Factores comportamentales y psicológicos asociados a la hipertensión arterial en pacientes atendidos en EsSalud Puno

El presente estudio tuvo como objetivo determinar los factores comportamentales y psicológicos asociados a la Hipertensión Arterial en pacientes atendidos en ESSALUD Puno. Siendo de tipo analítico, correlacional con diseño no experimental, transversal, la muestra estuvo conformada por 130 pacientes hipertensos; la técnica utilizada fue la encuesta y como instrumento el cuestionario sobre consumo de tabaco, consumo de alcohol, actividad física, cuestionario de Bortner para personalidad tipo A y el Test de estrés de Leveinsten. Para el análisis estadístico se utilizó la Prueba de Chi cuadrado con un margen de error del 5% y el coeficiente de contingencia. Los resultados muestran que el 36.9% no consume tabaco, el 27,7% consume alcohol de 2 a 3 veces por semana, el 34,6% consume cerveza, el 36,9% consume de 7-9 vasos en un día, el 43,1% realiza actividad física aeróbica, el 26,2% menos de 10 minutos y el 25,4% algunas veces, el 42.3% presenta estrés moderado y el 34,6% personalidad tipo “A”. De acuerdo al planteamiento de hipótesis se acepta la hipótesis nula y se rechaza la hipótesis alterna: los factores comportamentales y psicológico no están relacionados con la hipertensión arterial donde la prueba estadística no es significativa, pero según el coeficiente de contingencia r de Pearson propuesta por Elorza existe relación positiva débil en: no consume tabaco, consumo de bebidas alcohólicas de dos a tres veces por semana, consumo de cerveza y cantidad de siete a nueve copas/vasos en un día; en tipo de actividad física existe una relación positiva débil, en tiempo menor a diez minutos y frecuencia algunas veces existe relación positiva muy débil; en estrés moderado y personalidad tipo “A” existe una relación positiva débil.Tesi

Protocol: Child and adolescent mental health and psychosocial support interventions: an evidence and gap map of low- and middle-income countries

This is the protocol for a Campbell review. The objective of this evidence and gap map is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in low- and middle-income countries

Is elimination of vertical transmission of HIV in high prevalence settings achievable?

Ameena Goga and colleagues argue that more realistic targets are needed to maintain momentum on reducing vertical transmission in countries with a high HIV prevalence.The South African Medical Research Council (SAMRC)http://www.bmj.com/thebmjam2020Paediatrics and Child Healt

Closing the know-do gap for child health: UNICEF's experiences from embedding implementation research in child health and nutrition programming.

UNICEF operates in 190 countries and territories, where it advocates for the protection of children's rights and helps meet children's basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition.This paper presents UNICEF's embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work.From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods.UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale

The case for viral load testing in adolescents in resource-limited settings.

INTRODUCTION: The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low- and middle-income settings, particularly in sub-Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90-90-90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges. DISCUSSION: Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second-line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third-line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens. CONCLUSIONS: Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale-up

Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa.

INTRODUCTION: Observational studies have shown considerable attrition among adolescents living with HIV across the "cascade" of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. METHODS: We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. RESULTS AND DISCUSSION: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents' engagement in HIV care. Stigma was the most salient factor impeding adolescents' interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. CONCLUSIONS: Adolescents' initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as "test and treat" policies are scaled up

Revealing the impact of loss : Exploring mental health through the use of drawing/writing with HIV positive adolescents in Johannesburg

This document is the Accepted Manuscript of the following article: Nataly Woollett, Heena Brahmbhatt, Kate Dodd, Michelle Booth, Hayley Berman, and Lucie Cluver, 'Revealing the impact of loss: Exploring mental health through the use of drawing/writing with HIV positive adolescents in Johannesburg', Children and Youth Services Review, Vol. 77: 197-207, June 2017. Under embargo until 29 October 2018. The Version of Record is available online at https://doi.org/10.1016/j.childyouth.2017.04.021. © 2017 Elsevier Ltd. All rights reserved.Research that utilises non-verbal methods, such as drawings, are also increasingly recognised as particularly ethical as they offer research subjects active participation in the research process, authenti- cating their voice through their engagement, offering more develop- mentally appropriate means of accessing data, diminishing stress in the child/adolescent-adult interaction and providing a more comfortable method of engagement than languagePeer reviewedFinal Accepted Versio

Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV : Cluster Randomised Controlled Trial

Young South Africans, especially women, are at high risk of HIV. We evaluated the effects of PREPARE, a multi-component, school-based HIV prevention intervention to delay sexual debut, increase condom use and decrease intimate partner violence (IPV) among young adolescents. We conducted a cluster RCT among Grade eights in 42 high schools. The intervention comprised education sessions, a school health service and a school sexual violence prevention programme. Participants completed questionnaires at baseline, 6 and 12 months. Regression was undertaken to provide ORs or coefficients adjusted for clustering. Of 6244 sampled adolescents, 55.3 % participated. At 12 months there were no differences between intervention and control arms in sexual risk behaviours. Participants in the intervention arm were less likely to report IPV victimisation (35.1 vs. 40.9 %; OR 0.77, 95 % CI 0.61-0.99; t(40) = 2.14) suggesting the intervention shaped intimate partnerships into safer ones, potentially lowering the risk for HIV

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd