Tracking land-use/land-cover change in a watershed of the Cordillera Blanca

Climate change is a global phenomenon with differing regional impacts. One region that stands to be severely affected is the Cordillera Blanca mountain range in northwestern Peru, home to the world’s highest concentration of tropical glaciers. The glaciers in the range have lost 11-30 percent of their area over the last four decades, prompting concern for the region’s future hydrological resources. The flow of the region’s primary river, the Rio Santa, has been found to be declining over the last few decades; one hypothesis is that land-use/land-cover change (LULCC) in the river’s watershed has affected the river’s flow. This thesis examines LULCC in the Rio Santa Watershed region to help contribute social research to the physical research being done in the area. A simple supervised classification was performed on four Landsat satellite images from May/September 1986 and 2006, and the results were compared. The results indicated that wetlands and agricultural areas expanded while forested areas declined; however, methodological and data quality issues impaired the validity of the study’s findings. Future research in the area is needed to provide a holistic view of the region’s systems in order to assist planners and agencies in this dynamic landscape. Advisor: Bryan G. MarkNo embarg

Research priorities for adolescent health in low- and middle-income countries: A mixed-methods synthesis of two separate exercises.

BACKGROUND: In order to clarify priorities and stimulate research in adolescent health in low- and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHNRI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda. METHODS: All of the 116 top-ranked questions presented in each exercise were analyzed by two independent reviewers. Word clouds were generated based on keywords from the top-ranked questions. Questions were coded and content analysis was conducted based on type of delivery platform, vulnerable populations, and the Survive, Thrive, and Transform framework from the United Nations Global Strategy for Women's, Children's, and Adolescents' Health, 2016-2030. FINDINGS: Within the 53 top-ranked intervention-related questions that specified a delivery platform, the platforms specified were schools (n = 17), primary care (n = 12), community (n = 11), parenting (n = 6), virtual media (n = 5), and peers (n = 2). Twenty questions specifically focused on vulnerable adolescents, including those living with HIV, tuberculosis, mental illness, or neurodevelopmental disorders; victims of gender-based violence; refugees; young persons who inject drugs; sex workers; slum dwellers; out-of-school youth; and youth in armed conflict. A majority of the top-ranked questions (108/116) aligned with one or a combination of the Survive (n = 39), Thrive (n = 67), and Transform (n = 28) agendas. CONCLUSIONS: This study advances the CHNRI methodology by conducting the first mixed-methods synthesis of multiple research priority-setting exercises by analyzing keywords (using word clouds) and themes (using content analysis)

Healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study

BACKGROUND: Adolescents’ sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa. METHODS: Twenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses. RESULTS: SRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area. CONCLUSIONS: Nurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved

Preserved differentiation between physical activity and cognitive performance across young, middle, and older adulthood over 8 years.

Objectives: A critical question in the activity engagement literature is whether physical exercise alters the trajectory of age-related cognitive decline (differential preservation) or is associated with enhanced baseline cognitive ability (preserved differentiation). Further, investigations considering that these relations may differ across young, middle, and older adulthood are rare. Method: We evaluated data from the PATH Through Life Project, where participants aged 20-24, 40-44, and 60-64 years at baseline (n = 6,869) completed physical activity (PA; mild, moderate, and vigorous) and cognitive measurements thrice over 8 years. Results: Multilevel models accounting for employment status, sex, education, health, and mental and social activity showed that between-person differences in PA participation positively predicted baseline performance on fluid cognitive ability (perceptual speed, short-term memory, working memory, and episodic memory). These effects were similar across age groups, but strongest for the youngest cohort, for whom there was also evidence of covariation between within-person change in PA and cognitive score. PA was not associated with change in cognition over time. DISCUSSION: Results support preserved differentiation, where physically active adults have higher initial cognitive ability, and the advantage is maintained over time. PA appears to be unique in showing differences across young, middle, and older adulthood in predicting cognition

The association between exposure to intimate partner violence and having an abnormal pap test and HPV infections among women in a low-income, urban area

