875 resultados para Sexually transmitted infections, Life course epidemiology, Sexual health, Women, Australia
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The dissertation reports on two studies. The purpose of Study I was to develop and evaluate a measure of cognitive competence (the Critical Problem Solving Skills Scale Qualitative Extension) using Relational Data Analysis (RDA) with a multi-ethnic, adolescent sample. My study builds on previous work that has been conducted to provide evidence for the reliability and validity of the RDA framework in evaluating youth development programs (Kurtines et al., 2008). Inter-coder percent agreement among the TOC and TCC coders for each of the category levels was moderate to high, with a range of .76 to .94. The Fleiss kappa across all category levels was from substantial agreement to almost perfect agreement, with a range of .72 to .91. The correlation between the TOC and the TCC demonstrated medium to high correlation, with a range of r(40)=.68, p Study II reports an investigation of a positive youth development program using an Outcome Mediation Cascade (OMC) evaluation model, an integrated model for evaluating the empirical intersection between intervention and developmental processes. The Changing Lives Program (CLP) is a community supported positive youth development intervention implemented in a practice setting as a selective/indicated program for multi-ethnic, multi-problem at risk youth in urban alternative high schools in the Miami Dade County Public Schools (M-DCPS). The 259 participants for this study were drawn from the CLPs archival data file. The study used a structural equation modeling approach to construct and evaluate the hypothesized model. Findings indicated that the hypothesized model fit the data (2 (7) = 5.651, p = .83; RMSEA = .00; CFI = 1.00; WRMR = .319). My study built on previous research using the OMC evaluation model (Eichas, 2010), and the findings are consistent with the hypothesis that in addition to having effects on targeted positive outcomes, PYD interventions are likely to have progressive cascading effects on untargeted problem outcomes that operate through effects on positive outcomes.
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Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery. Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality. Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities. Conclusion: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).
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Whether contemporary human populations are still evolving as a result of natural selection has been hotly debated. For natural selection to cause evolutionary change in a trait, variation in the trait must be correlated with fitness and be genetically heritable and there must be no genetic constraints to evolution. These conditions have rarely been tested in human populations. In this study, data from a large twin cohort were used to assess whether selection Will cause a change among women in contemporary Western population for three life-history traits: age at menarche, age at first reproduction, and age at menopause. We control for temporal variation in fecundity (the baby boom phenomenon) and differences between women in educational background and religious affiliation. University-educated women have 35% lower fitness than those with less than seven years education, and Roman Catholic women have about 20% higher fitness than those of other religions. Although these differences were significant, education and religion only accounted for 2% and 1% of variance in fitness, respectively. Using structural equation modeling, we reveal significant genetic influences for all three life-history traits, with heritability estimates of 0.50, 0.23, and 0.45, respectively. However, strong genetic covariation with reproductive fitness could only be demonstrated for age at first reproduction, with much weaker covariation for age at menopause and no significant covariation for age at menarche. Selection may, therefore, lead to the evolution of earlier age at first reproduction in this population. We also estimate substantial heritable variation in fitness itself, with approximately 39% of the variance attributable to additive genetic effects, the remainder consisting of unique environmental effects and small effects from education and religion. We discuss mechanisms that could be maintaining such a high heritability for fitness. Most likely is that selection is now acting on different traits from which it did in pre-industrial human populations.
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OBJECTIVE To analyze conditional and unconditional healthy life expectancy among older Brazilian women.METHODS This cross-sectional study used the intercensal technique to estimate, in the absence of longitudinal data, healthy life expectancy that is conditional and unconditional on the individual’s current health status. The data used were obtained from the Pesquisa Nacional por Amostra de Domiclios (National Household Sample Survey) of 1998, 2003, and 2008. This sample comprised 11,171; 13,694; and 16,259 women aged 65 years or more, respectively. Complete mortality tables from the Brazilian Institute of Geography and Statistics for the years 2001 and 2006 were also used. The definition of health status was based on the difficulty in performing activities of daily living.RESULTS The remaining lifetime was strongly dependent on the current health status of the older women. Between 1998 and 2003, the amount of time lived with disability for healthy women at age 65 was 9.8%. This percentage increased to 66.2% when the women already presented some disability at age 65. Temporal analysis showed that the active life expectancy of the women at age 65 increased between 1998-2003 (19.3 years) and 2003-2008 (19.4 years). However, life years gained have been mainly focused on the unhealthy state.CONCLUSIONS Analysis of conditional and unconditional life expectancy indicated that live years gained are a result of the decline of mortality in unhealthy states. This pattern suggests that there has been no reduction in morbidity among older women in Brazil between 1998 and 2008.
