1,721,131 research outputs found
The eco-bio-social determinants of the urban dengue virus episystem
No full textAs Latin America and the Caribbean (LAC) is challenged with climate change, rampant urbanization, and the control of the Aedes aegypti mosquito, the ecological, biological, and social (eco-bio-social) factors that determine dengue virus (DENV) transmission are important to consider. This thesis challenges reductionist research approaches and applied three principles of an ecosystems approach to health (Ecohealth) to identify, conceptualize, and investigate the eco-bio-social factors operating the urban dengue epidemiological system (episystem) in LAC. First, we conducted two scoping reviews to summarize the distinct and intersecting eco-bio-social factors. Then, we brought together a panel of eleven dengue researchers and practitioners from seven LAC countries using a qualitative, three-round e-Delphi method to achieve consensus on an evidence-informed and consensus-based eco-bio-social conceptual framework of the urban dengue episystem in LAC. Panelists also established research, and policy and program agendas for dengue research, prevention and vector control. Finally, we implemented a concurrent nested mixed-methods study, using an online survey, focus group discussions (FGDs), and a participatory action research (PAR) method called Photovoice in the metropolitan city of São Paulo, Brazil, to investigate knowledge, attitudes, practices, and perceptions (KAPP) of the eco-bio-social factors, the dengue vaccine, and dengue prevention measures among urban residents. Individual- and household- level socioeconomic and demographic factors associated with KAPP were investigated. Overall, knowledge about the eco-bio-social determinants was generally high. Higher level of educational attainment was significantly associated with positive vaccine attitudes. FGDs and Photovoice participants perceived climate change, socioeconomic vulnerability, and the spread of misinformation as key risk factors for community dengue transmission. Ultimately, by considering the factors determining urban dengue transmission, and the experiences of dengue-affected populations, this thesis advances research on the eco-bio-social determinants of urban dengue transmission in LAC and informs the design of community-oriented interventions for mosquito control and dengue prevention in urban, climate-vulnerable settings.ThesisDoctor of Philosophy (PhD)The spread of dengue is a growing health problem in Latin America and the Caribbean. The goal of this research was to understand the ecological, biological, and social factors that affect how dengue spreads in big cities. First, we reviewed research articles to sum up the relevant factors. Then, a group of professionals worked together to create a visual framework showing how the factors interact. Finally, we surveyed people in São Paulo city to learn about what they know about dengue, their views on the new dengue vaccine, and how they protect themselves from getting dengue. Most people in São Paulo believed that climate change is making dengue worse, and they had good knowledge about the factors affecting its spread. The results from this research point to the need for solutions that involve communities to prevent dengue and control mosquitoes and consider the experiences of people living in big cities
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Measures of retention in HIV care: A study within a review
Get PDFThis is the first comprehensive systematic review of the definitions used for retention measures in HIV care.
This review provides a compilation of existing definitions of retention in HIV care in randomized controlled trials. In summary, we report very little consensus regarding definitions of retention in HIV care in the research literature. We report and compare definitions of retention so researchers can weigh their definitions with the body of definitions, with the ultimate aim of motivating the research community to establish a clear and unambiguous definition. This work will provide resources for researchers to recommend a definition of retention. Future research is needed to seek practitioners’ views on the most unambiguous, explicit definition of retention. This is only a first step in research toward a standard definition of retention.Introduction
Retention in HIV care is critical for PLHIV. However, retention in HIV care is not measured uniformly across studies. The aim of this study within a review (SWAR) is to describe the diversity in definitions used for retention in HIV care in randomized controlled trials.
Methods
We conducted a SWAR, drawing data from an overview of systematic reviews on interventions to improve the HIV care cascade. A comprehensive and exhaustive search was conducted of the following databases: PubMed, Excerpta Medica data BASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Web of Science, and the Cochrane Library. We identified randomized controlled trials (RCTs) of interventions to improve retention in care for people living with HIV (PLHIV). First, from the included studies in systematic reviews and second using targeted searches for RCTs. Only English language systematic reviews were included, but RCTs in any language were eligible. Data were screened and extracted in duplicate using pre-set criteria, with arbitration as needed. We identified distinct components from the definitions used to measure retention. The components were further categorized based on the similarities between them. We described the components narratively and presented the definitions in tables.
Results
We identified 8001 records, after a duplication check, 4147 unique titles and abstracts were examined for relevancy, leaving 744 articles. Full-text screening of the articles resulted in 50 articles that measured retention and provided 59 definitions for retention in care. Of the included studies, 11(22%) were conducted in low-income countries, 12(24%) were conducted in lower-middle-income and upper-middle-income countries, and 13(26%) were conducted in high-income countries. We identified ten different components used to define retention. These components are follow-up times (83%), administrative records (8%), clinical visits (61%), gap scores (8%), group-level measures (17%), lab records (15%), pharmacy-based measures (29%), scheduled visits (27%) and visit counts (17%). The most frequently used components are follow-up times (n=49), and the easiest to measure are retention data derived from administrative records (n=5). We put the components into categories based on the similarities between them.
Conclusion
We identified existing definitions of retention in HIV care and the commonly used components in the definitions. This compilation of the definitions and identification of the components may provide a framework for developing the standard globally agreed-upon definition of retention in HIV care.ThesisMaster of Health Sciences (MSc)Globally, there are more than 37.7 million people living with HIV (PLHIV). Retention in human immunodeficiency virus (HIV) care is a common and modifiable determinant of increased adherence to antiretroviral therapy (ART), better health outcomes, and a better quality of life.
There is no consensus in the literature on measures of retention in HIV care. This makes it very difficult to compare different studies and jurisdictions. This thesis review summarizes the definitions of retention used in randomized controlled trials (RCTs) and identifies the various components used to measure retention, which can be used as a reference for researchers to identify the gaps in the current definitions for HIV retention measures and identify preferred measures with the goal of reaching a standard consensus definition of retention in HIV care
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
DESIGN, ANALYSIS, AND REPORTING OF PILOT STUDIES IN HIV
Get PDFPilot studies, a subset of feasibility studies, are essential in determining the feasibility of a larger study. This is especially true when targeting populations that are difficult to recruit, such as people with HIV. Designing high quality pilot studies can help limit waste by informing researchers how to proceed.
We conducted a meta-epidemiological review of pilot studies in the HIV literature published until November 25, 2020 using Medline, Embase and Cochrane Controlled Register of Trials (CENTRAL). We extracted bibliometric information, including the region and income of the country where the study was conducted, study design, using the pilot label, source of funding, nature of intervention, whether feasibility was the primary objective, progression criteria, protocol registration and sample size estimation. We used descriptive analysis to evaluate how pilot studies are designed and conducted, the outcomes assessed and how are they defined.
Our search retrieved 10,597 studies, of which 248 were included in our final review. The number of pilot studies has increased with time, with 25, 55, and 44 HIV studies published in 2018, 2019, and 2020, respectively. We found that 128 studies (70.39%) used the pilot or feasibility labels in their title, however 20.31% used these titles interchangeably. 5 studies in this review included progression criteria, all of which were published in 2020. Sample size estimation was only found in 59 studies (23.9%).
Pilot studies in the HIV literature are mislabeled. Sample size estimations are seldom included, and progression criteria are used. Formal guidance on the design and reporting of pilot studies in the HIV literature is necessary.ThesisMaster of Science (MSc)Pilot studies are important in evaluating whether planned larger studies can be conducted. They are particularly useful in the field of HIV where participants may be hard to identify and recruit. However, there are few instructions on how pilot studies in HIV should be designed. We searched the literature to see the current state of HIV pilot studies, including how they are designed, and their findings reported. We found that pilot studies are becoming more popular in the HIV field. However, there were gaps in how these studies are designed and reported. Studies were often mislabeled as pilots when they were not, the pilot study criteria were applied inconsistently and the outcomes that were evaluated were often poorly defined and their information poorly presented. Pilot studies in HIV can be reported better
ADHERENCE TO THE DAPIVIRINE VAGINAL RING AMONG WOMEN IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS
No full textIntroduction: Despite the availability of HIV preventive measures, new HIV infections are still on the rise. The Dapivirine Vaginal Ring (DVR), a silicone circular ring, continuously distributes Dapivirine into the vagina to prevent HIV infection. The objective of this systematic review is to summarize the evidence on adherence to DVR for HIV-1 prevention among women in Africa and to describe the factors associated with adherence.
