农村艾滋病患者抗病毒治疗依从性及其影响因素的研究

目的 了解农村抗逆转录病毒治疗服药依从性现状及其影响因素.方法 对广西横县农村地区157例艾滋病病人进行问卷调查,分析影响服药依从性的相关因素.结果 服药依从性好者占64.3％,漏服药的主要原因为忘记和工作忙.多因素Logistic回归分析显示壮族患者依从性较低,而常有服药不良反应的、常参加关爱机构活动的患者、医务人员服务治疗水平高的,则依从性高.结论 横县农村艾滋病患者服药依从性好的比例不高,受诸多因素影响.     

Barriers to physical activity among women in the rural midwest

Physical activity is an important factor in chronic disease control and prevention. Yet women and rural residents consistently report lower rates of physical activity than their male and urban/suburban counterparts. The objective of this study was to assess the relationship between personal, social, and environmental barriers and meeting moderate physical activity recommendations in a sample of rural women. Data were obtained from a telephone survey of 2,510 residents of rural southeastern Missouri, Tennessee, and Arkansas. After adjusting for age and income, women who identified personal barriers, such as lack of time, no motivation, disinterest in exercise, and having no one to exercise with were less likely to meet physical activity recommendations. There was evidence of a dose-response relationship between the number of barriers identified and meeting moderate physical activity recommendations among women with higher incomes and women with lower incomes; however, this relationship was most striking among women with annual household incomes of 25,000 US Dollar or more. These findings may be used to tailor physical activity interventions to women in rural communities.     

Barriers to care for women with breast cancer symptoms in rural Bangladesh

Breast cancer survival rates in lower-income countries like Bangladesh are approximately 50%, versus over 80% in high income countries. Anecdotal reports suggest that, beyond economic and health system barriers, sociocultural factors may influence a woman's care-seeking behavior and resultant early stage diagnoses. To understand these barriers, we conducted 63 interviews (43 women with breast cancer symptoms and 20 men) in Khulna, Bangladesh. We identified socio-cultural barriers like neglect and indifference toward women, women's lack of power to use resources, and reduced support from family due to stigma. Interventions must address these barriers and improve the status of women in Bangladesh.     

Factors associated with compliance among users of solar water disinfection in rural Bolivia

Background  

Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Promotion of Solar Water Disinfection (SODIS) has been suggested as a strategy for reducing the global burden of diarrhoea by improving the microbiological quality of drinking water. Despite increasing support for the large-scale dissemination of SODIS, there are few reports describing the effectiveness of its implementation. It is, therefore, important to identify and understand the mechanisms that lead to adoption and regular use of SODIS.     

山区小学生自我意识水平及其与家庭环境特征的关系

【目的】探讨山区小学生自我意识水平及其与家庭环境特征的关系,为有针对性地开展山区小学生心理健康教育提供依据。【方法】采用儿童自我意识量表(Piers-Harris Children's Self-concept Scale,PHCSS)、家庭环境特征量表和一般情况调查表对该山区703名在校小学生进行问卷调查。【结果】该山区小学生自我意识水平较差,正常者仅占39.8%,21.6%的小学生自我意识水平偏低,38.5%的小学生自我意识水平过高。女生的PHCSS总分、行为、智力、合群因子得分均显著高于男生(P0.05)。三年级小学生的PHCSS总分、智力、合群得分最低,六年级小学生的焦虑得分最低(P0.05)。相关分析结果表明,家庭环境特征部分因子与山区小学生的PHCSS部分因子得分呈显著相关(r=0.301~0.392,P0.05)。【结论】山区小学生自我意识水平较差,与家庭环境特征部分因子呈显著相关,建议积极改善家庭环境特征,有助于提高山区小学生自我意识水平。     

Perceived Facilitators and Barriers to Engaging with a Digital Intervention among Those with Food Insecurity,Binge Eating,and Obesity

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population’s needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.     

Barriers and Facilitators to Food Security among Adult Burundian and Congolese Refugee Females Resettled in the US

Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.     

Barriers to the utilization of maternal health care in rural Mali

This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29 km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.     

Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children

ObjectiveTo understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand.MethodsWhānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance.ResultsSelf-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program.Conclusions and ImplicationsProgram convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.     

The SIMPOC Philippine Survey of Children 2001: a data source for analyzing occupational injuries to children

Child labor is a global issue that exists in both industrialized and developing countries. With the unanimous adoption of International Labour Organization (ILO) Convention No. 182 in 1999 calling for the immediate elimination of the worst forms of child labor, ratifying member countries have committed themselves to identifying hazardous work for children in the context of their respective legislative frameworks. Part of tackling the problem of child labor is knowing what types of occupational activities children are engaged in, what types of work environments they are under, and what risks of injuries and illnesses they are exposed to while working. Using the Philippines as a country example, this study introduces a promising data source on children's work and presents a methodology for examining hazardous work to children through the examination of injury rates. Data for this study rely primarily on a nationally representative dataset from the Survey of Children 2001 carried out by the Philippine National Statistics Office, covering the months of October 2001 to September 2002.     

