RESUMO
Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5-20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents' questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.
Assuntos
Vacinas contra Dengue , Dengue , Vacinas , Criança , Humanos , Dengue/prevenção & controle , Vacinas contra Dengue/efeitos adversos , Pais , Porto Rico/epidemiologia , Estados Unidos , Vacinação/métodos , AdolescenteRESUMO
Aedes aegypti control has been fraught with challenges in Puerto Rico. The government has implemented commonly used vector control methods, but arboviral epidemics still occur. It is necessary to explore new Ae. aegypti control methods. This study aimed to understand the perceptions of community members in Ponce, Puerto Rico about emergent and traditional Ae. aegypti vector control methods and determine their acceptability and support for these methods. We identified the type of information needed to increase support for emergent vector control methods, and the preferred strategies to disseminate this information. Four group discussions were conducted with a total of 32 participants representing eight of the 14 clusters participating in the Communities Organized for the Prevention of Arboviruses (COPA), a project designed to mobilize communities in Ponce, Puerto Rico to prevent diseases transmitted by mosquitoes. Group discussions began with an overview of different methods used for controlling Ae. aegypti mosquitoes. These overviews facilitated participant understanding of the mosquito control methods presented. Use of source reduction, autocidal gravid ovitraps (AGO), and manual application of larvicide for arboviral mosquito control received support from almost all participants. Vector control methods that use more familiar techniques in Puerto Rico such as truck-mounted larvicide spraying (TMLS) and insecticide residual spraying received support from most participants. More than half of participants supported the use of emergent mosquito control methods including Wolbachia suppression, Wolbachia replacement, or genetically modified mosquitoes (GMM). Participants preferred to receive vector control information through house-to-house visits with the distribution of written materials, followed by dissemination of information through traditional (i.e., radio, television) and social media. The detailed information resulting from this study was used to develop messages for a communications campaign to garner future community support. Community acceptance and support are critical for the success of vector control programs using emergent mosquito control methods.
RESUMO
This study characterizes community perceptions on a large-scale project seeking to reduce the population of Aedes aegypti mosquitoes and prevent arboviral disease transmission in Ponce, Puerto Rico; and to leverage on these perceptions to make modifications to ensure effective project implementation. In 2017-2018 the team conducted informal interviews, focus groups, and in-depth interviews with leaders and residents of the communities, focusing on challenges and potential solutions to the project implementation. Possible challenges to the project implementation included the lack of geographic consistency between clusters defined by researchers and the participants' description of the communities' geographic boundaries. Few children living in the communities could affect the ability of the project to adequately measure arboviral disease incidence. Also, population attrition due to out-migration, and lack of community leaders and communication channels after Hurricane Maria could affect participation in project activities. Lack of trust on strangers was an important challenge due to criminal activity involving violence and drug use in some community areas. Solutions to the identified challenges included identifying emerging leaders and implementing community meetings to promote project activities. The information that community members provided helped us to understand the natural disasters' impact on population attrition in these communities with a disproportionate impact in younger groups, resulting in an aging population. We identified lack of community organization and leadership and increasing number of abandoned houses that could turn into Aedes aegypti breeding sites. The formative work helped to better define the geographic areas that the study would cover, evaluate the acceptability of innovative vector control methods, and identify communication methods used by residents. With this information, challenges and potential solutions in recruiting participants were anticipated, and the community engagement and communications plans were developed. We recommend selecting clusters before research, because opinions towards mosquito control technologies could vary in added clusters.
