RESUMEN

The human papillomavirus (HPV) causes many anogenital and oral cancers affecting young adults in the United States. Vaccination during adolescence can prevent HPV-associated cancers, but vaccine uptake among adolescents is low and influenced by factors serving as barriers and facilitators to HPV vaccination. In this systematic review, we synthesized research using the socioecological framework model to examine individual-level, relationship-level, community-level, and societal-level factors that influence HPV vaccine initiation and completion among US adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the methodology for this review. An electronic search was conducted in January 2020 using PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest Central, Scopus, and American Psychological Association PsycInfo databases. The Joanna Briggs Institute tools were used to assess the quality for the 57 studies included in this review. The most consistent influences of HPV vaccination included age at vaccination, awareness, and knowledge about HPV vaccination, socioeconomic status, insurance status, race/ethnicity, and preventative care behaviors at the individual level. Provider recommendation, familial/peer support of vaccination, and parental health behaviors were influences at the relationship level. Although fewer findings elucidated community-level and societal-level influences, high-poverty areas, high-risk communities with large proportions of racial/ethnic minority groups, healthcare facilities servicing children, and combined health policies appear to serve as facilitators of HPV initiation and completion. Findings from this review can inform culturally relevant and age-specific interventions and multi-level policies aiming to improve HPV vaccination coverage in the United States.

Asunto(s)

RESUMEN

In the early 20th century, public health nurse, Lillian Wald, addressed the social determinants of health (SDOH) through her work in New York City and her advocacy to improve policy in workplace conditions, education, recreation, and housing. In the early 21st century, addressing the SDOH is a renewed priority and provides nurse researchers with an opportunity to return to our roots. The purpose of this methods paper is to examine how the incorporation of geospatial data and spatial methodologies in community research can enhance the analyses of the complex relationships between social determinants and health. Geospatial technologies, software for mapping and working with geospatial data, statistical methods, and unique considerations are discussed. An exemplar for using geospatial data is presented regarding associations between neighborhood greenspace, neighborhood violence, and children's asthma control. This innovative use of geospatial data illustrates a new frontier in investigating nontraditional connections between the environment and SDOH outcomes.

Asunto(s)

RESUMEN

In South Africa, 60% of female sex workers are estimated to be living with human immunodeficiency virus (HIV). Many of these women face structural and individual-level barriers to initiating, accessing, and adhering to antiretroviral therapy (ART). While data are limited, it is estimated that less than 40% of sex workers living with HIV achieve viral suppression, leading to suboptimal clinical outcomes and sustained risks of onward sexual and vertical HIV transmission. Siyaphambili, a NINR/NIH-funded study, focuses on studying optimal implementation strategies for meeting HIV treatment needs among cisgender female sex workers living with HIV who are not virally suppressed. Here, we present the study protocol of this sequential multiple assignment randomized trial. In total, 800 viremic female sex workers will be enrolled into an 18-month adaptive implementation study to 1) compare the effectiveness and durability of a nurse-led decentralized ART treatment program versus an individualized case management approach, in isolation or in combination to achieve viral suppression and 2) estimate incremental cost-effectiveness of interventions and combinations of interventions. The primary outcome is a combined intention-to-treat outcome of retention in ART care and viral suppression at 18 months with secondary implementation outcomes. Siyaphambili aims to inform the implementation of and scale-up of HIV treatment services for female sex workers by determining the minimal package of services needed to achieve viral suppression and by characterizing individuals in need of more intensive HIV treatment approaches.

Asunto(s)

RESUMEN

Co-infection with HIV and hepatitis C virus (HCV) results in a threefold increase in relative risk of progression to end stage liver disease and cirrhosis compared to HCV alone. Although curative treatments exist, less than one quarter of people with HCV are linked to care, and even fewer have received treatment. The Care2Cure study is a single-blinded, randomized controlled trial to improve the HCV care continuum among people co-infected with HIV. This ongoing study was designed to test whether a nurse case management intervention can (i) improve linkage to HCV care and (ii) decrease time to HCV treatment initiation among 70 adults co-infected with HIV who are not engaged in HCV care. The intervention is informed by the Andersen Behavioral Model of Health Services Use and consists of nurse-initiated referral, strengths-based education, patient navigation, appointment reminders, and care coordination for drug-drug interactions in the setting of HIV primary care. Validated instruments are used to measure participant characteristics including HCV knowledge, substance use, and depression. The primary outcome is linkage to HCV care (yes/no) within 60 days. In this protocol paper, we describe the first clinical trial to examine the effects of a nurse case management intervention to improve the HCV care continuum among people co-infected with HIV/HCV in the era of all-oral HCV treatment. We describe our work in progress, challenges encountered, and strategies to engage this hard-to-reach population.