Session presented on Monday, July 27, 2015: Purpose: The purpose of this presentation is to examine the association between intimate partner violence (IPV) and abnormal Papanicolaou (Pap) test results, including human Pepillomavirus (HPV) infection and cellular abnormality. As well as the interaction of exposure to IPV with smoking, psychosocial stress and risky sexual behaviors on abnormal Pap test results. Intimate partner violence (IPV) affects 20-50% of women in the United States sometime in their lives. An estimated 40% of IPV victims seek medical treatment for their injuries. The National Center for Injury Prevention and Control has reported that 33% of all female homicides are perpetrated by current or ex intimate partners and IPV results in 550,000 injuries requiring medical attention every year. The same report estimated the total annual cost of IPV at around $3.9-7.6 billion in the United States. Professional organizations recommend routine screening of all female patients for IPV; however, IPV is significantly underreported, unidentified, and mismanaged by health care providers. It places victims at higher risk for physical injuries, psychosocial problems, Maternal complications, and death. Studies have reported a higher prevalence of IPV among poor women and women from ethnic minority groups; and these groups also had higher rates of many of the health consequences associated with IPV. According to the National Cancer Institute, 12,170 women will be diagnosed with cervical cancer in 2012 with a projected death rate of 4, 220 women. Further, high-risk, human Pepillomavirus (HR-HPV) is a major risk factor for cervical cancer and is associated with 95%-100% of squamous and 75%-95% of intraepithelial cervical cancers. The rate of HPV-associated cervical cancer was significantly higher among Black and Hispanic women compared to their White counterparts. In 2009, the national age-adjusted cervical cancer incidence rates (per 100,000) for Black and Hispanic women (10.0 and 10.9, respectively) were dramatically higher than the rate for White women (7.6). Also, the national age-adjusted cervical cancer mortality rate (per 100,000) for Black women (4.2) is dramatically higher than the rates for Hispanic and White women (2.9 and 2.1, respectively). In addition to race and ethnicity, the incidence rate of cervical cancer increases with higher poverty. Intimate Partner Violence is associated with all the known risk factors for cervical cancer, including smoking, stress, risky sexual behaviors, and HPV infection. Exposure to IPV and the control imposed by the abusive partner may influence the risk for cervical cancer by restricting the woman\u27s ability to seek cervical cancer screening services and screening for cancer at recommended intervals. Exposure to IPV and fear in a relationship interferes with receiving follow-up care among women with abnormal Pap test results as well treatment of cervical cancer. Women exposed to IPV have many of the factors that impact access to health services such as being under or uninsured, living in poverty, lower education, poor employment opportunities, and lower access to transportation. Methods: This prospective, descriptive, correlational study consists of 400 women between the ages of 21 and 50 years recruited from an urban community health center. The majority of women are Black (81%), single (84%), and insured (76%). The study outcomes include exposure to IPV, history of smoking, psychological stress, and risky sexual behaviors. Study participants completed a 20-minute survey about their IPV history, smoking, stress, and risky sexual behaviors. Recent Pap test results and HPV infection status were collected from their health records. Results: Past year exposure to IPV was 13% for physical, 4% for sexual, and 21% for psychological IPV. Lifetime exposure to IPV was 38% for physical, 19% for sexual, and 37% for psychological IPV. A substantial number of women reported current or past smoking (24% and 10%) respectively. The mean number of years of smoking was 7 (SD=6.1). Prevalent risky sexual behaviors included not using a condom (24%), ever having any STIs (40%), and having an intimate partner who has had sex with more than one partner. The average number of sexual partners was 8 in a lifetime (SD=6) and 1.6 in the past year (SD=1.4). Women reported relatively high levels of perceived stress such as often feeling nervous and stressed (56%), upset due to unexpected life events (45%), and angered because things were outside their control (39%). A substantial number of women reported never feeling that things were going their way (16%), able to control irritations in your life (11%), and confident about their ability to handle personal problems (11%). Physical, sexual, and psychological IPV were significantly associated with smoking history, ever having any STI, number of sexual partners, and perceived stress. Having an abnormal Pap test was significantly associated with past year exposure to physical (30.8% vs. 7.1%), sexual (66\u3e7% vs. 8.4%), and psychological IPV (26.7 % vs. 7.2%). Having a positive HPV infection was associated with past year exposure to physical (33.3% vs. 2.0%) and sexual IPV (50.0% vs. 3.8%). Having an abnormal Pap test or a positive HPV infection was not associated with lifetime exposure to IPV. Additional results will be presented about the association between exposure to IPV and each of the mediating cervical cancer risk factors (smoking, perceived stress, and risky sexual behaviors) in a multivariate analysis with calculated adjusted odds ratios and 95% confidence intervals. Conclusion: Exposure to IPV is detrimental to women\u27s gynecologic health. Women exposed to IPV may feel that the Pap test is threatening and a reminder of the abuse and violence. Therefore, in cervical cancer screening, it is important to routinely ask about history or exposure to abuse and apply the strategies of trauma informed care when working with women. On a global level, the World Health Organization (WHO) identified that 1 out of 3 women throughout the world will experience physical or sexual violence by a partner or sexual violence by a non-partner. This study has potential for engaging in scholarly conversations with global partners regarding best practices for women exposed to violence and the impact on cervical abnormalities and HPV infections. The study has received funding from the New Jersey Foundation Grant

Brazilian adolescents' knowledge and beliefs about abortion methods: A school-based internet inquiry

Background: Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics.Methods: We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12-21 years in three Rio de Janeiro public schools.Results: Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil's existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views.Conclusions: Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods

On-going collaborative priority-setting for research activity: a method of capacity building to reduce the research-practice translational gap

Background: International policy suggests that collaborative priority setting (CPS) between researchers and end users of research should shape the research agenda, and can increase capacity to address the research-practice translational gap. There is limited research evidence to guide how this should be done to meet the needs of dynamic healthcare systems. One-off priority setting events and time-lag between decision and action prove problematic. This study illustrates the use of CPS in a UK research collaboration called Collaboration and Leadership in Applied Health Research and Care (CLAHRC). Methods: Data were collected from a north of England CLAHRC through semi-structured interviews with 28 interviewees and a workshop of key stakeholders (n = 21) including academics, NHS clinicians, and managers. Documentary analysis of internal reports and CLAHRC annual reports for the first two and half years was also undertaken. These data were thematically coded. Results: Methods of CPS linked to the developmental phase of the CLAHRC. Early methods included pre-existing historical partnerships with on-going dialogue. Later, new platforms for on-going discussions were formed. Consensus techniques with staged project development were also used. All methods demonstrated actual or potential change in practice and services. Impact was enabled through the flexibility of research and implementation work streams; ‘matched’ funding arrangements to support alignment of priorities in partner organisations; the size of the collaboration offering a resource to meet project needs; and the length of the programme providing stability and long term relationships. Difficulties included tensions between being responsive to priorities and the possibility of ‘drift’ within project work, between academics and practice, and between service providers and commissioners in the health services. Providing protected ‘matched’ time proved difficult for some NHS managers, which put increasing work pressure on them. CPS is more time consuming than traditional approaches to project development. Conclusions: CPS can produce needs-led projects that are bedded in services using a variety of methods. Contributing factors for effective CPS include flexibility in use and type of available resources, flexible work plans, and responsive leadership. The CLAHRC model provides a translational infrastructure that enables CPS that can impact on healthcare systems

Sexual Power and HIV Risk, South Africa1

Among a sample of young women, limited sexual power was associated with inconsistent condom use but not directly with HIV

A new conceptual framework for maternal morbidity

© 2018 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. Background: Globally, there is greater awareness of the plight of women who have complications associated with pregnancy or childbirth and who may continue to experience long-term problems. In addition, the health of women and their ability to perform economic and social functions are central to the Sustainable Development Goals. Methods: In 2012, WHO began an initiative to standardize the definition, conceptualization, and assessment of maternal morbidity. The culmination of this work was a conceptual framework: the Maternal Morbidity Measurement (MMM) Framework. Results: The framework underscores the broad ramifications of maternal morbidity and highlights what types of measurement are needed to capture what matters to women, service providers, and policy makers. Using examples from the literature, we explain the framework's principles and its most important elements. Conclusions: We express the need for comprehensive research and detailed longitudinal studies of women from early pregnancy to the extended postpartum period to understand how health and symptoms and signs of ill health change. With respect to interventions, there may be gaps in healthcare provision for women with chronic conditions and who are about to conceive. Women also require continuity of care at the primary care level beyond the customary 6 weeks postpartum

Behind the silence of harmony: risk factors for physical and sexual violence among women in rural Indonesia

BACKGROUND: Indonesia has the fourth largest population in the world. Few studies have identified the risk factors of Indonesian women for domestic violence. Such research will be useful for the development of prevention programs aiming at reducing domestic violence. Our study examines associations between physical and sexual violence among rural Javanese Indonesian women and sociodemographic factors, husband's psychosocial and behavioral characteristics and attitudes toward violence and gender roles. METHODS: A cohort of pregnant women within the Demographic Surveillance Site (DSS) in Purworejo district, Central Java, Indonesia, was enrolled in a longitudinal study between 1996 and 1998. In the following year (1999), a cross-sectional domestic violence household survey was conducted with 765 consenting women from that cohort. Female field workers, trained using the WHO Multi-Country study instrument on domestic violence, conducted interviews. Crude and adjusted odds ratios at 95% CI were applied for analysis. RESULTS: Lifetime exposure to sexual and physical violence was 22% and 11%. Sexual violence was associated with husbands' demographic characteristics (less than 35 years and educated less than 9 years) and women's economic independence. Exposure to physical violence among a small group of women (2-6%) was strongly associated with husbands' personal characteristics; being unfaithful, using alcohol, fighting with other men and having witnessed domestic violence as a child. The attitudes and norms expressed by the women confirm that unequal gender relationships are more common among women living in the highlands and being married to poorly educated men. Slightly more than half of the women (59%) considered it justifiable to refuse coercive sex. This attitude was also more common among financially independent women (71%), who also had a higher risk of exposure to sexual violence. CONCLUSIONS: Women who did not support the right of women to refuse sex were more likely to experience physical violence, while those who justified hitting for some reasons were more likely to experience sexual violence. Our study suggests that Javanese women live in a high degree of gender-based subordination within marriage relationships, maintained and reinforced through physical and sexual violence. Our findings indicate that women's risk of physical and sexual violence is related to traditional gender norms