Methods and Analysis:
This thesis comprises two separate publishable manuscripts (a published protocol with Health Science Reports and an article currently in press with PLOS Global Public Health). The core parts of this thesis include: chapter one, where a comprehensive summary of evidence on HIV, Pre-Exposure Prophylaxis, Dapivirine Vaginal Ring, adherence, and other components is described. There is limited evidence on the extent of DVR adherence among females in Africa, as well as factors associated with existing adherence. This formed the basis for the study that is conducted in this thesis. In chapter two, details on how the thesis was conducted are presented. That is: a systematic review of studies in which DVR was used to prevent HIV-1 in African women. We searched MEDLINE, Global Health, CINAHL, and EMBASE from database inception to December 2024. We included observational studies and randomized trials of females between 16 and 45 years of age, resident in Africa, who have used the DVR. Our primary outcome was adherence to DVR explored as women adhering, mean adherence, and visit/rings adhering. Pairs of reviewers independently screened for eligible studies and extracted relevant data. We performed a random-effects meta-analysis of proportions and mean for DVR adherence. The certainty of the evidence was assessed using the GRADE approach.
Results and Discussion:
In chapter three, we presented the study findings according to the study-specific objectives.
Chapter four of the thesis discusses a summary of the methodological issues, future directions, and review conclusions will be presented. As such, our search retrieved 217 records, of which 15 published between 2016 and 2024 were found. Across the seven included studies, there were a total of 2,424 DVR women users reported in four studies, 1,552 participants in the two studies reporting mean adherence, 27,904 follow-up visits, and 14,034 rings distributed. Adherence to the DVR among women was generally high, with a pooled estimate of 83%, although the certainty of evidence was very low. Mean adherence scores also suggested good adherence, with a pooled mean of 3.34 (95% CI: 3.00–3.67). There were 74% (95% CI: 74–75%) of rings used well and 89% (95% CI: 89–90%) of visits with adherence. Factors influencing adherence included individual characteristics (e.g., education level, country), partner-related aspects (e.g., partner feeling the ring during sex), ring-related challenges (e.g., difficulty inserting the ring), and environmental influences (e.g., discussing the study with non-study staff).
Conclusion
The evidence suggests generally good adherence to the DVR, which may enhance its effectiveness in reducing HIV infections in real-world settings; however, the certainty of this evidence is low. Given this limitation, we recommend that DVR use be accompanied by additional prevention methods, such as condoms. We also encourage further implementation research, particularly individual patient data meta-analyses, to assess adherence more accurately. These efforts can provide critical insights for developing targeted strategies to improve adherence and generate comprehensive pooled estimates to better inform practice and policy.
Protocol Registration
This study was registered on Prospero (CRD42024593018).ThesisMaster of Science (MSc)Even though there are many ways to protect against HIV, like the Dapivirine Vaginal Ring (DVR) made for women, some people still get infected. Using the ring exactly as the doctor recommends helps lower the chance of getting HIV, even if exposed. Our research focused on how many women aged 16 to 45 in Africa use the ring correctly, the actual number of times women used the ring correctly, and, narratively, by how many visits/rings indicated adherence. We looked at all the available information on the DVR up to December 2024. After registering the study in a research database called PROSPERO (CRD42024593018) and collecting and analyzing the data, we found that about 83% of users used the ring the right way. Factors like age, country, and whether they could feel the ring during sex played a role in how well it was used. These findings suggest that some women in Africa don’t use the ring as recommended, which means they may still be at risk of HIV even when they have the ring
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
YOUTH AND MATERNAL HEALTH IN LOW-RESOURCE SETTINGS
No full textPhD thesis (Health Research Methodology); composed of 3 studies and 1 protocolBackground and objectives
The world’s state of maternal health and well-being remains stunted by global inequities. Action continues to be needed for the optimisation of maternal health and well-being. Action must consider how youth can be agents of change. While youth are an often-marginalised group, they are a valuable resource to their communities. Our objectives were to investigate the maternal-neonatal health context in a Haitian community after implementation of a new maternity unit, to assess the impact of youth-led community-based interventions in low- and middle-income countries on community maternal-neonatal health, and to explore near-miss maternal experiences among Haitian youth.