Asunto(s)

RESUMEN

BACKGROUND: Large-scale use of insecticide-treated nets and indoor residual spraying have contributed to a significant decrease in malaria transmission worldwide. Further reduction and progress towards elimination, however, require complementary control measures which can address the remaining gaps in protection from mosquito bites. Following the development of novel pyrethroids with high knockdown effects on malaria vectors, programmatic use of spatial repellents has been suggested as one potential strategy to fill the gaps. This report explores social and contextual factors that may influence the relevance, uptake and sustainable use of a spatial repellent in two remote villages in Mondulkiri province, Cambodia, with endemic malaria transmission. The repellent consisted of polyethylene emanators, held in an open plastic frame and impregnated with 10% metofluthrin. RESULTS: In a baseline survey, 90.9% of households in Ou Chra (n = 30/33) and 96.6% in Pu Cha (n = 57/59) were interviewed. Behavioural data were collected for all household occupants (n = 448). In both villages, there were times and places in which people remained exposed to mosquito bites. Prior to the installation of the repellent, 50.6 and 59.5% of respondents noted that bites occurred "very often" inside the house and in the outdoor area surrounding the house, respectively. Indoor biting was reported to occur more frequently in the evening, followed by at night, while outdoor biting occurred more frequently in the early morning. In a follow-up survey, spatial repellents were well received in both villages, although 63.2% of respondents would not replace bed nets with repellents. Most participants (96.6%) were willing to use the product again; the mean willingness to pay was US$ 0.3 per unit. A preference for local procurement methods emerged. CONCLUSION: Widespread use of spatial repellents would not fill all protective gaps, but, if their entomological efficacy can be ascertained, outdoor application has the potential to enhance vector control strategies in Cambodia. Successful implementation would require subsidisation and integration with the existing national malaria control strategy. It is hoped that this study, while contributing to a better understanding of the social contexts of residual malaria transmission, will generate further interest in the evaluation of spatial repellents for malaria control.

Asunto(s)

RESUMEN

Objetivo: A pesquisa objetivou descrever o perfil sócio econômico profissional dos naturólogos do Brasil. Materiais e método: Tratou-se de um estudo com abrangência nacional, classificado como pesquisa descritiva, de natureza quantitativa e de levantamento. Para a coleta de dados foi utilizado um questionário desenvolvido pelos autores. Os sujeitos da pesquisa foram 386 bacharéis em naturologia formados por instituições brasileiras até o ano de 2014 e a coleta de dados realizada entre fevereiro a maio de 2015. Resultados: Segundo os dados obtidos, observa-se que atualmente a Naturologia é uma profissão de predominância feminina (82,5%), cuja idade variou entre 21 e 64 anos, com média de 31 anos. A prevalência dos profissionais concentra-se no estado de São Paulo (45,6%), seguido por Santa Catarina (30,5%). Dentre os respondentes, a maioria (60,6%) atua com a Naturologia, predominando os que atuam no setor privado (78,9%), sendo as práticas mais utilizadas a aromaterapia (85,3%), a terapia floral (77,4%) e a massoterapia (76,1%). Considerações finais: A inserção de naturólogos dentro do Sistema Único de Saúde ainda é baixa, necessitando de maior estimulação para que a atuação deste profissional não corra o risco de se restringir a uma determinada classe social.(AU)

Objective: This work had as objective describing the social and economic profile of professional naturologists from Brasil. Materials and Method: It was a nation-wid study, classifiel as as descritive study, of quantitative and investigative natuure. For data acquiring was developed a questionnaire by the authors. Subjects were 386 professionals of Naturology graduated from brazilian colleges up to 2014 and was conducted between february and april of 2015. Results: According to data obtained, to this date Naturology is a profession majorly selected by women (82,5%), aging from 21 to 64 years, being 31 years the meddium age. Most professional are residents in São Paulo (41,6%), followed by Santa Catarina (30,5%). Amongst the subjects, the majority (60,6%) Works actually in the field of Naturology, mostly in the privat pratices (78,9%), beign aromatherapy (85,3%), floral therapy (77,4%) and masotherpy (76,1%) the most common pratices. Final Considerations: The insrtion of natutrologists in the public healthy system system is still low-profile, needing more stimuli so that the naturologists´ fiels of work does not become restriceted to a determinated social class.(AU)

Asunto(s)