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Overall introduction.- Longitudinal studies have been designed to investigate prospectively, from their beginning, the pathway leading from health to frailty and to disability. Knowledge about determinants of healthy ageing and health behaviour (resources) as well as risks of functional decline is required to propose appropriate preventative interventions. The functional status in older people is important considering clinical outcome in general, healthcare need and mortality. Part I.- Results and interventions from lucas (longitudinal urban cohort ageing study). Authors.- J. Anders, U. Dapp, L. Neumann, F. Prfener, C. Minder, S. Golgert, A. Daubmann, K. Wegscheider,. W. von Renteln-Kruse Methods.- The LUCAS core project is a longitudinal cohort of urban community-dwelling people 60 years and older, recruited in 2000/2001. Further LUCAS projects are cross-sectional comparative and interventional studies (RCT). Results.- The emphasis will be on geriatric medical care in a population-based approach, discussing different forms of access, too. (Dapp et al. BMC Geriatrics 2012, 12:35; http://www.biomedcentral.com/1471-2318/12/35): - longitudinal data from the LUCAS urban cohort (n = 3.326) will be presented covering 10 years of observation, including the prediction of functional decline, need of nursing care, and mortality by using a self-filling screening tool; - interventions to prevent functional decline do focus on first (pre-clinical) signs of pre-frailty before entering the frailty-cascade ("Active Health Promotion in Old Age", "geriatric mobility centre") or disability ("home visits"). Conclusions.- The LUCAS research consortium was established to study particular aspects of functional competence, its changes with ageing, to detect pre-clinical signs of functional decline, and to address questions on how to maintain functional competence and to prevent adverse outcome in different settings. The multidimensional data base allows the exploration of several further questions. Gait performance was exmined by GAITRite-System. Supported by the Federal Ministry for Education and Research (BMBF Funding No. 01ET1002A). Part II.- Selected results from the lausanne cohort 65+ (Lc65 + ) Study (Switzerland). Authors.- Prof Santos-Eggimann Brigitte, Dr Seematter-Bagnoud Laurence, Prof Bla Christophe, Dr Rochat Stphane. Methods.- The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934-1938) in the non-institutionalized population of Lausanne (Switzerland). Results.- Information is collected about life course social and health-related events, socio-economics, medical and psychosocial dimensions, lifestyle habits, limitations in activities of daily living, mobility impairments, and falls. Gait performance are objectively measured using body-fixed sensors. Frailty is assessed using Fried's frailty phenotype. Follow-up consists in annual self-completed questionnaires, as well as physical examination and physical and mental performance tests every three years. - Lausanne cohort 65+ (Lc65 + ): design and longitudinal outcomes. The baseline data collection was completed among 1422 participants in 2004-2005 through self-completed questionnaires, face-to-face interviews, physical examination and tests of mental and physical performances. Information about institutionalization, self-reported health services utilization, and death is also assessed. An additional random sample (n = 1525) of 65-70 years old subjects was recruited in 2009 (birth year 1939-1943). - lecture no 4: alcohol intake and gait parameters: prevalent and longitudinal association in the Lc65+ study. The association between alcohol intake and gait performance was investigated.
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Les POCT (point of care tests) ont un grand potentiel d'utilisation en mdecine infectieuse ambulatoire grce leur rapidit d'excution, leur impact sur l'administration d'antibiotiques et sur le diagnostic de certaines maladies transmissibles. Certains tests sont utiliss depuis plusieurs annes (dtection de Streptococcus pyogenes lors d'angine, anticorps anti-VIH, antigne urinaire de S. pneumoniae, antigne de Plasmodium falciparum). De nouvelles indications concernent les infections respiratoires, les diarrhes infantiles (rotavirus, E. coli entrohmorragique) et les infections sexuellement transmissibles. Des POCT, bass sur la dtection d'acides nucliques, viennent d'tre introduits (streptocoque du groupe B chez la femme enceinte avant l'accouchement et la dtection du portage de staphylocoque dor rsistant la mticilline). POCT have a great potential in ambulatory infectious diseases diagnosis, due to their impact on antibiotic administration and on communicable diseases prevention. Some are in use for long (S. pyogenes antigen, HIV antibodies) or short time (S. pneumoniae antigen, P. falciparum). The additional major indications will be community-acquired lower respiratory tract infections, infectious diarrhoea in children (rotavirus, enterotoxigenic E. coli), and hopefully sexually transmitted infections. Easy to use, these tests based on antigen-antibody reaction allow a rapid diagnosis in less than one hour; the new generation of POCT relying on nucleic acid detection are just introduced in practice (detection of GBS in pregnant women, carriage of MRSA), and will be extended to many pathogens
