Asunto(s)
Células Escamosas Atípicas del Cuello del Útero/patología , Cuello del Útero/patología , Papillomaviridae/aislamiento & purificación , Trabajadores Sexuales/estadística & datos numéricos , Displasia del Cuello del Útero/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Cuello del Útero/citología , Femenino , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Humanos , México/epidemiología , Prueba de Papanicolaou , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Prevalencia , Trabajo Sexual , Trabajadores Sexuales/psicología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/virologíaRESUMEN
Despite having good intentions, hemodialysis (HD) clinics often fail to sustain exercise programs that they initiate. There are many reasons for this, including a lack of funding, inadequate training of the clinic staff, a lack of exercise professionals to manage the program or train the staff, and the many challenges inherent to exercising a patient population with multiple comorbid diseases. Despite these barriers, there are several outstanding examples of successful exercise programs in HD clinics throughout the world. The aim of this manuscript is to review the characteristics of four successfully sustained HD exercise programs in Portugal, Canada, Mexico, and Germany. We describe the unique approaches they have used to fund and manage their programs, the varied exercise prescriptions they incorporate, the unique challenges they face, and discuss the benefits they have seen. While the programs differ in many regards, a consistent theme is that they each have substantial and committed support from the entire clinic staff, including the nephrologists, administration, nurses, dietitians, and technicians. This suggests that exercise programs in HD clinics can be successfully implemented and sustained provided significant effort is made to foster a culture of physical activity throughout the clinic.
Asunto(s)
Terapia por Ejercicio/organización & administración , Fallo Renal Crónico/terapia , Enfermedades Musculares/rehabilitación , Calidad de Vida , Diálisis Renal/efectos adversos , Anciano , Canadá , Femenino , Alemania , Humanos , Internacionalidad , Fallo Renal Crónico/diagnóstico , Masculino , México , Persona de Mediana Edad , Debilidad Muscular/etiología , Debilidad Muscular/rehabilitación , Enfermedades Musculares/etiología , Portugal , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Diálisis Renal/métodos , Resultado del TratamientoRESUMEN
Increasingly, 'place', including physical and geographical characteristics as well as social meanings, is recognized as an important factor driving individual and community health risks. This is especially true among marginalized populations in low and middle income countries (LMIC), whose environments may also be more difficult to study using traditional methods. In the NIH-funded longitudinal study Mapa de Salud, we employed a novel approach to exploring the risk environment of female sex workers (FSWs) in two Mexico/U.S. border cities, Tijuana and Ciudad Juárez. In this paper we describe the development, implementation, and feasibility of a mix of quantitative and qualitative tools used to capture the HIV risk environments of FSWs in an LMIC setting. The methods were: 1) Participatory mapping; 2) Quantitative interviews; 3) Sex work venue field observation; 4) Time-location-activity diaries; 5) In-depth interviews about daily activity spaces. We found that the mixed-methodology outlined was both feasible to implement and acceptable to participants. These methods can generate geospatial data to assess the role of the environment on drug and sexual risk behaviors among high risk populations. Additionally, the adaptation of existing methods for marginalized populations in resource constrained contexts provides new opportunities for informing public health interventions.