Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Qualitative Focus Groups with Professionals of Special Education and Parents of Young Females with Intellectual Disability Exploring Experiences with Menstrual Hygiene Management and the Trigger for the Non-Therapeutic Hysterectomy in Mexico
No full textHow primary carers, physicians, health education professionals, and others see or understand the subject of menstruation in women with intellectual disability (ID) is rooted in the socio-cultural context and in the socio-economic structures in which all of them live. The aim of this study was to explore how parents of young females with ID and special education professionals perceive and experience menstrual hygiene management, which coping strategies are applied; and what triggers the performance of a hysterectomy. A qualitative focus group study design was conducted with 69 parents and 11 special education professionals, in 14 schools and one Down syndrome clinic, in Mexico City. Data were analysed using the method of thematic analysis. The main concern of parents was how to cope with the underlying disease. They perceived menstrual bleeding positively. Their psychological distress had to do with the reproductive health of their daughters, with their wish to avoid pregnancy, and with their fear of death and leaving their daughters alone and helpless without them. None of them favoured hysterectomy. Medical indication of hysterectomy was identified as the trigger for its performance. There is an urgent need of policy development/review on best practices for hysterectomy in the females in question
Quasi experimental study of same-sex marriage laws & sexually transmitted infections
Get PDFObjectives:
On June 26, 2015, the Supreme Court legalized same-sex marriages in the United States. This change has had some positive implications for the health of Lesbian, gay, bisexual, and transgender (LGBT) individuals and public health in general. Sexually transmitted infections (STIs) are common among LGBT individuals and legalization of same sex marriage effected the rate of emergency department (ED) visits for STIs. We examined the effect of same-sex marriage legalization on emergency department visits related to STIs among LGBT individuals.
Study design:
Quasi-experimental difference-in-difference negative binomial design is used with state and time fixed-effects. We used data for 16 states from State Emergency Department Database and State Inpatient Database from January 2007–December 2015. People over 18 years of age visited the ED for STIs were included.
Results:
At 5% significance level, number of STIs cases decreased by 6.1% (95% CI, 0.906–0.973; P = 0.001) after same-sex marriage legalization. When adjusting for sex, these cases decreased by 7.6% (95% CI, 0.885–0.966; P < 0.001) for females, and 4.7% (95% CI, 0.914–0.995; P = 0.027) for males. By age cohorts, 18–24 aged had 8.5% (95% CI, 0.875–0.957; P < 0.001) decrease, while older age cohorts was statistically insignificant.
Conclusions:
Our results show that there is an association between legalization and decreased STIs cases in ED visits. Policy makers need to focus on encouraging a positive attitude towards LGBT community, as it leads to better quality of health for sexual minority groups and leads to positive externalities for general community
The impact of different treatment protocols on achieved radiation doses of high-dose-rate brachytherapy for locally advanced cervical cancer: a comparison between 2 fractions in 1 application and separate applications for each fraction
Get PDFPurpose:
To compare radiation doses achieved by image-guided brachytherapy for locally advanced cervical carcinoma implemented with two different protocols.
Material and methods:
Medical records of 117 patients with locally advanced cervical carcinoma treated with brachytherapy from 2009 to 2018 at our institution were retrospectively reviewed. All patients had received previous external beam radio/chemotherapy. We performed magnetic resonance image-guided adaptive high-dose-rate brachytherapy delivered by intra-cavitary/interstitial applicators. Dose prescription was 7 Gy for four fractions within two weeks. Original schedule of brachytherapy was two fractions delivered on consecutive days with one applicator insertion; this process was repeated one week later (group 1, 54 patients). From 2015 onwards, another protocol of brachytherapy was mainly used, separately performing applicator insertions for each of the four administered fractions (group 2, 63 patients).
Results:
The high-risk clinical target volume (HR-CTV) D90 planning aim (PA) of ≥ 85 Gy (hard constraint) was not achieved in 9 cases out of 54 (17%) in group 1 compared with only 2 out of 63 cases (3%) in group 2 (p = 0.022). A difference between the two groups was also found in the fulfillment of PA 90 Gy (soft constraint) (p = 0.027). We conducted a sub-group analysis of target volume groups and observed that the differences were most pronounced with very large tumors (> 50 cm3). In these patients, PA 85 Gy was only fulfilled in 67% cases when treatment involved two applications, but in all cases with four separate applicator insertions (p = 0.010).
Conclusions:
In our experience, by performing an applicator insertion for each of the fractions, it is possible to correct the non-optimal position of the applicator immediately, and to deliver better doses for consecutive fractions. As a result, the planning aim is more often achieved, especially for large tumors
Sexually transmitted infections and associated risk factors among male clients of sex workers: a cross-sectional pilot project in Antwerp, Belgium
Get PDFIntroduction:
Prevalence of sexually transmitted infections (STIs) is increasing in Belgium in recent years. Clients of sex workers form a key population for acquisition of STIs, due to their sexual relations, with or without a condom, with sex workers. STI testing uptake is low among clients of sex workers, and prevalence of STIs remains to be investigated in Belgium. Therefore, we offered STI-testing to clients of sex workers during outreach sessions in Antwerp.
Methods:
Time location sampling (TLS) was used to improve representativeness of the sample during ten test sessions in the red light district, Antwerp in May and September 2019 by using a passive approach. Individuals that were interested to get tested for STIs could enter the study. Participants completed an online survey and samples for STI testing were collected. Testing included HIV, syphilis, Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng). Test results were communicated via a cell phone message (for negative test results) or by phone (for positive test results).