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La igualdad de oportunidades para las mujeres, como factor clave para avanzar en la consecucin de calidad de vida preocupa hoy en da a la sociedad en general y alas instituciones en particular. Antes de la elaboracin de programas de intervencin social es necesario conocer las percepciones de las propias mujeres acerca de sus problemas y de sus necesidades. Siguiendo esta lnea de pensamiento presentamos un trabajo emprico en el que analizamos las percepciones de las mujeres de la ciudad de Girona, centrndonos en dos aspectos de manera particular: la percepcin de calidad de vida proporcionada por su ciudad y la percepcin de desigualdad de oportunidades y/o de discriminacin. Los principales resultados, obtenidos a partir de las respuestas a un cuestionario auto-administrado, y proporcionados por una muestra de mujeres seleccionadas aleatoriamente a partir de un muestreo estratificado geogrficamente, indican que en general estn satisfechas con su ciudad aunque detectamos las principales causas de insatisfaccin. Por otra parte, tas principales fuentes de desigualdad se refieren al mundo laboral (menos salario por el mismo trabajo, dificultades de encontrar trabajo si tienen hijos o si son ya mayores), y en la actitud general de la sociedad en el sentido de tener que cumplir el papel que tradicionalmente se les ha asignado
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PURPOSE: To assess quality of life and climacteric symptoms in women with and without liver transplants. METHODS: This was a cross-sectional study of 52 women undergoing follow-up at a university hospital in southeastern Brazil from February 4th, 2009 to January 5th, 2011. Twenty-four of these women were 35 years old or older and had undergone liver transplantation at least one year before study entry. The remaining 28 women had no liver disease and were matched by age and menstrual patterns to the patients with transplants. The abbreviated version of the World Health Organization (WHOQOL-BREF) questionnaire was used to assess quality of life. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Statistical analysis was carried out by Student's t-test, Mann-Whitney test and analysis of variance. Correlations between MRS and the WHOQOL-BREF were established by correlation coefficients. RESULTS: The mean age of the women included in the study was 52.2 (10.4) years and the mean time since transplantation was 6.1 (3.3) years. Women with liver transplants had better quality of life scores in the environment domain (p=0.01). No difference was noted between the two groups in any domain of the MRS. For women in the comparison group, there was a strongly negative correlation between somatic symptoms in the MRS and the physical domain of the WHOQOL-BREF (p<0.01; r=-0.8). In contrast, there was only a moderate association for women with liver transplants (p<0.01; r=-0.5). CONCLUSIONS: Women with liver transplants had better quality of life scores in the domain related to environment and did not exhibit more intense climacteric symptoms than did those with no liver disease. Climacteric symptoms negatively influenced quality of life in liver transplant recipients, although less intensely than in women without a history of liver disease.
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Bien que la relation entre ltat de sant peru et les mesures de sant physique et mentale soit bien documente dans les pays dvelopps, trs peu dtudes ont examin cette association dans le monde en dveloppement, particulirement en Afrique subsaharienne. De mme, les tudes menes dans divers contextes sociaux ont document que les femmes et les personnes de plus faible statut socioconomique (SS) sont les plus susceptibles de porter un lourd fardeau des incapacits et de la mauvaise sant perue, mais il nest pas connu si ces associations existent aussi dans les pays africains. L'objectif gnral de cette recherche doctorale tait daboutir une meilleure comprhension de la stratification sociale de la sant en Afrique subsaharienne. Plus spcifiquement, cette tude visait : 1) Examiner les associations entre la sant perue et les mesures de sant physique et mentale (maladies chroniques, incapacits et dpression) parmi les adultes Ouagadougou, Burkina Faso, et valuer comment ces associations varient selon le sexe, le niveau dducation et l'ge; 2) Analyser les diffrences en matire dincapacit cognitive et physique entre les hommes et les femmes gs de 50 ans et plus Ouagadougou et valuer la mesure dans laquelle les diffrences observes pourraient tre attribuables aux ingalits de genre en matire de conditions sociales et de sant travers le cycle de vie; 3) Examiner la relation entre le SS et une multitude de mesures dincapacits parmi les adultes gs de 18 ans et plus dans 18 pays dAfrique subsaharienne et dterminer si les diffrences socioconomiques dans les incapacits sont caractrises par une divergence, convergence ou stabilit travers lge. Les rsultats de nos analyses sont prsents sous forme de trois articles scientifiques, qui se sont appuys sur les donnes de l'Enqute sant ralise en 2010 dans l'Observatoire de Population de Ouagadougou (OPO) et de la World Health Survey ralise en 2002-2004 par lOMS. Dans le premier article, nous avons trouv que la mauvaise sant perue tait fortement associe aux maladies chroniques et aux incapacits, mais pas la dpression. Leffet des incapacits sur la mauvaise sant perue sintensifiait avec lge et avec la diminution du niveau dducation. Par contre, leffet des