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BACKGROUND: Tuberculosis (TB) is a disease that is influenced by social determinants of health. However, the specific structural and intermediary determinants of TB in Eastern Amazonia remain unclear. Despite being rich in natural resources, the region faces significant challenges related to poverty, inequality, and neglected diseases. The objective of this study was to use mathematical modeling to evaluate the influence of structural and intermediary determinants of health on TB in Eastern Amazonia, Brazil. METHODS: This cross-sectional included all TB cases diagnosed and registered in the Notifiable Diseases Information System (SINAN) from 2001 to 2017. Data on social determinants were collected at the census tract level. The generalized additive model for location, scale, and shape (GAMLSS) framework was employed to identify the effect of social determinants on communities with a high TB prevalence. The Double Poisson distribution (DPO) was chosen, and inclusion of quadratic effects was tested. RESULTS: A total of 1730 individuals were diagnosed with TB and reported in SINAN during the analyzed period. The majority were female (59.3%), aged 31 to 59 years (47.6%), identified as blacks (67.9%), and had incomplete elementary education (46.6%). The prevalence of alcoholism was 8.6% and mental illness was 0.7%. GAMLSS analyses demonstrated that the risk of community incidence of TB is associated with the proportion of the population lacking basic sanitation, as well as with the age groups of 16-31 years and > 61 years. CONCLUSIONS: The study highlights the strategic utility of GAMLSS in identifying high-risk areas for TB. Models should encompass a broader range of social determinants to inform policies aimed at reducing inequality and achieving the goals of the End TB strategy.
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OBJECTIVE: to examine the usage and content of the Global Alliance for Nursing and Midwifery (GANM) discussion forum in relation to nursing and midwifery education and practice. METHOD: a qualitative conventional content analysis was performed. Subject lines from 1689 discussion board threads were extracted and used as the unit of analysis. A-priori codes were developed based on topical relevance (e.g. maternal health) and typical discussion board usage (e.g. announcing educational opportunities). Emerging codes were further identified while coding the data (e.g. infectious diseases). RESULTS: the GANM discussion forum was used most frequently for information exchange (43.8%), such as dissemination of new information on evidence-based practice, and to announce educational opportunities (24.8%). The most frequently discussed topics were nursing (14.2%; e.g. the role of nurses in primary care, nursing education, etc.) and maternal health (13.8%; e.g. postpartum care, maternal mortality, etc.). Infectious diseases were discussed in 9% of threads, 40% of which concerned the current coronavirus pandemic. CONCLUSION: findings reinforce the utility of the GANM as a platform for professional development and continuing education. As a platform for disseminating empirical research, the GANM can be leveraged to have an influence on real-world, evidence-based practice.
Assuntos
Educação em Enfermagem , Tocologia , Feminino , Humanos , GravidezRESUMO
Objective: to examine the usage and content of the Global Alliance for Nursing and Midwifery (GANM) discussion forum in relation to nursing and midwifery education and practice. Method: a qualitative conventional content analysis was performed. Subject lines from 1689 discussion board threads were extracted and used as the unit of analysis. A-priori codes were developed based on topical relevance (e.g. maternal health) and typical discussion board usage (e.g. announcing educational opportunities). Emerging codes were further identified while coding the data (e.g. infectious diseases). Results: the GANM discussion forum was used most frequently for information exchange (43.8%), such as dissemination of new information on evidence-based practice, and to announce educational opportunities (24.8%). The most frequently discussed topics were nursing (14.2%; e.g. the role of nurses in primary care, nursing education, etc.) and maternal health (13.8%; e.g. postpartum care, maternal mortality, etc.). Infectious diseases were discussed in 9% of threads, 40% of which concerned the current coronavirus pandemic. Conclusion: findings reinforce the utility of the GANM as a platform for professional development and continuing education. As a platform for disseminating empirical research, the GANM can be leveraged to have an influence on real-world, evidence-based practice.
Objetivo: examinar o uso e o conteúdo do fórum de discussão da Aliança Global para Enfermagem e Obstetrícia (Global Alliance for Nursing and Midwifery, GANM) em relação à educação e prática de enfermagem e obstetrícia. Método: análise de conteúdo convencional qualitativa. Foram extraídas e usadas como unidade de análise linhas de assunto de 1.689 tópicos do fórum de discussão. A priori, os códigos foram desenvolvidos com base na relevância do tópico (por exemplo, saúde materna) e no uso típico de um fórum de discussão (por exemplo, anúncio de oportunidades educacionais). Códigos emergentes foram identificados posteriormente durante a codificação dos dados (por exemplo, doenças infecciosas). Resultados: o fórum de discussão da GANM foi utilizado com maior frequência para troca de informações (43,8%), como divulgação de novas informações sobre a prática baseada em evidências e para anunciar oportunidades educacionais (24,8%). Os tópicos mais discutidos foram Enfermagem (14,2%; por exemplo, o papel do enfermeiro na atenção primária, educação em enfermagem, etc.) e saúde materna (13,8%; por exemplo, cuidados pósparto, mortalidade materna, etc.). Doenças infecciosas foram discutidas em 9% dos tópicos, sendo que 40% estavam relacionados à atual pandemia de coronavírus. Conclusão: os achados reforçam a utilidade da GANM como plataforma de desenvolvimento profissional e educação continuada. Como plataforma para disseminar a pesquisa empírica, a GANM pode ser aproveitada para ter uma influência na prática do mundo real baseada em evidências.