Methods
This research is primarily based in Haiti, but also concerns research in low-resource settings, involving youth. This research uses a variety of methodologies, including an interrupted time series study of the impact of health facility infrastructure on maternal-neonatal outcomes, a systematic review of the effect of youth-led interventions for improved maternal-neonatal health, and a Photovoice study of youth perspectives of maternal near-misses.
Results and conclusions
In our research in Haiti, we found that there is some evidence in support of creating new health facilities in the overall effectiveness of positively impacting and improving maternal and neonatal outcomes. For youth-led interventions in low-income and middle-income countries, we concluded that there was no significant effect on antenatal care coverage or youth pregnancy. More studies are needed to understand how youth may be most effective in influencing community health among their peers or other community members. Research among youth with experiences of maternal near-misses in Haiti illuminated challenges related to social context, structural, systemic and political forces, experiences of pain and suffering, search for support and solutions for improved health and well-being. Our findings highlight a need to address multiple, intersecting issues of maternal health and well-being in this rural Haitian community.ThesisDoctor of Philosophy (PhD)This thesis broadens and deepens our understanding of youth as a resource for improving the health and well-being of women and childbearing individuals in their communities, by focusing on a community in the Republic of Haiti. First, an investigation of the impact of health facility infrastructure on maternal-newborn outcomes in a community in Haiti was examined. Second, a review of all existing studies that engaged youth in interventions to improve maternal-newborn health and well-being in low-income and middle-income countries was conducted. Third, an exploration of the perspectives of Haitian youth with lived experiences of maternal near-misses was studied. Overall, the work of this thesis suggests that there is an important role for youth to play in maternal health and well-being in their communities. This work makes recommendations that youth should not be left behind but should be involved in local research that concerns community health and well-being
METHODOLOGICAL STUDIES IN HEALTH RESEARCH: A REVIEW OF CONTEMPORARY PRACTICES AND EXPERT OPINIONS
No full textBackground:
Methodological studies 1 critically evaluate how health research is designed, conducted, analyzed, and reported. Despite their growing importance, there is currently no dedicated reporting guideline tailored to MS, which hampers the visibility, reproducibility, and usability of their findings.
Methods:
We conducted a scoping review of 596 methodological studies across multiple databases to map current practices regarding nomenclature, study design, analysis, and reporting. In parallel, an international cross-sectional survey was conducted with 119 researchers experienced in methodological studies to gather expert opinions on appropriate terminology, study categories, and key reporting elements. Quantitative data from each phase were analyzed descriptively, and qualitative survey responses were explored thematically.
Results:
The review identified substantial inconsistencies in terminology and reporting practices among MS. Only a minority of studies (4.2%) defined their design clearly or followed reporting guidelines(22.7%). These guidelines, when mentioned, were general (e.g., PRISMA) and not specifically developed for methodological studies. Most studies (84.7%) did not report a protocol, and 16.6% failed to describe the type of analysis used. When reported, descriptive statistics (51%) and between-group comparisons (44%) were the most common analytic approaches. Eighty-five different terms were used to label MS. The survey findings reflected similar concerns, with no single proposed term reaching expert consensus.ThesisMaster of Health Sciences (MSc)Health research often depends on studies that evaluate how research itself is designed, conducted, analyzed, and reported. These are known as methodological studies. However, there is no standard way to report these studies, making it difficult for others to find, understand, and build on them. This thesis reviewed 596 methodological studies and surveyed 119 international experts to identify common patterns and gaps in how these studies are labeled, structured, and reported. The findings showed inconsistent naming and reporting practices, making the field hard to navigate. Based on these results, this research supports the need for a dedicated reporting guideline specifically for methodological studies. The next steps will focus on reaching consensus among experts and developing a reporting checklist to help improve clarity, transparency, and consistency in this important type of research
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