RESUMEN

This article discusses various aspects of pastoralism in the Latin American countries with the largest dryland areas. The topics covered include: social, economic and institutional issues; grasslands and their carrying capacity; production systems and productivity rates; competition for forage resources between domestic livestock and wildlife; and the health status of livestock and wildlife. Most grasslands exhibit some degree of degradation. The percentage of offspring reaching weaning age is low: 47-66% of calves and 40-80% of lambs. Some pastoralists adopt patterns of transhumance. In the main, pastoralists experience a high poverty rate and have poor access to social services. For many pastoralists, wildlife is a source of food and by-products. Argentina, Chile, Mexico and Peru have animal health control agencies, are members of the World Organisation for Animal Health (OIE) and have signed the United Nations Convention to Combat Desertification. Pastoral systems subsist mainly on income unrelated to pastoral farming. The OIE recognises all four countries as free from infection with peste des petits ruminants virus, and from rinderpest and African horse sickness. It is difficult to predict the future of pastoralism in Latin America because the situation differs from country to country. For instance, pastoralism is more important in Peru than in Argentina, where it is a more marginal activity. In the future, lack of promotion and protection policies could lead to a decline in pastoralism or to an adverse environmental impact on drylands.

Les auteurs abordent les particularités du pastoralisme dans les quatre pays d'Amérique latine dotés des plus vastes étendues de terres arides du souscontinent ; ils examinent notamment les aspects sociaux, économiques et institutionnels du pastoralisme, les pâtures et leur capacité de charge, les systèmes de production et les indices de productivité, la concurrence entre le bétail et les animaux sauvages pour le prélèvement de fourrage et le statut sanitaire respectif des animaux d'élevage et de la faune sauvage. Les prairies dédiées au pastoralisme présentent dans leur majorité un certain degré de dégradation. Le taux de survie au sevrage fluctue entre 47 % et 66 % pour les veaux et entre 40 % et 80 % pour les agneaux. Certains pasteurs adoptent des schémas de transhumance. Les populations pastorales se caractérisent par un niveau élevé de pauvreté et un accès très limité aux services sociaux. Pour de nombreux pasteurs, la faune sauvage constitue une ressource alimentaire directe mais elle fournit aussi des produits dérivés. En Argentine, au Chili, au Mexique et au Pérou, des services gouvernementaux sont chargés du contrôle de la santé animale. Ces pays sont Membres de l'Organisation mondiale de la santé animale (OIE) et signataires de la Convention des Nations Unies sur la lutte contre la désertification. Les systèmes pastoraux subsistent essentiellement grâce à des revenus autres que ceux issus de la production. Ces territoires ont été reconnus par l'OIE comme étant indemnes d'infection par les virus de la peste des petits ruminants, de la peste bovine et de la peste équine. Il est difficile de prédire l'avenir du pastoralisme en Amérique latine, en raison de la diversité des situations rencontrées d'un pays à l'autre. Par exemple, l'activité pastorale est plus importante au Pérou qu'en Argentine où elle a un caractère marginal. L'absence de politiques de promotion et de protection spécifiques pourrait se traduire à l'avenir par un déclin du pastoralisme ou par un impact écologique négatif pour ces zones arides.

Se abordan matices del pastoralismo relativos a los países con mayor extensión de zonas áridas de Latinoamérica, concretamente, los aspectos sociales, económicos e institucionales, los pastizales y su receptividad, los sistemas de producción e índices de productividad, la competencia entre ganado doméstico y fauna silvestre por el recurso forrajero, y el estatus sanitario del ganado y de los animales silvestres. La mayor parte de los pastizales presenta algún grado de deterioro. El porcentaje de crías que llega al destete fluctúa entre el 47% y el 66% en bovinos y entre el 40% y el 80% en ovinos. Algunos pastoralistas adoptan patrones de trashumancia. Los pastores se caracterizan básicamente por un índice alto de pobreza y un escaso acceso a los servicios sociales. La fauna es un recurso alimentario y una fuente de subproductos para numerosos pastores. Argentina, Chile, México y Perú cuentan con organismos destinados al control de la sanidad animal, son miembros de la OIE y han suscrito la Convención de las Naciones Unidas de Lucha contra la Desertificación. Los sistemas pastoriles subsisten principalmente a partir de ingresos ajenos a su producción. La OIE reconoce a estos territorios como libres de infección por peste de los pequeños rumiantes, por peste bovina y por peste equina. Es difícil predecir el futuro del pastoralismo en Latinoamérica debido a las diferentes situaciones de cada país. Así, por ejemplo, en Perú, esta práctica tiene mayor importancia que en Argentina, donde es más marginal. La carencia de políticas de promoción y protección podría conducir en el futuro a una disminución de la actividad o a un impacto ecológico negativo en las zonas áridas.

Asunto(s)