-
The Pan African Medical Journal 2024the increasing number of people receiving antiretroviral therapy (ART) in sub-Saharan Africa has stressed already overburdened health systems. A care model utilizing...
INTRODUCTION
the increasing number of people receiving antiretroviral therapy (ART) in sub-Saharan Africa has stressed already overburdened health systems. A care model utilizing community-based peer-groups (ART Co-ops) facilitated by community health workers (CHW) was implemented (2016-2018) to address these challenges. In 2018, a post-intervention study assessed perceptions of the intervention.
METHODS
forty participants were engaged in focus group discussions consisting of ART Co-op clients, study staff, and health care providers from Kitale HIV clinic. Data were analyzed thematically for content on the intervention, challenges, and recommendations for improvement.
RESULTS
all participants liked the intervention. However, some reported traveling long distances to attend ART Co-op meetings and experiencing stigma with ART Co-ops participation. The ART Co-op inclusion criteria were considered appropriate; however, additional outreach to deliberately include spouses living with HIV, the disabled, the poor, and HIV pregnant women was recommended. Participants liked CHW-directed quarterly group meetings which included ART distribution, adherence review, and illness identification. The inability of the CHW to provide full clinical care, inconvenient meeting venues, poor timekeeping, and non-attendance behaviors were noted as issues. Participants indicated that program continuation, regular CHW training, rotating meetings at group members´ homes, training ART Co-ops leaders to assume CHW tasks, use of pill diaries to check adherence, nutritional support, and economically empowering members through income generation projects would be beneficial.
CONCLUSION
the intervention was viewed positively by both clinic staff and clients. They identified specific challenges and generated actionable key considerations to improve access and acceptability of the community-based model of care.
Topics: Humans; Kenya; HIV Infections; Female; Community Health Workers; Focus Groups; Male; Adult; Anti-HIV Agents; Social Stigma; Peer Group; Anti-Retroviral Agents; Medication Adherence; Middle Aged; Young Adult; Community Health Services; Perception
PubMed: 38828427
DOI: 10.11604/pamj.2024.47.113.41843 -
World Development Jun 2024The dynamics in intra-household decision-making are often neglected in literature on the adoption of agricultural innovations. However, households' farm management...
The dynamics in intra-household decision-making are often neglected in literature on the adoption of agricultural innovations. However, households' farm management decisions are often made following negotiations between female and male farmers. These may differ in terms of individual bargaining power and personal preferences. A better understanding of the links between gender roles in household decision-making and the adoption of technologies is postulated to enhance the uptake of innovations in smallholder farming systems. In this study, we use survey data from 1,088 wheat-producing households in Ethiopia to analyze the links between women's role in household decisions concerning crop production and the adoption and turnover rates of rust-resistant wheat varieties. We interviewed female and male respondents from the same households, but separately, which facilitated capturing individual perceptions and the intra-household dynamics in decision-making. To account for observed heterogeneity that may simultaneously determine the level of women's agency and varietal adoption by households, we employed Inverse Probability-Weighted Regression Adjustment (IPWRA). A positive association was found between women's role in decision-making concerning choice of wheat seed and household adoption of rust-resistant wheat varieties and wheat varietal turnover. Spouses may be in agreement or have different opinions regarding their decision-making roles. The disagreement scenario in which the wife claims to have a role in decision-making is associated with lower adoption rates of rust-resistant wheat varieties and less frequent testing of new varties in recent growing seasons, compared to a scenario where both spouses agree that wives do not have a role. We conclude that gender-disaggregated data and the examination of intra-household decision-making can offer novel and valuable insights for designing and implementing strategies to enhance the uptake of agricultural technologies among smallholders. The results emphasize the need to include complementary perspectives on the intra-household decision-making process.
PubMed: 38826843
DOI: 10.1016/j.worlddev.2024.106567 -
International Journal of General... 2024Genetic factors contribute significantly to the risk of ischaemic heart disease (IHD), which is the leading cause of mortality in Bangladesh. The BANGABANDHU...
BACKGROUND
Genetic factors contribute significantly to the risk of ischaemic heart disease (IHD), which is the leading cause of mortality in Bangladesh. The BANGABANDHU (Bangladeshi Atherosclerosis Biobank AND Hub) study will allow a hypothesis-free genome-wide association study (GWAS) to identify genetic risk factors associated with ischaemic heart disease patients undergoing coronary artery bypass graft (CABG) surgery in Bangladesh.