Results:
In total, 154 male clients of sex workers with a median age of 38 participated. A total of eight Ct and one Ng infections were detected. TLS analysis revealed a Ct/Ng prevalence of 8.2%. No new HIV nor syphilis infections were detected. Using univariate analysis, testing positive for STI was associated with younger age and anorectal sex with a sex worker. Using multivariate analysis, an STI-positive test result was associated with being younger, having non-Belgian nationality, and being in a relationship.
Conclusion:
Our study found a substantial prevalence of Ct/Ng which highlights the need for sensitization and facilitation of STI testing among clients of sex workers. It is difficult to compare results due to the lack of reference material. Moreover, our relatively small convenience sample limits generalizability of results. However, phone counseling (for positive test results) was accepted, linkage to care was provided, and partner notification was facilitated
Effect of modified no‐touch laparoscopic radical hysterectomy on outcomes of early stage cervical cancer: a retrospective cohort study
Get PDFObjectives:
We aimed to compare the prognosis of modified no‐touch laparoscopic radical hysterectomy (MLRH) and laparoscopic radical hysterectomy (LRH) on survival in patients with early stage cervical cancer.
Materials and Methods:
The clinicopathological data of patients with stage IB1 and IIA1 cervical cancer, who underwent radical surgery between 2014 and 2019, were retrospectively reviewed. The 5‐year disease‐free survival (DFS) and overall survival (OS) were compared between the MLRH and LRH groups using the Kaplan–Meier method. Independent prognostic factors for 5‐year DFS and OS were identified using multivariate, forward, stepwise Cox proportional hazards regression models.
Results:
A total of 223 patients with stage IB1 and IIA1 cervical cancer were included. Kaplan–Meier analysis revealed that the 5‐year DFS and OS rates in the MLRH (n = 81) group were significantly higher than those in the LRH group (n = 142) (DFS, 94.5% vs. 78.8%, p = 0.007; OS, 96.7% vs. 87.6%, p = 0.033). No significant differences were identified between the two groups in terms of operative time, blood loss, transfusion requirement, and intraoperative or postoperative complications. MLRH was an independent prognostic factor associated with increased 5‐year DFS (adjusted hazard ratio [HR], 0.202; 95% confidence interval [CI], 0.069–0.594; p = 0.004) and 5‐year OS (adjusted HR, 0.163; 95% CI, 0.035–0.748; p = 0.020).
Conclusion:
The oncologic outcomes were superior with MLRH than with LRH in patients with stage IB1 and IIA1 cervical cancer. Contact of cervical tumor cells with the pelvic cavity likely explains the worse prognosis associated with LRH
Female genital mutilation/cutting and birthing: enhanced education and training is critical for health care providers
Get PDFApplying reflective writing as a participatory methodology for “speaking-up” about gender-based violence in South Africa
Get PDFSouth Africa contends with gender-based violence (GBV) and its societal consequences. This study, therefore, engages with discussions around reflective writing as a participatory methodology to foster free and inclusive expression on issues around GBV in South Africa. My study proffers a diverse response by exploring how participatory research and assessment approaches, through reflective writing as a pedagogical practice, serve as viable premises to further debates on opposing acts of violence. It discusses the feasibility of reflective writing as a tool for articulating and understanding human views on GBV. I also evaluate how creating a safe and anonymous space through reflective writing influences how issues on GBV are perceived. I achieve these using a qualitative research approach and applying a thematic method of data analysis. The story of Fatmata and Mohamed and the poem I got flowers today were the literary pieces used as a springboard for the written reflections analysed in the study. Results indicate that students found it easier to communicate through written reflections rather than publicly speaking about their perceptions of GBV. Their reflections became tools for expression. This can be advantageous for public engagement and a call to action on GBV
Differences in Sexual Behavior and Partner Notification for Sexually Transmitted Infections Between the Out of School Youth and University Students in a Peri-Urban District in South Africa—A Cross-Sectional Survey
Get PDFThe increase in sexually transmitted infections (STIs) in young people is a public health concern. Among those in university and out of school, different contextual factors contribute to their risky sexual behavior and increased susceptibility to STIs and HIV. There are limited comparative studies examining risky sexual behavior and partner notification (PN) between these two groups, particularly in South Africa. We investigated sexual behaviors, self-reported STI diagnosis, health seeking behavior, and preferred PN methods of university students and out of school youth. A descriptive cross-sectional survey was used using convenient sampling to select 917 students across five health sciences universities and through periodic sampling 699 out of school youth were selected from two main local shopping centers in South Africa. Descriptive statistics, bivariate and multivariable logistic analysis were performed using Stata IC version 14. More university students (71.7%) than out of school youth were in casual relationships (28.3%), with half of out of school youth being in steady relations (50.2%). Moreover, university students (65.7%) used a condom in the past 6 months compared to their counterparts (34.3%). Of the 124 youth who were diagnosed with STI in the past 12 months, majority (n = 106, 85%) were out of school youth. The probability of notifying a partner about a STI infection was 82% among university students compared to their counterparts (p = >0.05). The odds of notifying a partner was 1.79 times more for those having multiple sexual partners than those who had only one partner. Both groups preferred a face-to-face STI disclosure with partner; however, more university students (67%) preferred SMS notification than PN referral slips as compared to out of school youth (42%). Both the university students and the out of school youth engaged in risky sexual behaviors. Both groups preferred face-to-face and clinic SMS partner notifications, even though university students were in the majority. There is a need for developing health promotion scripts on disclosing STIs to sexual partners to empower the majority of the youth who prefer face-to-face PN over the prescribed methods