Objetivo: examinar el uso y contenido del foro de discusión de la Alianza Global para Enfermería y Obstetricia (Global Alliance for Nursing and Midwifery, GANM) en relación con la educación y práctica de Enfermería y Obstetricia. Método: se realizó un análisis de contenido convencional cualitativo. Se extrajeron líneas de 1689 hilos de conversación en foros de discusión y se utilizaron como unidad de análisis. A priori, los códigos se desarrollaron sobre la base de la relevancia del tema (por ejemplo, salud materna) y el uso típico de los foros de discusión (por ejemplo, anunciar oportunidades educativas). Los códigos emergentes se identificaron con mayor precisión al codificar los datos (por ejemplo, enfermedades infecciosas). Resultados: el foro de discusión de la GANM se utilizó con mayor frecuencia para el intercambio de información (43,8%), como la difusión de nueva información sobre la práctica basada en la evidencia, y para anunciar oportunidades educativas (24,8%). Los temas más discutidos fueron la Enfermería (14,2%; por ejemplo, el rol de los enfermeros en la atención primaria, educación en Enfermería, etc.) y la salud materna (13,8%; por ejemplo, atención postparto, mortalidad materna, etc.). Las enfermedades infecciosas se discutieron en 9% de los hilos de conversación, de los cuales, el 40% refirieron a la actual pandemia de coronavirus. Conclusión: los hallazgos refuerzan la utilidad de la GANM como plataforma para el desarrollo profesional y la educación continua. Como plataforma para difundir investigación empírica, la GANM se puede aprovechar para influir en la práctica basada en la evidencia del mundo real.
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Humanos , Feminino , Gravidez , Educação Continuada , Educação em Enfermagem , Prática Clínica Baseada em Evidências , Saúde Materna , TocologiaRESUMO
BACKGROUND: Adherence is key to the success of antiretroviral therapy. Enhanced partner support might benefit patients with previous treatment failure. We aimed to assess whether an enhanced partner-based support intervention with modified directly observed therapy would improve outcomes with second-line therapy in HIV-infected patients for whom first-line therapy had failed. METHODS: We did a multicentre, international, randomised clinical trial at nine sites in Botswana, Brazil, Haiti, Peru, South Africa, Uganda, Zambia, and Zimbabwe. Participants aged 18 years or older for whom first-line therapy had failed, with HIV RNA concentrations greater than 1000 copies per mL and with a willing partner, were randomly assigned (1:1), via computer-generated randomisation, to receive partner-based modified directly observed therapy or standard of care. Randomisation was stratified by screening HIV RNA concentration (≤10â000 copies per mL vs >10â000 copies per mL). Participants and site investigators were not masked to group assignment. Primary outcome was confirmed virological failure (viral load >400 copies per mL) by week 48. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00608569. FINDINGS: Between April 23, 2009, and Sept 29, 2011, we randomly assigned 259 participants to the modified directly observed therapy group (n=129) or the standard-of-care group (n=130). 34 (26%) participants in the modified directly observed therapy group achieved the primary endpoint of virological failure by week 48 compared with 23 (18%) participants in the standard-of-care group. The Kaplan-Meier estimated cumulative probability of virological failure by week 48 was 25·1% (95% CI 17·7-32·4) in the modified directly observed therapy group and 17·3% (10·8-23·7) in the standard-of-care group, for a weighted difference in standard of care versus modified directly observed therapy of -6·6% (95% CI -16·5% to 3·2%; p=0·19). 36 (14%) participants reported at least one grade 3 or higher adverse event or laboratory abnormality (n=21 in the modified directly observed therapy group and n=15 in the standard-of-care group). INTERPRETATION: Partner-based training with modified directly observed therapy had no effect on virological suppression. The intervention does not therefore seem to be a promising strategy to increase adherence. Intensive follow-up with clinic staff might be a viable approach in this setting. FUNDING: AIDS Clinical Trials Group and the National Institute of Allergy and Infectious Diseases, US National Institutes of Health.