Assuntos
Aedes , Tempestades Ciclônicas , Animais , Criança , Humanos , Idoso , Mosquitos Vetores , Porto Rico/epidemiologia , Controle de Mosquitos/métodosRESUMO
Clinical trial participants do not reflect the racial and ethnic diversity of people with cancer. ASCO and the Association of Community Cancer Centers collaborated on a quality improvement study to enhance racial and ethnic equity, diversity, and inclusion (EDI) in cancer clinical trials. The groups conducted a pilot study to examine the feasibility, utility, and face validity of a two-part clinical trial site self-assessment to enable diverse types of research sites in the United States to (1) review internal data to assess racial and ethnic disparities in screening and enrollment and (2) review their policies, programs, procedures to identify opportunities and strategies to improve EDI. Overall, 81% of 62 participating sites were satisfied with the assessment; 82% identified opportunities for improvement; and 63% identified specific strategies and 74% thought the assessment had potential to help their site increase EDI. The assessment increased awareness about performance (82%) and helped identify specific strategies (63%) to increase EDI in trials. Although most sites (65%) were able to provide some data on the number of patients that consented, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. Documenting and evaluating such data are critical steps toward improving EDI and are key to identifying and addressing disparities more broadly. ASCO and Association of Community Cancer Centers will partner with sites to better understand their processes and the feasibility of collecting screening, offering, and enrollment data in systematic and automated ways.
Assuntos
Diversidade, Equidade, Inclusão , Neoplasias , Humanos , Etnicidade , Neoplasias/terapia , Projetos Piloto , Autoavaliação (Psicologia) , Estados Unidos , Ensaios Clínicos como AssuntoRESUMO
Cancer clinical trials are critical for testing new treatments, yet less than 5% of patients with cancer enroll in these trials. Minority groups, elderly individuals, and rural populations are particularly underrepresented in cancer treatment trials. Strategies for advancing equity in cancer clinical trials for these populations include (1) optimizing clinical trial matching by broadening eligibility criteria, screening all patients for trial eligibility, expanding the number of trials against which patients are screened, and following up on all patient matches with an enrollment invitation; (2) conducting site self-assessments to identify clinical-, patient-, provider-, and system-level barriers that contribute to low rates of clinical trial screening and enrollment; (3) creating a quality improvement plan that addresses the barriers to enrollment and incorporates the use of tools and strategies such as clinical trial checklists; workforce development and trainings to improve cultural competence and reduce unconscious bias; guides to promote community education, outreach and engagement with cancer clinical trials; screening and accrual logs designed to measure participation by demographics; models of informed consent that improve understanding; clinical trial designs that reduce accessibility barriers; use of cancer clinical trial patient navigators; and programs to eliminate barriers to participation and out-of-pocket expenses; and (4) working with stakeholders to develop both protocols that are inclusive of diverse populations' geographic locations, and strategies to access those trials. These actions will support greater access for populations that have remained underrepresented in cancer clinical trials and thereby increase the generalizability and efficiency of cancer research.
Assuntos
Neoplasias , Idoso , Protocolos de Ensaio Clínico como Assunto , Humanos , Consentimento Livre e Esclarecido , Grupos Minoritários , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Seleção de PacientesRESUMO
A concerted commitment across research stakeholders is necessary to increase equity, diversity, and inclusion (EDI) and address barriers to cancer clinical trial recruitment and participation. Racial and ethnic diversity among trial participants is key to understanding intrinsic and extrinsic factors that may affect patient response to cancer treatments. This ASCO and Association of Community Cancer Centers (ACCC) Research Statement presents specific recommendations and strategies for the research community to improve EDI in cancer clinical trials. There are six overarching recommendations: (1) clinical trials are an integral component of high-quality cancer care, and every person with cancer should have the opportunity to participate; (2) trial sponsors and investigators should design and implement trials with a focus on reducing barriers and enhancing EDI, and work with sites to conduct trials in ways that increase participation of under-represented populations; (3) trial sponsors, researchers, and sites should form long-standing partnerships with patients, patient advocacy groups, and community leaders and groups; (4) anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving EDI; (5) research stakeholders should invest in programs and policies that increase EDI in trials and in the research workforce; and (6) research stakeholders should collect and publish aggregate data on racial and ethnic diversity of trial participants when reporting results of trials, programs, and interventions to increase EDI. The recommendations are intended to serve as a guide for the research community to improve participation rates among people from racial and ethnic minority populations historically under-represented in cancer clinical trials. ASCO and ACCC will work at all levels to advance the recommendations in this publication.