METHODS
This is a multi-centre population-based case-control study aimed to evaluate 1500 (Fifteen Hundred) adult (≥18 years of age) people divided into 2 study groups: Case/Proband (750 IHD patients undergoing CABG surgery) and Control (750 healthy people). Spouses or family members are preferred as healthy control subjects due to their shared geographic location and similar environmental exposure.
RESULTS
This will be the first largest DNA repository of CABG patients in Bangladesh, and identifying novel gene loci among CABG patients might help to discover novel therapeutic targets for Bangladeshi IHD patients. Further, identifying and comparing novel gene loci among CABG patients with other ancestry might help devise national guidelines for treating coronary artery disease.
CONCLUSION
Promising current study results will encourage Bangladeshi researchers and pharmaceutical companies to conduct further studies into the genetic basis of Bangladeshi complex coronary artery disease, which might identify novel genes for therapeutic targets for Bangladeshi patients and strengthen the healthcare standards in Bangladesh.
PubMed: 38826511
DOI: 10.2147/IJGM.S466706 -
BMC Geriatrics Jun 2024Disability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles'...
BACKGROUND
Disability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles' links to end-of-life care arrangements and place of death, and predictors of the profiles.
METHODS
In total, data were extracted from the records of 10,529 deceased individuals from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analyses, bivariate analysis, and multivariate logistic regression were applied to identify prior-to-death disability profiles, explore the profiles' links to end-of-life care arrangements and place of death, and examine predictors in the profiles, respectively.
RESULTS
Three prior-to-death disability profiles, namely, Disabled-Incontinent (37.6%), Disabled-Continent (34.6%), and Independent (27.8%), were identified. Those with the Independent profile were more likely to live alone or with a spouse and receive no care or care only from the spouse before death. Disabled-Continent older adults had a higher chance of dying at home. Being female, not "married and living with a spouse", suffering from hypertension, diabetes, stroke or cerebrovascular disease (CVD), bronchitis/emphysema/pneumonia, cancer, or dementia, and dying in a later year were associated with more severe prior-to-death disability patterns. Not having public old-age insurance predicted lower chances of having a Disabled-Incontinent profile, and advanced age increased the chance of having a Disabled-Continent profile.
CONCLUSIONS
Three prior-to-death disability patterns were identified for Chinese adults aged 65 years and older. These profiles were significantly linked with the end-of-life caregiving arrangements and place of death among older adults. Both demographic information and health status predicted prior-to-death disability profiles.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; China; Death; Disabled Persons; East Asian People; Longitudinal Studies; Terminal Care
PubMed: 38824494
DOI: 10.1186/s12877-024-05105-y -
BMC Public Health May 2024spousal violence against women (SVAW) is a common form of violence that occurs within the family context, with spouses being the main perpetrators. Afghanistan has one...
BACKGROUND
spousal violence against women (SVAW) is a common form of violence that occurs within the family context, with spouses being the main perpetrators. Afghanistan has one of the highest rates of SVAW in the world, and its impact on reproductive health and fertility is not well understood. This study aims to investigate the extent to which SVAW influences the total fertility rate (TFR) of Afghan women.
METHODS
In this study, a regression model of discrete-time survival models was used to calculate the total fertility rate (TFR), parity progression ratio (PPRs), and average closed birth intervals (CBI) between two children. The method used in this study has its roots in the works of Griffin Finney (1983) and was further developed by Redford et al. (2010). The study population utilized the 2015 Afghanistan Demographic and Health Survey, and sample weights were used to ensure accurate estimates for the population of Afghanistan as a whole.
RESULTS
The study found that women in Afghanistan who have experienced SV are more likely to progress to the next parity, start childbearing faster, and continue to do so. Women who have not experienced SV tend to progress to higher parities at a slower pace during their initial reproductive years. The study also suggests that women with spousal violence (SV) experience may have slightly higher fertility rates and shorter birth intervals for certain birth orders, although the differences between the two groups are generally small. Specifically, the total fertility rate (TFR) for women who experienced SV was 6.9, while the TFR for women who did not experience SV was 6.2.
CONCLUSIONS
These results provide valuable information for policymakers and public health professionals in developing effective policies and programs to address SVAW and improve maternal and child health outcomes in Afghanistan.
