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D'Ambruoso, Lucia, et al.
(författare)
Maternal mortality and severe morbidity in rural Indonesia Part 2: Implementation of a community audit : [Maternal mortality and severe morbidity in rural Indonesia Part 2: Implementation of a community audit]
2012
Ingår i: Social Medicine. - : Latin American Association of Social Medicine. - 1557-7112. ; 7:2, s. 86-97
Tidskriftsartikel (refereegranskat) abstract
Introduction: In the absence of unifying conceptual and operational frameworks, there have been calls to share practical experiences of community participation in health (CPH) to document the contexts and dynamics of participatory practice.Objectives: This article describes the implementation of a participatory community-based audit of care in obstetric emergencies that was conducted in rural Indonesia.Methods: Four village-based groups were convened to review a series of cases of maternal death and disability and to develop recommendations for health planning. Thematic narrative analysis of the discussion transcripts was employed to describe how participation occurred.Results: Participation was complex and dynamic and evolved over the course of the study. Although blame and defensiveness characterized the early discussions, over time, participants became less condemning of individuals and more so of systems and services, situating individual behaviors within the wider health system context. Participants also increasingly shared personal experiences, generating rich and explicit assessments of care. Eliciting this information was contingent on skillful facilitation, assuring anonymity, and instilling "permission to criticize" among the participants. Sufficient time was also required to convey the necessary principles and reassurances. Despite evidence the process had resulted in women and community members being more prepared, informed, and responsive toward obstetric emergencies in villages, the short-term nature of the study meant that implementation and evaluation of the recommendations were not possible. Without a sustained and ongoing approach, the potential for impact, sustainability and empowerment were limited.Conclusions: The study demonstrates that when carefully implemented, CPH can yield rich explanatory accounts of adverse health events, providing unique information for health planning. We recommend the method for routine district health planning, configured as a continuous process characterized by autonomy, authority, and self-reliance, and involving those excluded by health and social systems. Despite its potential and relevance, authentic CPH may be threatened by wider socio-economic and political conditions, as well as by prevailing evidence hierarchies that exist in public health research. We recommend policy and research to establish a firmer foundation for this progressive, yet obscured, public health concept.
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de la Fuente, Luis, et al.
(författare)
Metodología del estudio de cohortes del proyecto ITINERE sobre consumidores de heroína en tres ciudades españolas y características básicas de los participantes
2005
Ingår i: Revista Española de Salud Pública. - 1135-5727. ; 79, s. 475-491
Tidskriftsartikel (refereegranskat) abstract
Cohort Study Methodology of the ITINERE Project on Heroin Users in Three Spanish Cities and Main Characteristics of the ParticipantsBackground: Cohort studies make it possible to monitor the health impact of drug use and to identify related factors. We describe the methodology and baseline characteristics of a cohort of heroin users designed with this objective. Methods: The participants were 991 young, community-recruited heroin users in Barcelona, Madrid and Seville. Most subjects were named by other participants (39.7%) or by non-participating drug users or ex-users (44.7%). A computer-aided questionnaire was administered (self-administered with audio for questions related with sex). A dried-blood spot sample was collected and anthropometric measurements were made. Both participants and recruiters received remuneration. Univariate and bivariate statistical methods were used. Results: Some 42.4% had changed the main route of heroin administration, mainly to injection in Barcelona and to the pulmonary route in Seville. About 75.8% (Barcelona), 49.8% (Madrid), and 15.5% (Seville) had injected drugs in the last 12 months. In Madrid and Seville, 96-97% used heroin in base form, while in Barcelona heroin hydrochloride predominated. Heroin and cocaine were frequently mixed in the same dose (generally base cocaine in Madrid and Seville, and cocaine hydrochloride in Barcelona). Conclusions: Important geographic differences persist in the prevalence of drug injection and in the patterns of heroin and cocaine use, which could explain the unequal distribution of some health problems. The difficulties encountered in recruiting the sample suggest that the incidence of heroin use has declined considerably.
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Escolar-Pujolar, Antonio, et al.
(författare)
El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía
2018
Ingår i: Endocrinología, Diabetes y Nutrición. - : Elsevier. - 2530-0180 .- 2530-0164. ; 65:1, s. 21-29
Tidskriftsartikel (refereegranskat) abstract
Objetivos: Evaluar el efecto modificador del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus (DM) en Andalucía.Material y métodos: Estudio transversal a partir de la Cohorte Censal 2001 de Andalucía. Se estudiaron defunciones por DM entre 2002 y 2013 según nivel de estudios y estado civil. Se calcularon tasas de mortalidad ajustadas por edad (TA) y razones de tasas de mortalidad (RTM) mediante modelos de regresión de Poisson, controladas por otras variables sociodemográficas. Se evaluó el efecto modificador del estado civil incorporando a los modelos un término de interacción. Todos los análisis se realizaron separadamente para hombres y mujeres.Resultados: Sobre un total de 4.229.791 sujetos se registraron 18.158 muertes por DM (10.635 mujeres y 7.523 hombres). A medida que disminuye el nivel educativo aumenta el riesgo de muerte. El estado civil modifica la desigualdad social en la mortalidad por DM de forma diferente en cada sexo. Las mujeres viudas y separadas/divorciadas con menor nivel de estudios presentan las mayores RTM: 5,1 (IC 95%: 3,6-7,3) y 5,6 (IC 95%: 3,6-8,5), respectivamente, mientras que los hombres solteros tienen la RTM más elevada: 3,1 (IC 95%: 2,7-3,6).Conclusiones: El nivel de estudios es un determinante fundamental de la mortalidad por DM en ambos sexos; su relevancia es mayor entre las mujeres, mientras que en los hombres también el estado civil es un factor clave. Para abordar las desigualdades en la mortalidad nuestros resultados sugieren que el énfasis actual en los factores individuales y el autocuidado debería extenderse hacia intervenciones sobre la familia, la comunidad y los contextos sociales más cercanos a los pacientes.