Assuntos
Ensaios Clínicos como Assunto , Etnicidade , Neoplasias , Seleção de Pacientes , Humanos , Oncologia , Grupos Minoritários , Neoplasias/terapia , Grupos Raciais , Estados UnidosRESUMO
PURPOSE: Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS: We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS: Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive (v 30 minutes, importance weights [95% CI] of -0.54 [-0.80 to -0.27], -0.57 [-0.84 to -0.29], and -0.17 [-0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION: Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.
Assuntos
Assistência ao Convalescente , Oncologistas , Humanos , Fatores Sociodemográficos , Inquéritos e Questionários , ViagemRESUMO
Arboviral diseases transmitted by Aedes species mosquitoes pose an increasing public health challenge in tropical regions. Wolbachia-mediated population suppression (Wolbachia suppression) is a vector control method used to reduce Aedes mosquito populations by introducing male mosquitoes infected with Wolbachia, a naturally occurring endosymbiotic bacterium. When Wolbachia-infected male mosquitoes mate with female wild mosquitoes, the resulting eggs will not hatch. Public support is vital to the successful implementation and sustainability of vector control interventions. Communities Organized to Prevent Arboviruses (COPA) is a cohort study to determine the incidence of arboviral disease in Ponce, Puerto Rico and evaluate vector control methods. Focus groups were conducted with residents of COPA communities to gather their opinion on vector control methods; during 2018-2019, adult COPA participants were interviewed regarding their views on Wolbachia suppression; and a follow-up questionnaire was conducted among a subset of participants and non-participants residing in COPA communities. We analyzed factors associated with support for this method. Among 1,528 participants in the baseline survey, median age was 37 years and 63% were female. A total of 1,032 (68%) respondents supported Wolbachia suppression. Respondents with an income of $40,000 or more were 1.34 times as likely [95% CI: 1.03, 1.37] to support Wolbachia suppression than those who earned less than $40,000 annually. Respondents who reported repellant use were 1.19 times as likely to support Wolbachia suppression [95% CI: 1.03, 1.37]. A follow-up survey in 2020 showed that most COPA participants (86%) and non-participants living in COPA communities (84%) supported Wolbachia suppression during and after an educational campaign. The most frequent questions regarding this method were related to its impact on human and animal health, and the environment. Continuous community engagement and education efforts before and during the implementation of novel vector control interventions are necessary to increase and maintain community support.
Assuntos
Aedes/microbiologia , Controle de Mosquitos/métodos , Mosquitos Vetores/microbiologia , Wolbachia/fisiologia , Adulto , Aedes/fisiologia , Animais , Estudos de Coortes , Apoio Comunitário/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mosquitos Vetores/fisiologia , Comportamento Sexual Animal , Inquéritos e Questionários , Adulto JovemRESUMO
Performance incentives for preventive care may encourage inappropriate testing, such as cancer screening for patients with short life expectancies. Defining screening colonoscopies for patients with a >50% 4-year mortality risk as inappropriate, the authors performed a pre-post analysis assessing the effect of introducing a cancer screening incentive on the proportion of screening colonoscopy orders that were inappropriate. Among 2078 orders placed by 23 attending physicians in 4 academic general internal medicine practices, only 0.6% (n = 6/1057) of screening colonoscopy orders in the preintervention period and 0.6% (n = 6/1021) of screening colonoscopy orders in the postintervention period were deemed "inappropriate." This study found no evidence that the incentive led to an increase in inappropriate screening colonoscopy orders.
Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Fatores Etários , Idoso , Índice de Massa Corporal , Comorbidade , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Guias de Prática Clínica como Assunto , Fatores de Risco , Fatores Sexuais , Fatores SocioeconômicosRESUMO
BACKGROUND: Prior to 2010, the clinical management of dengue in Puerto Rico was inconsistent with World Health Organization guidelines. A 4-hour classroom-style course on dengue clinical management was developed in 2009 and mandated for Puerto Rico medical licensure in 2010. Fifty physicians were trained as "master trainers" and gave this course to 7638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients. METHODS: Pre- and post-course test responses were compared. Changes in physician practices were assessed by reviewing medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008-2009 (pre-intervention) and 2011 (post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management. RESULTS: Physician test scores increased from 48% to 72% correct. Chart reviews showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.7-9.5) and from 91% to 96% in pediatric patients (OR, 2.7; 95% CI, 1.5-4.9). Usage of isotonic intravenous saline during the critical period increased from 57% to 90% in adult patients (OR, 6.2; 95% CI, 1.9-20.4) and from 25% to 44% in pediatric patients (OR, 3.4; 95% CI, 2.2-5.3). CONCLUSIONS: Management of dengue inpatients significantly improved following implementation of a classroom-style course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability.
Assuntos
Dengue/terapia , Educação Médica Continuada/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Administração de Caso , Criança , Pré-Escolar , Dengue/epidemiologia , Educação Médica Continuada/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Soluções Isotônicas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Porto Rico , Adulto JovemRESUMO
El envejecimiento es un proceso natural de cambios biológicos, psicoafectivos, sociales y culturales, el cual se inicia con el nacimiento y continua a lo largo de la vida. Este estudio tuvo como objetivo, interpretar el significado de envejecer para el profesional de enfermería en los escenarios de su práctica. Utilizamos la metodología cualitativa con un abordaje fenomenológico hermenéutico. El método para el análisis de datos fue el de Spiegelberg. Los sujetos del estudio fueron cuatro profesionales de enfermería de tres hospitales públicos y tres informantes externos. Seleccionados de manera intencional. Utilizando la entrevista en profundidad para recoger los datos. Obteniendo como resultados cuatro categorías: Interpretando el proceso de envejecimiento humano, vivenciando el cuidado humano del adulto mayor, comprendiendo los sentimientos y emociones del profesional de enfermería e identificando la tipología de los valores de la experiencia cuidadora. Como conclusión, emergió un producto final de la interpretación de los relatos de los sujetos en el estudio, surgiendo la teoría. Los cambios significativos que afectan a los adultos mayores que afrontan las transiciones y perciben pérdidas de identidad y pérdidas en apoyo social se sienten desarraigadas, vulnerables, en desequilibrio e incertidumbre por sus vidas tanto en el presente como en el futuro y hace visualizar en el profesional de enfermería el envejecimiento como una enfermedad y no como un proceso natural.
Aging is a natural process of biological, psycho, social and cultural changes, which begins at birth and continues throughout life. This study aimed to interpret the meaning of aging for professional nursing practice scenarios. Qualitative methodology was used with a hermeneutic phenomenological approach. The method of data analysis was Spiegelberg. The subjects were four professional nurses in three public hospitals and three external informants. Selected intentionally. Using in-depth interviews to collect data. Data analysis showed four categories: Interpreting the human aging process, experiencing human care of the elderly, the feelings and emotions of the nurse in understanding and identifying the type of the values of the caregiver experience. In conclusion emerged a final product of the interpretation of the stories of the subjects in the study, emerging theory. Significant changes affecting older adults facing transitions and perceived loss of identity and loss of social support feel uprooted, vulnerable, imbalance and uncertainty in their lives both in the present and in the future and makes viewing in professional nursing aging as a disease and not as a natural process.