Topics: Humans; Afghanistan; Female; Adult; Birth Rate; Spouse Abuse; Young Adult; Adolescent; Middle Aged; Health Surveys; Pregnancy
PubMed: 38822292
DOI: 10.1186/s12889-024-18944-6 -
Gynecologic Oncology May 2024Due to limited data on homologous recombination deficiency (HRD) in older patients (≥ 70 years) with advanced stage high grade serous ovarian cancer (HGSC), we aimed...
OBJECTIVE
Due to limited data on homologous recombination deficiency (HRD) in older patients (≥ 70 years) with advanced stage high grade serous ovarian cancer (HGSC), we aimed to determine the rates of HRD at diagnosis in this age group.
METHODS
From the Phase 3 trial VELIA the frequency of HRD and BRCA1/2 pathogenic variants (PVs) was compared between younger (< 70 years) and older participants. HRD and somatic(s) BRCA1/2 pathogenic variants (PVs) were determined at diagnosis using Myriad myChoice® CDx and germline(g) BRCA1/2 PVs using Myriad BRACAnalysis CDx®. HRD was defined if a BRCA PV was present, or the genomic instability score (GIS) met threshold (GIS ≥ 33 & ≥ 42 analyzed).
RESULTS
Of 1140 participants, 21% were ≥ 70 years. In total, 26% (n = 298) had a BRCA1/2 PV and HRD, 29% (n = 329) were HRD/BRCA wild-type, 33% (n = 372) non-HRD, and 12% HR-status unknown (n = 141). HRD rates were higher in younger participants, 59% (n = 476/802), compared to 40% (n = 78/197) of older participants (GIS ≥ 42) [p < 0.001]; similar rates demonstrated with GIS ≥ 33, 66% vs 48% [p < 0.001]. gBRCA PVs observed in 24% younger vs 8% of older participants (p < 0.001); sBRCA in 8% vs 10% (p = 0.2559), and HRD (GIS ≥ 42) not due to gBRCA was 35% vs 31% (p = 0.36).
CONCLUSIONS
HRD frequency was similar in participants aged < 70 and ≥ 70 years (35% vs 31%) when the contribution of gBRCA was excluded; rates of sBRCA PVs were also similar (8% v 10%), thus underscoring the importance of HRD and BRCA testing at diagnosis in older patients with advanced HGSC given the therapeutic implications.
PubMed: 38821039
DOI: 10.1016/j.ygyno.2024.05.021 -
PloS One 2024Providing care for individuals dealing with long-term illnesses like cancer demands significant amounts of time, energy, and emotional investment, potentially resulting...
BACKGROUND
Providing care for individuals dealing with long-term illnesses like cancer demands significant amounts of time, energy, and emotional investment, potentially resulting in a challenging and overwhelming quality of life for those providing the care.
OBJECTIVE
The purpose of this study was to assess the level of health-related quality of life (HRQoL) and associated factors among family caregivers of patients with cancer in oncologic centers of Northwest Ethiopia.
METHOD
A cross-sectional study was conducted among 412 family caregivers of patients with cancer who were following treatment at oncologic centers in Northwest Ethiopia from August to October 2023. Systematic random sampling was used to enroll study participants. Epi-data version 4.6.1 and SPSS version 26 were used for data entry and analysis, respectively. The relationship between quality of life and independent variables was examined using linear regression. Statistical significance was determined for variables having a p-value of less than 0.05 at a 95% confidence range.
RESULT
A total of 412 eligible caregivers were included in the study out of 422 approached samples, yielding a 97.6% response rate. The mean score of the overall Quality of Life Brief-Scale Version was 52.7 ± 9.57. Being Spouse (β = -3.39; 95% CI: -6.49, -0.29), presence of chronic illness (β = -3.43; 95% CI: -5.56, -1.31), depression, (β = -2.55; 95% CI: -4.34, -0.75), anxiety (β = -3.27; 95% CI: -5.22, -1.32),and social support, (β = -3.61; 95% CI: -6.20, -1.02) were negatively associated with quality of life.
CONCLUSION AND RECOMMENDATION
In this study, the psychological domain had the lowest mean score. Caregivers being as spouse, who were with chronic illness, manifested depression and anxiety and had a poor social support needs attention and support to improve HRQoL.