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González-De Schroeder, María Mercedes, et al.
(författare)
Vigilancia ambiental de la circulación de poliovirus en tres municipios considerados como punto transitorio de migrantes en Colombia 2017-2019
2022
Ingår i: Infectio. - : Asociacion Colombiana de Infectologia - ACIN. - 0123-9392 .- 2422-3794. ; 26:2, s. 107-112
Tidskriftsartikel (refereegranskat) abstract
Objective: To determine the circulation of poliovirus in three municipalities considered as transitory points for migrants in Colombia. Material and Method: Wastewater samples (n = 36) were collected from border municipalities, selected for greater transit of regular and irregular migrants, in the period between 2017-2019. The samples were concentrated and cultured following the World Health Organization (WHO) environmental surveillance algorithm for poliovirus circulation. Molecular identification was performed by polymerase chain reaction using group-specific, serotype and sabin vaccine strain primers. Results: The presence of non-polio Enterovirus (NPV) was detected in the environmental samples obtained and no circulation of poliovirus derived from the vaccine or wild poliovirus was found in the three evaluated municipalities; However, in two previous studies published by Gonzales et al with a similar methodology in 2005 and 2015 evaluating the wastewater of the city of Armenia-Quindío; It was possible to identify the presence of virus derived from vaccine, with negative results for the identification of wild poliovirus. Conclusions: The findings indicate that the wastewater monitoring system in order to determine the presence of viruses is a useful tool to carry out environmental surveillance.
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González, María M., et al.
(författare)
Seroprevalencia de anticuerpos a virus del sarampión, rubeola, parotiditis, hepatitis B y los tres serotipos de poliovirus, en niños de Quindío, Colombia
2016
Ingår i: Revista de Salud Publica. - : Universidad Nacional de Colombia. - 0124-0064. ; 18:1, s. 95-103
Tidskriftsartikel (refereegranskat) abstract
Objective: The main goal of this research was to assess the seroprevalence of antibodies against measles, rubella, mumps, hepatitis B and all three poliovirus serotypes among children in the Quindio Department, Colombia. Methods: Blood samples were obtained from 170 healthy children aged 5-9 years from nine municipalities in Quindio. The presence of serum IgG antibodies against measles, rubella, mumps and Hepatitis B were determined using commercial indirect ELISA kits. Immunity to poliomyelitis was assessed through the presence of neutralizing antibodies following the method recommended by the World Health Organization. Results: Among the 170 children enrolled, 169 (99.41%), 170(100 %), and 167 (98.2 %) were seropositive to poliovirus 1, poliovirus 2, and poliovirus 3, respectively. The average reciprocal antibody titers were 178 for poliovirus type 1, 120 for type 2 and 56 for type 3. Of the 170 children, 96.47 % were protected against mumps and rubella, and 86.47 % against measles. Only 106 (62.35 %) of the studied subjects were proved to be seropositive to hepatitis B. Conclusion: The immunization program in Quindio has provided seroprotection against all three poliomyelitis serotypes, rubella and mumps. However, the child population is not fully protected against measles and hepatitis B virus infections.
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Juárez, Sol Pía
(författare)
Calidad de los datos del Instituto Nacional de Estadística para la elaboración de los indicadores de salud perinatal : pequeño y grande para su edad gestacional [Quality of the Spanish Vital Statistics to Estimate Perinatal Health Outcomes: Small and Large for Gestational Age]
2015
Ingår i: Revista Española de Salud Pública. - 1135-5727. ; 89:1, s. 85-91
Tidskriftsartikel (refereegranskat) abstract
Background: Relative measures of birthweight (small and large-for-gestational age, SGA-LGA) are increasingly preferred to absolute measures (low birthweight, macrosomia). In this study we assess whether the national vital statistics provided by the Spanish National Statistical Institute (INE) reliably estimate SGA and LGA. Also, we will assess whether missing data (selection) and misreported information (bias) are systematically associated with parental socioeconomic information. Methods: We linked the information on 6,339 births at the Hospital Clínico San Carlos of Madrid (2005-06) with the vital statistics records (successful for the 95% of the observation). Validity measures and concordance were estimated for low birthweight (LBW, <2500 gr), macrosomia (>4500 gr), SGA (<10th percentile) and LGA (>90 percentile). Logistic regressions were fitted. Results: The prevalence estimated with the hospital data were: LBW (6%), macrosomia (0.5%) SGA (1%) and LGA (15%) and, with the data from INE: 5% 0.5% 2% 12% respectively. Kappa statistics: LBW (83%), macrosomia (79%), PEG (24%) and LGA (82%). Missing and misreported data vary with parental nationality and their situation in the labor market (OR between 1.5 y 2.2). Conclusions: Vital statistics overestimate the prevalence of SGA and underestimate the prevalence of LGA. The concordance between the sources is very good for low birthweight, macrosomia and LGA, and moderately good for SGA. Both missing and misreported birthweight and gestational age are associated with parental socioeconomic characteristics.