RESUMO
Dengue is a major cause of morbidity in Puerto Rico and is well-known to its physicians. Early case identification and timely initiation of treatment for patients with severe dengue can reduce medical complications and mortality. To determine clinical management and reporting practices, and assess knowledge of dengue and its management, a survey was sent to 2,512 physicians with a medical license in Puerto Rico. Of the 2,313 physicians who received the survey, 817 (35%) completed the questionnaire. Of the respondents, 708 were currently practicing medicine; 138 were board certified (Group 1), 282 were board eligible (Group 2), and 288 had not finished residency (Group 3). Although respondents clinically diagnosed, on average, 12 cases of dengue in the preceding three months, 31% did not report any suspected cases to public health officials while about half (56%) reported all cases. Overall, 29% of respondents correctly identified early signs of shock and 48% identified severe abdominal pain and persistent vomiting as warning signs for severe dengue with the proportion of correct respondents highest in Group 1. Reportedly about sixty percent (57%) appropriately never give corticosteroids or prophylactic platelet transfusions to dengue patients. One third (30%) of respondents correctly identified administration of intravenous colloid solution as the best treatment option for dengue patients with refractory shock and elevated hematocrit after an initial trial of intravenous crystalloids, and nearly one half (46%) correctly identified administration of a blood transfusion as the best option for dengue patients with refractory shock and decreased hematocrit after a trial of intravenous crystalloids. Even though dengue has been endemic in Puerto Rico for nearly 4 decades, knowledge of dengue management is still limited, compliance with WHO treatment guidelines is suboptimal, and underreporting is significant. These findings were used to design a post graduate training course to improve the clinical management of dengue.
Assuntos
Dengue/diagnóstico , Dengue/terapia , Notificação de Doenças/métodos , Adulto , Coleta de Dados , Dengue/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Todos los seres humanos son intrínsecamente sexuales y el desarrollo sexual evoluciona desde la concepción, sentando las bases para la salud sexual del adulto. El propósito de este trabajo es interpretar la significación de la salud sexual como valor en los y las adolescentes. El abordaje se enmarca en un enfoque fenomenológico hermenéutico y el método utilizado fue de Spiegelberg y hecho en 2010. Los cinco sujetos de investigación tienen edades comprendidas entre 14 y 19 años de edad, son estudiantes del Liceo Nacional Bolivariano San Carlos con residencia en San Carlos, Estado Cojedes-Venezuela. Se usó como técnica de recolección de datos la entrevista cualitativa en profundidad. Los resultados apuntan las siguientes categorías: confunden sexualidad con genitalidad, autoestima alta, deficiente comunicación padres-hijos, aceptanla salud sexual como un valor, comunicación escasa docente-estudiante. Se concluyó que estos indicios permitieron comprender que los adolescentes no dan el verdadero significado a la salud sexual.
All human beings are inherently sexual and sexual development evolves from conception, setting the stage foradult sexual health. The purpose of this qualitative research is to interpret the significance of sexual health as a value in adolescents aged between 14 and 19 years of age, students of Lyceum Bolivarian San Carlos based in San Carlos, Edo. Cojedes. Venezuela. The approach is part of a hermeneutic phenomenological approach and the method used was Spiegelberg and happened in 2010. This study was performed in five adolescents. Was used as a technique for collecting qualitative indepth interview. The categories that emerged were: confuse sexuality with genitalia, high self-esteem, poor parent-child communication, accept sexual health as a value, low teacher-student communication. These clues allowed to understand that adolescents do not give true meaning to sexual health.
Todos os seres humanos são intrinsecamente sexuais e o desenvolvimento sexual evolui desde a concepção, fundamentando as bases para a saúde sexual do adulto. Teve-se como objetivo compreender o significado da saúde sexual como valor entre os adolescentes. A abordagem de pesquisa demarca um enfoque fenomenológico hermenêutico, sendo utilizado o método de Spiegelberg e realizado em 2010. Foram sujeitos do estudo cinco adolescentes situados na faixa etária de 14 a 19 anos. São estudantes do Liceu Nacional Bolivariano San Carlos e residem nesta cidade do Estado Cojedes-Venezuela. Utilizou-se como técnica de produção de dados a entrevista qualitativa em profundidade. Os resultados apontaram as seguintes categorias: confundem sexualidade com genitalidade, autoestima alta, deficiente comunicação pais-filhos, aceitação da saúde sexual como um valor, comunicação escassa docente-estudante. Concluiu-se que esses indícios permitiram compreender que os adolescentes não dão um significado real à saúde sexual.
