around the implementation of the program suggested that this was sub-optimal. Governments who advocate widespread use of peer education as an approach need to recognise barriers to implementation and ensure ongoing monitoring and evaluation of effectiveness and cost effectiveness.


Assuntos
Educação em Saúde/métodos , Grupo Associado , Saúde Reprodutiva/educação , Educação Sexual/métodos , Comportamento Sexual , Estudantes/psicologia , Adolescente , Comportamento do Adolescente , Preservativos/estatística & dados numéricos , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Instituições Acadêmicas , Fatores Socioeconômicos , África do Sul , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
19.
Health Educ Res ; 26(3): 563-71, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21081483

RESUMO

Characteristics of learners who become peer educators are rarely explored despite the potential relevance to the success of peer education programmes. Fifteen high schools selected to implement peer education HIV prevention programmes in South Africa were recruited. A total of 2339 Grade 10 learners were surveyed and comparisons were made between socio-demographic characteristics, key skills, school experience and sexual behaviour of those students who had volunteered or been chosen by teachers to be peer educators (n = 295) and their fellow students (n = 2044), the potential recipients of the programme. On most of the socio-demographic variables, school experiences, aspirations, sexual debut and use of condoms at last sex or whether they had been tested for HIV status, there were no significant differences between the two groups. Volunteers and teacher-chosen peer educators tended to be younger than their classmates (16.19 versus 16.52, P < 0.0001), score higher on a goal-orientation scale (3.27 versus 3.15, P =< 0.0001) and had more access to basic resources [electricity (97.9% versus 94.0%, P = 0.006), a bicycle (41.9% versus 32.7%, P = 0.004) or car (50.2% versus 41.0%, P = 0.005)]. Further research is needed to explore specific peer educator characteristics and recruitment and selection approaches that are associated with effective HIV prevention interventions.


Assuntos
Infecções por HIV/prevenção & controle , Educação em Saúde , Grupo Associado , Instituições Acadêmicas , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , África do Sul , Adulto Jovem
20.
Am J Prev Med ; 35(4): 370-379, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18779031

RESUMO

BACKGROUND: Childhood falls are an important global public health problem, but evidence on their prevention has not been quantitatively synthesized. Despite social inequalities in childhood injury rates, there is a lack of evidence examining the effect of fall-prevention practices by social group. METHODS: A systematic review of literature was conducted up to June 2004 and meta-analysis using individual patient data to evaluate the effect of home-safety interventions on fall-prevention practices and fall-injury rates. Meta-regression examined the effect of interventions by child age, gender, and social variables. Included were 21 studies, 13 of which contributed to meta-analyses. RESULTS: Home-safety interventions increased stair-gate use (OR=1.26; 95% CI=1.05, 1.51), and there was some evidence of reduced baby-walker use (OR=0.66; 95% CI=0.43, 1.00), but little evidence of increased possession of window locks, screens, or windows with limited opening (OR=1.16, 95% CI=0.84, 1.59) or of nonslip bath mats or decals (OR=1.15; 95% CI=0.51, 2.62). Two studies reported nonsignificant effects on falls (baby-walker-related falls on flat ground [OR=1.35; 95% CI=0.64, 2.83] or down steps or stairs [OR=0.70; 95% CI=0.14, 3.49]) and medically attended falls (OR=0.78; 95% CI=0.61, 1.00). CONCLUSIONS: Home-safety education and the provision of safety equipment improved some fall-prevention practices, but the impact on fall-injury rates is unclear. There was some evidence that the effect of home-safety interventions varied by social group.


Assuntos
Prevenção de Acidentes/métodos , Acidentes por Quedas/prevenção & controle , Acidentes Domésticos/prevenção & controle , Criança , Pré-Escolar , Humanos , Lactente , Equipamentos de Proteção
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