maladies chroniques semblait diminuer avec lge. Aucune variation selon le sexe ntait observe dans les associations de la sant perue avec les maladies chroniques, les incapacits et la dpression. Ces rsultats suggrent que les diffrentes sous-populations dfinies selon le niveau d'ducation et l'ge pondrent diffremment les composantes de sant dans la sant perue Ouagadougou. Les rsultats du second article indiquaient que le genre fminin tait positivement associ des niveaux plus levs de dtrioration cognitive et de mobilit rduite. L'excs des femmes dans ces incapacits tait seulement partiellement expliqu par les ingalits de genre dans ltat nutritionnel, le statut matrimonial et, dans une moindre mesure, l'ducation. Ces rsultats suggrent que lamlioration de l'tat nutritionnel et des opportunits d'ducation travers le cycle de vie pourrait prvenir la dtrioration cognitive et la mobilit rduite et rduire partiellement l'excs fminin dans ces incapacits. Dans le troisime article, nous avons montr que le manque d'ducation tait positivement associ des niveaux plus levs d'incapacits, et le diffrentiel dtat de sant fonctionnel entre les diffrents niveaux d'ducation restait stable travers l'ge. Ces rsultats suggrent quen Afrique subsaharienne, comparativement aux individus hautement duqus, les personnes faiblement duques ont moins de ressources conomiques et sociales et de saines habitudes de vie qui ont des effets bnfiques, constants sur la sant fonctionnelle selon lge.
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Each day close to 20,000 people become infected with the HIV virus worldwide; a large portion of whom are infected through unprotected sex with sex workers. While condoms are an effective defense against the transmission of HIV and other sexually transmitted infections, large numbers of sex workers are not using them with their clients. We argue that some sex workers are willing to take the risk because clients are willing to pay more to avoid using condoms. Using a panel data set from Mexico, we estimate that sex workers received a 23 percent premium for unprotected sex from clients who requested not to use a condom. However, this premium jumped to 46 percent if the sex worker was considered very attractive. These results suggest that the current policies aimed at educating sex workers about risk, empowering them and improving their access to condoms need to be complemented with interventions aimed at teaching clients about the joy of safe sex thereby increasing the demand for using condoms.
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Objectives: To investigate if the participation of Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. in the bacterial community of bacterial vaginosis (BV) is associated with distinct patterns of this condition. Methods: In this cross-sectional controlled study, 205 women with BV and 205 women with normal flora were included. Vaginal rinsing samples were obtained for measuring the levels of pro-inflammatory cytokines and bacterial sialidases. Real-time PCR was used to quantify the BV-associated bacteria and to estimate the total bacterial load using the 16S rRNA. Principal component analysis (PCA) using the measured parameters was performed to compare the BV samples with lower and higher loads of the species of interest. Results: Higher bacterial load (p<0.001), levels of interleukin 1- (p<0.001) and sialidase activity (p<0.001) were associated with BV. Women with BV and higher relative loads of A vaginae, Megasphaera sp. and Leptotrichia sp. presented increased sialidase activity, but unchanged cytokine levels. PCA analysis did not indicate a different pattern of BV according to the loads of A vaginae, Megasphaera sp. and Leptotrichia sp. Conclusions: Greater participation of A vaginae, Megasphaera sp. and Leptotrichia sp. in vaginal bacterial community did not indicate a less severe form of BV; moreover, it was associated with increased sialidase activity.
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Coordenao de Aperfeioamento de Pessoal de Nvel Superior (CAPES)
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Coordenao de Aperfeioamento de Pessoal de Nvel Superior (CAPES)
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Fundao de Amparo Pesquisa do Estado de So Paulo (FAPESP)
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Although having a large access to information during adolescence, many teenagers are still uninformed on this subject. The aim of this study was verifying which and how are clarified the doubts that students have about Human Sexuality. In this study, 20 students from both genders, from 11 to 15 years old and from the 7th grade attended and answered a questionnaire with 9 questions. The doubts have been categorized in themes: pregnancy, sexually transmitted diseases, contraceptive methods and sexual response. The themes of interest were: the usage of contraceptive methods, puberty, sex and masturbation, pregnancy and virginity. The young reported that is important to talk about sexuality and they have their doubts explained with their parents, mainly the mother, with their friends and also with the internet. It is concluded that the adolescent students revealed doubts about the biological sexuality and did not receive an intentional sexual education at school. It is expected that the school can assume a role of promoting an adequate Sexual Education attending to the demand from these teenagers.