Assuntos
Humanos , Feminino , Adolescente , Desenvolvimento Sexual , Saúde Reprodutiva , Saúde do Adolescente , Sexualidade , Valores Sociais , Pesquisa QualitativaRESUMO
Dengue, endemic in Puerto Rico, is a major public health problem. Vaccines are thought the best means to prevent dengue because vector control alone has been largely ineffective. We implemented qualitative studies in 2006 and 2010 to determine the acceptability of conducting placebo-controlled dengue vaccine efficacy trials in Puerto Rican children. Key informant interviews and focus groups with parents and children were conducted in municipalities with high dengue incidence. We used structured open-ended questions to determine motivators and attitudes regarding vaccine trial participation. Knowledge about dengue risk and prevention, and knowledge, attitudes, and beliefs regarding vaccines and vaccine trials were assessed. Using grounded theory, we conducted content analysis and established categories and sub-categories of participant responses. All participants were knowledgeable about dengue prevention and perceived children as most affected age groups. Participants were aware of vaccines benefits and they thought a vaccine could prevent dengue. However, most would not allow their children to participate in a placebo-controlled vaccine trial. Barriers included lack of trust in new vaccines and vaccine trial procedures; fear of developing dengue or side effects from the vaccine and lack of information about candidate dengue vaccines. Participants thought information, including results of previous trials might overcome barriers to participation. Motivators for participation were altruism, protection from dengue, free medical attention, and compensation for transportation and participation. Parents would consider children participation if accurate vaccine trial information is provided.
Assuntos
Vacinas contra Dengue/administração & dosagem , Vacinas contra Dengue/imunologia , Dengue/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Ensaios Clínicos Controlados como Assunto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico , Adulto JovemRESUMO
Breast cancer is the main cause of cancer deaths for Hispanic women. This study analyzes the role of functional health literacy on mammography screening behavior and adherence of Hispanic women. Survey data from 722 Mexican American women age 40 and over residing in the Lower Rio Grande Valley of Texas in 2008 were used to estimate logistic regression models to assess the role of functional health literacy on mammography screening behavior and adherence. About 51% of survey respondents had a functional health literacy level deemed as inadequate or marginally functional. After adjusting for other factors, women with adequate health literacy levels were more likely to report to have ever had a mammogram (odds ratio [OR] = 2.92; 95% confidence interval [CI] = 1.62-5.28), to have had a mammogram within the last 2 years (OR = 1.70; 95% CI = 1.14-2.53) or to have had one within the last year (OR = 2.30; 95% CI = 1.54-3.43), compared to women with inadequate or marginally adequate functional health literacy levels. Inadequate/marginal functional health literacy is strongly associated with lower mammography screening. Large improvements in breast cancer control in this population may come from either basic advances in health literacy or by tailored approaches to help women with low literacy navigate local health care systems.
Assuntos
Neoplasias da Mama/prevenção & controle , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Mamografia/estatística & dados numéricos , Americanos Mexicanos/psicologia , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Mamografia/psicologia , Pessoa de Meia-Idade , Projetos Piloto , TexasRESUMO
OBJECTIVE: In spite of long-term endemicity and repeated government and private efforts, effective, sustained community participation for dengue prevention remains a challenge in Puerto Rico. This study explored differences found in interviews conducted in 2001 in attitudes toward dengue and its prevention by respondents' gender and whether they had a prior dengue infection. Findings may be used to develop messages to promote Aedes aegypti control practices. METHODS: From September to October 2003, 11 focus groups were conducted in San Juan, Puerto Rico. Fifty-nine persons (35 women, 24 men), >or= 18 years of age, who had been identified through the Puerto Rico dengue surveillance system participated in the focus groups. Analysis was based on grounded theory. RESULTS: Women considered dengue important because of its economic, emotional, and health impact, and they were concerned more often than men about insufficient garbage removal and water disposal. Participants with a previous dengue diagnosis were more concerned about risk of the disease, were more knowledgeable about dengue and its prevention, and recommended use of repellents more often than their counterparts without a previous dengue diagnosis. Barriers to sustained dengue prevention included misconceptions from outdated educational materials, "invisibility" of dengue compared with chronic diseases, and lack of acceptance of responsibility for dengue prevention. CONCLUSIONS: Suggested strategies to motivate residents' actions included working with government agencies to address structural problems that increase mosquito populations, improving access to information on garbage collection and water disposal through telephone hotlines, increasing publicity and information about dengue by mass media campaigns, and educating health professionals.