Assessment of dietary intake among pregnant women in a rural area of western China

Background  

Adequate maternal nutrient intake during pregnancy is important to ensure satisfactory birth outcomes. There are no data available on the usual dietary intake among pregnant women in rural China. The present study describes and evaluates the dietary intake in a cohort of pregnant women living in two counties of rural Shaanxi, western China.     

High prevalence of HCV infection among the general population in a rural area of central Italy

The hepatitis C virus infection (HCV) is the most frequent cause of hepatic infection in Europe. In Italy, anti-HCV positivity values are extremely variable, depending on the age and geographic location of the population being analysed. The aims of the study were: (1) evaluating positivity for anti-HCV antibodies in various age groups and determining the HBsAg in a mountainous and predominantly farming area in central Italy; (2) assessing some anamnestic and clinical variables through a questionnaire, submitted during the taking of blood samples, in order to determine HCV exposure and risk factors for the target population. 344 subjects selected by random sampling among 3308 people, older than 16, were considered as the target population. A prevalence study was carried out. The sources of data were: blood samples taken to carry out the HCV positivity test; a questionnaire including items about exposures at risk and case-historical and clinical patient data. The risk of infection was evaluated by a multiple logistic regression model. The inferred HCV+ prevalence rate is 22.4/100 (95% confidence interval (CI): 20.8–24.1). An increasing age trend is shown with a higher positive predominance among females (28.99/100 vs. 14.29/100 in males). The positive HBsAg prevalence in the examined survey is 1.2/100. Variables associated with the HCV occurrence are case history of pneumonopathy (OR: 4.9) and exposure to parenteral therapies with glass syringes (OR: 3.3). This study is consistent with literature about the hypothesis of a north-south geographic gradient in the hepatitis C occurrence in Italy. Data clearly show the effects of the inappropriate use of medical or surgery practices on the population, with particular reference to the use of glass syringes. No elements prove that the farming features of the area may be predictive of HCV infection risk. The extent of the recorded prevalence values calls for the implementation of programmes aimed at detecting clusters or population areas at risk.     

Factors Involved in the Persistence of Overweight among Children Enrolled in the Supplemental Food Program for Women,Infants, and Children

Objective To investigate differences between children ages 2 and 5 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas whose overweight persisted and those whose overweight resolved. Methods The study involved administration of a survey to a randomly selected stratified sample of parents and guardians of WIC children residing in the 11 public health regions in Texas. Subjects volunteered to complete the survey during a scheduled WIC appointment. A total of 445 surveys were completed, 206 by parents/guardians of children classified as having persistent overweight, and 239 by those with children classified as having non-persistent overweight. Results and Conclusions A higher percentage of children in the non-persistent group were male, younger, white, consumed more dairy products, had a mother living in the household, and a family member who participated in physical activity with the child. A higher percentage of parents of children in the persistent group reported that they had been told their child was overweight and received information about overweight in children from the WIC staff. A higher percentage also felt their child was overweight, that their child’s weight could be improved, that their child’s weight did not improve in the last year and were concerned about their child’s weight. This study identified several variables associated with overweight persistence. WIC personnel and other public health educators can utilize these findings to identify overweight children who are at higher risk for non-improvement and to plan more effective intervention strategies for the population studied.     

Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh

Bangladesh typifies many south-eastern countries where female children experience inferior health and uncertain survival, especially after the neonatal period. This paper attempts to study the gender inequality in nutritional status and the effects of various socioeconomic, demographic, and health-programme factors on gender inequality in a remote rural area of Bangladesh. Measurements of mid-upper arm circumference (MUAC) were taken from 2,016 children aged less than 5 years (50.8% male, 49.2% female) in 1994. Children were characterized as severely malnourished if MUAC was < 125 mm. Independent variables included various characteristics of children, households, and mothers. Average MUAC for all children was 130 mm; 33% were severely malnourished. Of the severely-malnourished children, 54.2% were female, and 45.8% were male. The gender gap persisted in the multivariate situation, with female 1.44 times more likely to be severely malnourished. Other variables with a statistically significant relationship included the age of children, acceptance of DPT1, and education of household heads. The persistence of such a gender discrimination now when the country has achieved a lot in terms of child survival is striking. The issue is important and demands appropriate corrective actions.     

An epidemic of hepatitis B among injection drug users in a rural area.

An epidemic of hepatitis B occurring in a rural area of Nova Scotia in 1988 and 1989 was investigated. This epidemic identified injection drug use (IDU) as the major determinant of transmission and was the first highly visible indication of IDU in rural Nova Scotia. Contact-tracing was used to identify 186 injection drug users (IDUs), of whom 153 (82%) were interviewed. Of 133 (72%) IDUs who underwent serological testing, 78 had serological evidence of hepatitis B infection. Using epidemiological criteria, 57 IDUs formed a cluster of hepatitis B infections. Using logistic regression techniques, age (O.R. = 1.1), the total number of IDU-contacts named (O.R. = 1.1), and the number of hepatitis B seropositive IDU-contacts named (O.R. = 1.3), were identified as risk factors predictive of an IDU being a cluster case. The characterization of this epidemic may be useful as a model for the spread of hepatitis B and other viral infections among IDUs in rural areas.