Seguimiento de la ejecución del Plan Municipal de Igualdad entre Mujeres y Hombres (2007-2011)

Este trabajo aborda, desde una aplicación práctica de los contenidos adquiridos en el Máster de Relaciones de Género, el seguimiento de la ejecución del Plan de Igualdad entre Mujeres y Hombres de Zaragoza (PIMHZ). Este seguimiento se realiza sobre las acciones ejecutadas en el segundo semestre de 201

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Equity in access to HIV/AIDS services in Zambia : the role of social cohesion in HIV prevention and care

Zambia has for many years experienced a generalised HIV epidemic. Large-scale antiretroviral programmes have been successfully introduced (Egger et al. 2005; Stringer et al. 2006). Despite progress in controlling both new infections and access to treatment, the scale and impact of the epidemic remain major concerns. Persistent social inequalities and discrimination continues to create significant barriers to access HIV/AIDS services. It has been argued that social cohesion, understood as collective networks of solidarity and trust in a society, could reduce susceptibility and vulnerability to HIV (Meyer-Weitz, 2005; Loewenson, 2007) and generate social action (Kawachi et al., 1997). This thesis aimed to investigate the influence of social cohesion along the continuum of HIV care in Zambia (uptake of testing; uptake of ART; adherence to ART and retention in care). To do so, a community-based cross-sectional survey methodology was implemented in four sites in the Southern and Central provinces of Zambia: two rural (Namwala and Monze district), one commercial centre (Mazabuka) and one urban area (Lusaka). The study population consisted of adults, women and men, over the age of 18, who were residents of one of the four sites. The main conclusions of this thesis are based on the results of four studies conducted to explore the effect of social cohesion along the HIV care continuum. The results are presented in four scientific papers that have been included as chapters in this thesis (Chapter 6 to Chapter 9) The box below presents an overview of what this thesis adds to the existing evidence. What is already known? Social cohesion plays a positive role in both reducing susceptibility to HIV and dealing with vulnerability to AIDS. Gender-based violence and gender inequalities increase vulnerability to HIV infection and deter uptake of HIV testing in women. HIV/AIDS-related stigma is a major barrier to HIV prevention efforts hampering uptake of HIV testing, adherence to ART and delaying general health seeking among people with HIV. The existing quantitative studies on the link between poverty and HIV/AIDS present conflicting evidence. What does this thesis add? In Zambia, social cohesion - measured by networks of action, trust and reciprocity either at the level of the couple, the family and the community - plays a significant role in access to HIV/AIDS services even when factors such as stigma, socio-economic status, gender and other individual factors are taken into account. Not all levels of social cohesion (couple, family and community) exert their effect in the same way along the continuum of HIV care. Not only enacted violence but tolerance to gender-based violence within households hampers the uptake of HIV testing. This is often a reflection of prevailing social norms with respect to gender and power relations in a community. High levels of tolerance to gender-based violence are more common in discohesive environments. HIV/AIDS-related stigma strongly hinders uptake of testing and retention in care. High levels of stigma are more common in discohesive environments. Livelihoods insecurity deters uptake of treatment and adherence especially in women. However, increasing social ties can help balance this negative effect. Promoting social cohesion among men, especially through increasing men’s participation in community activities, could have harmful effects unless underlying gender norms of masculinity are mainstreamed in the design of the intervention. What do these findings lead to? Social discohesion and disempowering conditions (discriminatory gender norms, high levels of stigma and livelihoods insecurity) are the recurrent obstacles of access along the HIV continuum of care in Zambia. The strategy to scale up access to HIV/AIDS services in Zambia needs to prioritize interventions aimed at promoting social cohesion and reducing disempowering conditions which are especially present in discohesive environments. Social cohesion primarily deals with creating environments that enable couples, families and/or communities to overcome (inevitable) social tensions and conflicts. These enabling environments can be achieved through facility-, community- and policy/institutional- level interventions promoting non-violence and gender-equitable norms as well as mobilizing communities to enforce laws preventing discrimination based on gender and/or HIV status. In conclusion, promoting greater social cohesion in local communities in Zambia has the potential to reduce social inequalities that deters access to HIV/AIDS services. It may also facilitate collective action, for reducing tolerance to violence, reducing stigma and discrimination and compensating economic burden. However, the mobilisation of social cohesion in local communities requires an awareness of the risk of rising inequality, especially for men unless “masculine” gender norms are changed

A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa.

BACKGROUND: Despite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking. METHODS: Using Noblit and Hare's meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass' notion of first-, second-, and third-order constructs. RESULTS: The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as 'opt-out' provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers' inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women's decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing. CONCLUSIONS: Improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA

A case of acquired trichorrhexis nodosa after applying new hair spray

AbstractTrichorrhexis nodosa is a hair shaft disorder presented with whitish nodes all over the hair (diffuse form) or localized to an area (localized form) and could be either congenital or acquired. We are reporting a case of acquired localized form of trichorrhexis nodosa due to trauma (physical–chemical)

HIV testing and tolerance to gender based violence : a cross-sectional study in Zambia

This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR = 2.48 95% CI = 1.00-6.19); tolerance to gender-based violence (OR = 2.10 95% CI = 1.05-4.32) and fear of social rejection (OR = 1.48 95% CI = 1.23-1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families