Assuntos
Dengue/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Feminino , Humanos , Masculino , Porto Rico , Adulto JovemRESUMO
OBJECTIVE: In spite of long-term endemicity and repeated government and private efforts, effective, sustained community participation for dengue prevention remains a challenge in Puerto Rico. This study explored differences found in interviews conducted in 2001 in attitudes toward dengue and its prevention by respondents' gender and whether they had a prior dengue infection. Findings may be used to develop messages to promote Aedes aegypti control practices. METHODS: From September to October 2003, 11 focus groups were conducted in San Juan, Puerto Rico. Fifty-nine persons (35 women, 24 men), > 18 years of age, who had been identified through the Puerto Rico dengue surveillance system participated in the focus groups. Analysis was based on grounded theory. RESULTS: Women considered dengue important because of its economic, emotional, and health impact, and they were concerned more often than men about insufficient garbage removal and water disposal. Participants with a previous dengue diagnosis were more concerned about risk of the disease, were more knowledgeable about dengue and its prevention, and recommended use of repellents more often than their counterparts without a previous dengue diagnosis. Barriers to sustained dengue prevention included misconceptions from outdated educational materials, " invisibility" of dengue compared with chronic diseases, and lack of acceptance of responsibility for dengue prevention. CONCLUSION: Suggested strategies to motivate residents' actions included working with government agencies to address structural problems that increase mosquito populations, improving access to information on garbage collection and water disposal through telephone hotlines, increasing publicity and information about dengue by mass media campaigns, and educating health professionals.
OBJETIVO: A pesar de la prolongada endemia y los reiterados esfuerzos gubernamentales y privados, la participación efectiva y sostenida de la comunidad en las tareas de prevención del dengue sigue siendo un reto en Puerto Rico. A partir de entrevistas realizadas en 2001 se analizaron las diferencias en las actitudes hacia el dengue y su prevención según el sexo de los encuestados y sus antecedentes de haber sufrido esta enfermedad. Estos resultados pueden servir para desarrollar mensajes dirigidos a promover prácticas de control de Aedes aegypti. MÉTODOS: Entre septiembre y octubre de 2003 sesionaron 11 grupos focales en San Juan, Puerto Rico. Participaron 59 personas (35 mujeres y 24 hombres) de 18 años o más, identificados a través del sistema de vigilancia de dengue de Puerto Rico. El análisis se basó en la teoría fundamentada o inductiva. RESULTADOS: Las mujeres consideraban importante el dengue por su impacto económico, emocional y sanitario y más mujeres que hombres estaban preocupadas por la insuficiente recolección de basura y disposición de aguas residuales. Los participantes con diagnóstico previo de dengue estaban más preocupados por los riesgos de la enfermedad, conocían más sobre el dengue y su prevención y con mayor frecuencia aconsejaron el uso de repelentes que sus pares sin diagnóstico previo de dengue. Entre las barreras para la prevención sostenida del dengue estaban: conceptos erróneos por materiales educativos obsoletos, la " invisibilidad" del dengue en comparación con las enfermedades crónicas y la falta de aceptación de responsabilidad por la prevención del dengue. CONCLUSIONES: Las estrategias sugeridas para motivar la acción de los residentes comprenden: trabajar con las agencias gubernamentales para resolver los problemas estructurales que incrementan las poblaciones de mosquitos, mejorar el acceso a la información sobre la recolección de basura y la disposición de las aguas residuales mediante líneas telefónicas...