Topics: Humans; Quality of Life; Caregivers; Ethiopia; Male; Female; Adult; Middle Aged; Neoplasms; Cross-Sectional Studies; Surveys and Questionnaires; Young Adult; Aged; Social Support; Depression; Anxiety
PubMed: 38820474
DOI: 10.1371/journal.pone.0304392 -
Nature Cardiovascular Research Dec 2023Coronary artery calcification (CAC) is a measure of atherosclerosis and a well-established predictor of coronary artery disease (CAD) events. Here we describe a...
Coronary artery calcification (CAC) is a measure of atherosclerosis and a well-established predictor of coronary artery disease (CAD) events. Here we describe a genome-wide association study (GWAS) of CAC in 22,400 participants from multiple ancestral groups. We confirmed associations with four known loci and identified two additional loci associated with CAC ( and ), with evidence of significant associations in replication analyses for both novel loci. Functional assays of and in human vascular smooth muscle cells (VSMCs) demonstrate that is a promoter of VSMC calcification and VSMC phenotype switching from a contractile to a calcifying or osteogenic phenotype. Furthermore, we show that the association of variants near with reduced CAC is likely explained by reduced expression with the G allele of enhancer variant rs5982944. Our study highlights ARSE as an important contributor to atherosclerotic vascular calcification, and a potential drug target for vascular calcific disease.
PubMed: 38817323
DOI: 10.1038/s44161-023-00375-y -
International Journal of Offender... May 2024The facilitation of domestic abuse perpetrator programs (DAPPs) by mixed gender co-facilitation pairs brings different facilitator perspectives and enables the modeling...
The facilitation of domestic abuse perpetrator programs (DAPPs) by mixed gender co-facilitation pairs brings different facilitator perspectives and enables the modeling of egalitarian and respectful male-female relationships. This study analyzed 22 video and audio recordings of community-based DAPP groups featuring male participants, and male and female facilitators. Using thematic analysis, we aimed to understand how facilitators engaged participants and whether the facilitator's gender affected this. We found an asymmetry in the positioning of the facilitators. Group participants challenged both facilitators, but especially the female facilitators. Facilitator strategies toward behavior change included softening direct challenges (female facilitators) and mobilizing the shared category of men (male facilitators). Implications from this study are for reflective practice in facilitator management and supervision specifically focused on gendered power dynamics. Skilled facilitation is key to behavior change and the gendered interplay within groups may be a crucial element in the reduction of interpersonal violence and abuse.
PubMed: 38817084
DOI: 10.1177/0306624X241254699 -
Social Science & Medicine (1982) May 2024Health-related social control (HRSC) includes efforts to regulate or influence others' health behaviors and is an important way interpersonal relationships can affect...
Health-related social control (HRSC) includes efforts to regulate or influence others' health behaviors and is an important way interpersonal relationships can affect individual-level health. This study used egocentric network data to describe the size and composition of HRSC networks, identify trajectories of HRSC receipt, and examine how HRSC is related to binge drinking and alcohol-related problems. Data come from a U.S. nationally representative sample of 1235 adults age 30 and older (baseline mean age = 52, 52% female, 64% White) who completed four annual surveys between 2019 and 2022. On average, 30% of adults' network members were HRSC agents who told or reminded them to do things to protect their health. At baseline, 50% of respondents identified a spouse/partner as a HRSC agent, 56% a relative, 46% a friend, and 12% someone else. Respondents' relationships with HRSC agents were generally strong, 93% of agents were described as people "whose opinion matters," and only 10% were described as hassling or making life difficult for the respondent. Growth mixture modeling identified five trajectories of HRSC receipt over the four-year period: Stable High (36% of sample), Stable Moderate (47%), Stable Low (14%), Decreasing (2%), and Increasing (2%). Binge drinking was relatively consistent for the three Stable HRSC classes (ranging from 11% to 15% of individuals), decreased steadily for the Increasing HRSC class (32%-16%), and fluctuated for the Decreasing HRSC class (decreasing from 10% to 2%, then increasing to 8%). For alcohol problems, the Increasing HRSC class showed the largest increase (2%-21%) before dropping to near-baseline levels (4%), whereas the Decreasing HRSC class fluctuated during the first three waves followed by no individuals reporting alcohol problems at the last wave. Results highlight the importance of examining heterogeneity in adults' HRSC experiences because of its implications for understanding social influences on health-related behaviors.
PubMed: 38815285
DOI: 10.1016/j.socscimed.2024.117004