RESUMO

Respect for parents' values and clinician-parent collaboration is less common among families from historically marginalized communities. We investigated how parents from marginalized communities operationalize health and their preferences for paediatric primary care. We recruited families who spoke English, Haitian Creole or Spanish with at least one child younger than 6 years old. Staff queried families' values and life experiences, perspectives on health and healthcare, social supports and resources. Fourteen interviews with the parents of 26 children were thematically analysed. Interviews revealed the following four themes: (1) parents' definitions of 'health' extend beyond physical health; (2) families' ability to actuate health definitions is complicated by poverty's impact on agency; (3) parents engage in ongoing problem recognition and identify solutions, but enacting solutions can be derailed by barriers and (4) parents want support from professionals and peers who acknowledged the hard work of parenting. Eliciting parents' multidimensional conceptualizations of health can support families' goal achievement and concern identification in the context of isolation, limited agency and few resources. Efforts to improve family centred care and reduce disparities in paediatric primary care must be responsive to the strengths, challenges, resources and priorities of marginalized families.

Assuntos

RESUMO

Purpose of Review: Review international efforts to build a global public health initiative focused on toxoplasmosis with spillover benefits to save lives, sight, cognition and motor function benefiting maternal and child health. Recent Findings: Multiple countries' efforts to eliminate toxoplasmosis demonstrate progress and context for this review and new work. Summary: Problems with potential solutions proposed include accessibility of accurate, inexpensive diagnostic testing, pre-natal screening and facilitating tools, missed and delayed neonatal diagnosis, restricted access, high costs, delays in obtaining medicines emergently, delayed insurance pre-approvals and high medicare copays taking considerable physician time and effort, harmful shortcuts being taken in methods to prepare medicines in settings where access is restricted, reluctance to perform ventriculoperitoneal shunts promptly when needed without recognition of potential benefit, access to resources for care, especially for marginalized populations, and limited use of recent advances in management of neurologic and retinal disease which can lead to good outcomes. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-022-00268-x.

RESUMO

Resumen En el presente estudio se analizan situaciones de alfabetización entre díadas de niños de 12 años, que asistían a la escuela primaria y niños de 5 años de jardín de infantes generadas en el marco del programa de niños tutores en alfabetización "De niño a niño" (Rosemberg y Alam, 2009) orientado a promover el aprendizaje de la lectura y la escritura de niños, quienes viven en poblaciones urbano marginadas de Argentina. El análisis se focaliza en las secuencias de intercambio en las que los niños mayores (tutores) explican palabras poco familiares a los niños pequeños (aprendices) durante dis tintos tipos de actividades: lectura de cuentos y actividades focalizadas en el sistema de escritura y el vocabulario. Durante el año escolar, se llevaron a cabo 7 sesiones y las sesiones de 8 díadas fueron filmadas y transcriptas. Se identificaron 89 secuencias donde el tutor explicaba una palabra al apren diz. Para el análisis, se elaboró una categorización que da cuenta de la estructura conversacional de las secuencias de explicación -modalidad monologal o dialogal- y del tipo de información empleada -estrategias que recurren a aspectos semánticos y de contextualización. A fin de comparar cómo se despliegan estas secuencias en cada tipo de actividad, se emplearon pruebas estadísticas no paramé tricas. Los resultados mostraron una preeminencia de la modalidad monologal y un mayor empleo de estrategias que recurren a aspectos semánticos en las situaciones de lectura. En las otras actividades de alfabetización, prevaleció la modalidad dialogal y el empleo de estrategias de contextualización.

Abstract: This study analyzes literacy situations between dyads of 12-year-olds attending primary school and 5-year-old kindergarten children generated in the framework of the "De niño a niño" program (Rosemberg & Alam, 2009). The goal of this program is to promote reading and writing learning among children living in urban-marginalized populations in Argentina. The analysis focuses on the interventions used by older children (tutors) to explain un familiar words to younger children (apprentices) in the context of different types of activities: reading stories and activities focused on the writing system and vocabulary. During the school year, 7 sessions were held. The tutoring sessions of 8 dyads were videotaped and transcribed. Eighty-nine exchanges in which a tutor explained a word to the apprentice were identified. For the analysis, a categorization was elaborated focusing on the conversational structure of the explanation sequence modality - monologal or dialogal - and the type of information used for the explanation -strategies that resort to semantic and contextual aspects. In order to compare how these sequences were deployed in each type of activity, nonparametric statistical tests were used. The results showed a pre-eminence of the monologal modality and a greater use of strategies that resort to semantic aspects in reading situations. In the other literacy activities, the dialogal modality and the use of contextual aspects prevailed.

Assuntos

RESUMO

BACKGROUND: The HIV prevalence among men who have sex with men (MSM) in Peru (12.4 %) is 30 times higher than in the general adult population (0.4 %). It is critical for community-based organizations to understand how to provide HIV services to MSM while maximizing limited resources. This study describes the HIV prevalence and risk profiles of MSM seeking HIV services at a community-based organization in Lima, Peru. It then compares HIV prevalence between those who found out about the HIV services through different sources. METHODS: A cross-sectional study of MSM seeking HIV services at Epicentro Salud in Lima, Peru for the first time between April 2012 and October 2013. We compared HIV prevalence among MSM who found out about Epicentro via online sources of information (N = 419), those using in-person sources (friends, partners) (N = 907), and sex workers (N = 140) using multivariable logistic regression models. RESULTS: HIV prevalence was 18.3 % overall: 23.2 % among MSM using online sources, 19.3 % among sex workers, and 15.9 % among MSM using in-person sources. However, when compared to the in-person group, sexual risk behaviors were not statistically higher among MSM using online sources. For the sex worker group, some behaviors were more common, while others were less. After adjusting for confounders, the odds of having HIV was higher for the online group (Odds Ratio = 1.61; 95 % Confidence Interval: 1.19-2.18), but not for the sex worker group (OR = 1.12; 95 % CI: 0.68-1.86), compared to the in-person group. CONCLUSION: Internet-based promotion appears to successfully reach MSM at high risk of HIV in Peru. Outreach via this medium can facilitate HIV diagnosis, which is the critical first step in getting infected individuals into HIV care. For community-based organizations working in resource-limited settings, this may be an effective strategy for engaging a subset of high-risk persons in HIV care.

Assuntos

RESUMO

Understanding the persistent inequalities in the prevalence rates of family planning and unmet need for family planning between indigenous and nonindigenous women in Guatemala requires localized explorations of the specific barriers faced by indigenous women. Based on social cognitive theory, elicitation interviews were carried out with a purposive sample of 16 young women, aged 20-24 years, married or in union, from the rural districts of Patzún, Chimaltenango, Guatemala. Content analysis was carried out using the constant-comparison method to identify the major themes. Based on this qualitative study, the following barriers are incorporated into the development of a self-efficacy scale: lack of knowledge about and availability of methods, fear of side effects and infertility, husbands being against family planning (and related fears of marital problems and abandonment), pressure from in-laws and the community, and the belief that using contraception is a sin. This is the first evidence-informed self-efficacy scale developed with young adult, indigenous women that addresses the issue of family planning in Latin America.

RESUMO

Social support can affect health outcomes of female sex workers. In this inductive feminist grounded theory study based on 20 in-depth interviews, we explore how establishment-based female sex workers in Tijuana perceive the impact of the connections among women on their lives and health. Participants elected to discuss the importance of social support from mothers, sisters, friends, and co-workers, and the empowering and disempowering aspects of these relationships. In previous studies, scholars demonstrated the efficacy of formal organization of female sex workers in promoting the mitigation of sexual and HIV risk. We show the importance of informal ties with other women. Some participants mentioned competitive relationships, others talked about cooperation and the desire for a venue to learn from one another. Social interactions with other women are especially empowering when female sex workers can openly engage in "woman talk" that may contribute to the mitigation of sexual and HIV risk.

Assuntos

RESUMO

We examined structural factors-social, political, economic, and environmental-that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex-including transactional sex between passengers and boat crew and commercial sex work-often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource extraction camps, where heavy drinking and unprotected sex work are common. Multilevel, combination prevention strategies that integrate empirically based interventions with indigenous knowledge are urgently needed, not only to reduce vulnerability to HIV transmission, but also to eliminate the structural determinants of indigenous people's health.

Assuntos