RESUMEN
INTRODUCTION: Violence against children is a health, human rights and social problem affecting approximately half of the world's children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries-Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam-to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers' biological stress markers and subjective well-being. METHODS AND ANALYSES: EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. ETHICS AND DISSEMINATION: The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.
Asunto(s)
Exposición a la Violencia , Violencia de Pareja , Niño , Estudios de Cohortes , Países en Desarrollo , Femenino , Ghana , Humanos , Jamaica , Estudios Longitudinales , Pakistán/epidemiología , Filipinas/epidemiología , Embarazo , Rumanía , Sudáfrica/epidemiología , Sri Lanka/epidemiología , Vietnam , ViolenciaRESUMEN
OBJECTIVE: To evaluate the association of Oregon's hard-stop policy limiting early elective deliveries (before 39 weeks of gestation) and the rate of elective early-term inductions and cesarean deliveries and associated maternal-neonatal outcomes. METHODS: This was a population-based retrospective cohort study of Oregon births between 2008 and 2013 using vital statistics data and multivariable logistic regression models. Our exposure was the Oregon hard-stop policy, defined as the time periods prepolicy (2008-2010) and postpolicy (2012-2013). We included all term or postterm, cephalic, nonanomalous, singleton deliveries (N=181,034 births). Our primary outcomes were induction of labor and cesarean delivery at 37 or 38 weeks of gestation without a documented indication on the birth certificate (ie, elective early term delivery). Secondary outcomes included neonatal intensive care unit admission, stillbirth, macrosomia, chorioamnionitis, and neonatal death. RESULTS: The rate of elective inductions before 39 weeks of gestation declined from 4.0% in the prepolicy period to 2.5% during the postpolicy period (P<.001); a similar decline was observed for elective early-term cesarean deliveries (from 3.4% to 2.1%; P<.001). There was no change in neonatal intensive care unit admission, stillbirth, or assisted ventilation prepolicy and postpolicy, but chorioamnionitis did increase (from 1.2% to 2.2%, P<.001; adjusted odds ratio 1.94, 95% confidence interval 1.80-2.09). CONCLUSIONS: Oregon's statewide policy to limit elective early-term delivery was associated with a reduction in elective early-term deliveries, but no improvement in maternal or neonatal outcomes.
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Cesárea/tendencias , Procedimientos Quirúrgicos Electivos/tendencias , Trabajo de Parto Inducido/tendencias , Adulto , Puntaje de Apgar , Transfusión Sanguínea/estadística & datos numéricos , Cesárea/legislación & jurisprudencia , Cesárea/estadística & datos numéricos , Corioamnionitis/epidemiología , Procedimientos Quirúrgicos Electivos/legislación & jurisprudencia , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Macrosomía Fetal/epidemiología , Edad Gestacional , Humanos , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Trabajo de Parto Inducido/legislación & jurisprudencia , Trabajo de Parto Inducido/estadística & datos numéricos , Oregon/epidemiología , Admisión del Paciente/estadística & datos numéricos , Mortalidad Perinatal , Embarazo , Estudios Retrospectivos , Mortinato/epidemiologíaRESUMEN
BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) "matrix support", c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment.
INTRODUÇÃO: O principal objetivo desse estudo foi revisar a agenda de prioridades em pesquisa em saúde mental no Brasil. MÉTODO: Foram selecionados 28 especialistas (22 pesquisadores, cinco legisladores e o coordenador) de diferentes regiões. Responderam ao que consideravam mais relevante em pesquisa para a saúde mental para os próximos 10 anos. Dezessete responderam e configuraram 110 questões, que foram reavaliadas por eles, com atribuição de escore, a partir de 15 itens distribuídos segundo grau de responsividade, eficácia, aplicabilidade, equidade e impacto na redução da carga da doença mental. 35 questões, e dentre elas as 10 mais bem pontuadas, foram destacadas. RESULTADOS: Prevaleceram indicações para estudos de efetividade das intervenções, matriciamento, comparação entre modelos de intervenção e detecção e tratamento de transtornos mais prevalentes na Estratégia da Saúde da Família. Avaliação de serviços quanto às barreiras ao tratamento; custo-efetividade dos antipsicóticos, intervenções contra efeitos do álcool e outras drogas, e aplicação de tecnologias (telemedicina) para educação e supervisão dos generalistas foram outros. CONCLUSÃO: Apontou-se para necessidade de investimentos na saúde mental na atenção primária à saúde; avaliação do sistema de serviços de cuidados de saúde mental, e pesquisas para romper barreiras ao acesso e à equidade no tratamento dos transtornos mentais.
Asunto(s)
Humanos , Prioridades en Salud , Investigación sobre Servicios de Salud , Salud Mental , Servicios de Salud Mental , Atención Primaria de Salud , Brasil , Trastornos Mentales/terapiaRESUMEN
BACKGROUND: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. METHODS: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and U.N. agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. RESULTS: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. CONCLUSIONS: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between the goals of "relevance" and "excellence." Research needs to be more sensitive to questions and concerns arising from humanitarian interventions, and practitioners need to take research findings into account in designing interventions.
Asunto(s)
Servicios de Salud Mental , Sistemas de Socorro , Investigación , Apoyo Social , Altruismo , Femenino , Grupos Focales , Investigación sobre Servicios de Salud/métodos , Investigación sobre Servicios de Salud/organización & administración , Humanos , Masculino , Salud Mental , Servicios de Salud Mental/organización & administración , Nepal , Perú , Sistemas de Socorro/organización & administración , Investigación/organización & administración , Proyectos de Investigación , UgandaRESUMEN
BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) "matrix support", c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment.