1
|
Henderson H, Soares Xavier HA, da Silva M, da Silva AM, Mendonca SA, de Araújo RM, Vaughan C, Bohren MA. 'If we take the engine out, how will the car go?': beliefs, understanding and access to vasectomy services in Timor-Leste. Cult Health Sex 2024:1-17. [PMID: 38634414 DOI: 10.1080/13691058.2024.2341847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Vasectomy is a safe, highly effective and affordable method of permanent contraception, and one of the few currently available contraceptive methods for men. Despite this, vasectomy uptake remains overall low, making up just 2% of the global contraceptive method mix. To better understand access to vasectomy in a country with negligible uptake, we conducted participatory and operational research in the Democratic Republic of Timor-Leste (Timor-Leste). We held 14 participatory group discussions with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse), and individual in-depth interviews with 24 healthcare providers (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. Community awareness and understanding about vasectomy were limited, with concerns expressed about physical and social side effects. Healthcare providers had limited experience and knowledge about vasectomy, and about male sexual and reproductive health more generally. However, our findings also indicate a small but existing demand for vasectomy services that could be grown and better met through health systems strengthening initiatives. Insights from our research have informed programmatic decision-making in Timor-Leste and can be further used to inform national health policy and practice.
Collapse
Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- MSI Asia Pacific, Melbourne, VIC, Australia
| | | | - Mariano da Silva
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
| | | | | | | | - Cathy Vaughan
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
2
|
Sutherland G, Hargrave J, Krnjacki L, Llewellyn G, Kavanagh A, Vaughan C. A Systematic Review of Interventions Addressing the Primary Prevention of Violence Against Women With Disability. Trauma Violence Abuse 2024; 25:1235-1247. [PMID: 37272380 PMCID: PMC10913298 DOI: 10.1177/15248380231175932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Women with disability experience significantly more violence and abuse than their nondisabled peers. Efforts to implement, evaluate, and scale-up strategies to prevent violence against women are rapidly expanding, but we know less about "what works" to prevent violence against women with disability. While secondary and tertiary prevention aim to identify violence early and prevent further occurrence, this review focuses on primary prevention. In the disability services sector, primary prevention is sometimes referred to as safeguarding and covers a range of activities that aim to address the underlying determinants of violence to prevent it from happening in the first place. The aim of this review is to identify and synthesize research on evaluated interventions addressing the primary prevention of violence against women with disability and explore evidence about their quality and effectiveness. A systematic search across the bibliographic databases of Medline, CINAHL, Embase, and PsychInfo for peer-reviewed literature published in English on or after January 1, 2010, yielded 483 papers of potential interest. Twelve studies met the inclusion criteria and were considered for review. Data were extracted and the quality of the studies was assessed using the Quality Assessment Tool for Quantitative Studies. Most studies reported outcomes from pre- and post-test research designs and received a weak rating of quality. Although interventions targeting awareness, knowledge, and skill development showed evidence of effectiveness, there is a distinct lack of program development that draws on known risk factors for violence such as the intersection of ableism and gender inequality.
Collapse
|
3
|
Henderson H, Soares Xavier HA, Mendonca SA, da Silva AM, da Silva M, de Araújo RM, Bohren MA, Vaughan C. 'It depends on who is asking and why they will use it': Access to male condoms in Timor-Leste. PLOS Glob Public Health 2023; 3:e0002409. [PMID: 37773929 PMCID: PMC10540955 DOI: 10.1371/journal.pgph.0002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023]
Abstract
The uptake of male condoms remains markedly low in The Democratic Republic of Timor-Leste (Timor-Leste), an island nation in South-East Asia. To understand why, we conducted participatory and operational research about beliefs, understanding and access to male condoms from both a community and healthcare provider perspective. We held 14 participatory group discussions (PGDs) with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse) in 2019. We held individual in-depth interviews (IDIs) with 24 healthcare providers working in the same community catchment areas as the PGDs. Two counsellors, four doctors, fifteen midwives, and three nurses participated (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. PGD and IDI participant awareness, understanding and beliefs about male condoms were diverse. Male condoms were often discussed as something negative and taboo, and as something that is highly regulated and discouraged within society and the health system. However, many PGD and IDI participants also challenged this narrative by providing a more rights-based perspective about universal access to sexual and reproductive health information and services, including male condoms. Insights from our research have been used to inform programmatic decision-making in Timor-Leste, including health promotion and service delivery initiatives. Our findings can be further used to inform national health policy, healthcare provider training, and advocacy and communication work.
Collapse
Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- MSI Asia Pacific, Melbourne, Victoria, Australia
| | | | | | | | - Mariano da Silva
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Cathy Vaughan
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
4
|
Idrees T, Zabala ZE, Moreno EM, Gerges A, Urrutia MA, Ruiz JG, Vaughan C, Vellanki P, Pasquel FJ, Peng L, Umpierrez GE. The effects of aging and frailty on inpatient glycemic control by continuous glucose monitoring in patients with type 2 diabetes. Diabetes Res Clin Pract 2023; 198:110603. [PMID: 36871877 DOI: 10.1016/j.diabres.2023.110603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Older adults with diabetes in the hospital are generally managed similarly to younger adults, however, it is unknown if the degree of frailty can affect glucose control among hospitalized patients. METHODS We examined glycemic parameters derived from continuous glucose monitoring (CGM) in older adults with type 2 diabetes and frailty who were hospitalized in non-acute settings. Data was pooled from 3 prospective studies using CGM including 97 patients wearing Libre CGM sensors and 166 patients wearing Dexcom G6 CGM. Glycemic parameters (time in range (TIR) 70-180; time below range (TBR) <70 and 54 mg/dl) by CGM were compared between 103 older adults ≥60 years and 168 younger adults <60 years. Frailty was assessed using validated laboratory and vital signs frailty index FI-LAB (n = 85), and its effect on hypoglycemia risk was studied. RESULTS Older adults, as compared to younger adults, had significantly lower admission HbA1c (8.76% ± 1.82 vs. 10.25% ± 2.29, p < 0.001), blood glucose (203.89 ± 88.65 vs. 247.86 ± 124.17 mg/dl, p = 0.003), mean daily BG (173.9 ± 41.3 vs. 183.6 ± 45.0 mg/dl, p = 0.07) and higher percent TIR 70-180 mg/dl (59.0 ± 25.6% vs. 51.0 ± 26.1%, p = 0.02) during hospital stay. There was no difference in hypoglycemia occurrence between older and younger adults. Higher FI-LAB score was associated with higher % CGM < 70 mg/dl (0.204) and % CGM < 54 mg/dl (0.217). CONCLUSION Older adults with type 2 diabetes have better glycemic control prior to admission and during hospital stay compared to younger adults. Frailty is associated with longer presence of hypoglycemia in non-acute hospital settings.
Collapse
Affiliation(s)
- T Idrees
- Emory University School of Medicine, Atlanta, GA, United States.
| | - Z E Zabala
- Emory University School of Medicine, Atlanta, GA, United States
| | - E M Moreno
- Emory University School of Medicine, Atlanta, GA, United States
| | - A Gerges
- Emory University School of Medicine, Atlanta, GA, United States
| | - M A Urrutia
- Emory University School of Medicine, Atlanta, GA, United States
| | - J G Ruiz
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - C Vaughan
- Emory University School of Medicine, Atlanta, GA, United States
| | - P Vellanki
- Emory University School of Medicine, Atlanta, GA, United States
| | - F J Pasquel
- Emory University School of Medicine, Atlanta, GA, United States
| | - L Peng
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - G E Umpierrez
- Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
5
|
Muluneh MD, Negash K, Tsegaye S, Abera Y, Tadesse D, Abebe S, Vaughan C, Stulz V. COVID-19 Knowledge, Attitudes, and Vaccine Hesitancy in Ethiopia: A Community-Based Cross-Sectional Study. Vaccines (Basel) 2023; 11:vaccines11040774. [PMID: 37112686 PMCID: PMC10140841 DOI: 10.3390/vaccines11040774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 04/03/2023] Open
Abstract
The current healthcare system’s efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.
Collapse
|
6
|
Wong HTH, Wang P, Sun Y, Newman CE, Vujcich D, Vaughan C, O'Connor CC, Jin D, Ogilvie E, Zhang Y, Mao L, Carter A. Is sex lost in translation? Linguistic and conceptual issues in the translation of sexual and reproductive health surveys. Cult Health Sex 2023; 25:1-17. [PMID: 34941479 DOI: 10.1080/13691058.2021.2016975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Translated questionnaires are increasingly used in population health research. Nevertheless, translation is often not conducted with the same rigour as the process of survey development in the original language. This has serious limitations and may introduce bias in question relevance and meaning. This article describes and reflects on the process of translating a large and complex sexual and reproductive health survey from English into Simplified Chinese. We interrogated assumptions embedded in taken-for-granted translation practice to locate the sociocultural origins of these assumptions. We discuss how terminology and expression related to sexual and reproductive health may lose their conceptual or linguistic significance during translation in three different ways. Firstly, meanings can be lost in the negotiation of meanings associated with linguacultural and geographical variations of terminology. Secondly, meanings can be lost in the clash between everyday and professional sexual and reproductive health discourses. Thirdly, meanings can be lost due to the design of the source questionnaire and the intended mode of survey administration. We discuss ways to help overcome the unavoidable translation challenges that arise in the process of translating English sexual and reproductive health surveys for migrants from non-English speaking backgrounds.
Collapse
Affiliation(s)
- Horas T H Wong
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Pan Wang
- School of Humanities and Languages, UNSW Sydney, Sydney, NSW, Australia
| | - Yingli Sun
- School of Humanities and Languages, UNSW Sydney, Sydney, NSW, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Daniel Vujcich
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Cathy Vaughan
- Gender and Women's Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Defeng Jin
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Erin Ogilvie
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Ye Zhang
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Allison Carter
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| |
Collapse
|
7
|
Ganbaatar D, Vaughan C, Akter S, Bohren MA. Exploring the identities and experiences of young queer people in Mongolia using visual research methods. Cult Health Sex 2022; 24:1695-1712. [PMID: 34743678 DOI: 10.1080/13691058.2021.1998631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
There is limited evidence about the lives of queer Mongolian youth. This is despite mental health problems being a pressing concern among young Mongolians, and international evidence suggesting queer youth may experience more mental health challenges than their non-queer peers. We explored the experiences of queer youth in their immediate environments and navigation of their identities in Mongolian society. In this study, twelve young queer-identifying people aged 18-25 from Ulaanbaatar, Mongolia participated in photo-elicitation interviews. Visual research methods allowed participants to generate rich (visual, textual, and oral) data about their lived experiences. We analysed data using a thematic approach and identified three main themes, each with three sub-themes. Participants reported that peer bullying and gendered expectations at school, heteronormativity and gender role expectation in family settings, along with strong stereotypes about queerness in broader society, substantially impacted participants' mental and physical wellbeing. Mongolian queer youth need strong support from their immediate environments, such as school and family. Stigma and misconception around queerness remain persistent among the public but young people are continuously resisting the prejudice expressed towards them. Understanding these challenges is crucial to increasing inclusivity in policies and programmes to enhance the wellbeing of young queer Mongolians.
Collapse
Affiliation(s)
- Dorjjantsan Ganbaatar
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Health Programme, LGBT Centre (Mongolia), Ulaanbaatar, Mongolia
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Shahinoor Akter
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
8
|
Hourani J, Jarallah Y, Block K, Murray L, Chen J, Hach M, Vaughan C. How structural and symbolic violence during resettlement impacts the social and mental wellbeing of forced migrant women: the lived experiences of Arabic speaking survivors of IPV resettled in Melbourne, Australia. Confl Health 2022; 16:59. [PMID: 36369087 PMCID: PMC9652810 DOI: 10.1186/s13031-022-00494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
Forced migrant women experience high levels of violence across their journeys and violence can be characterised as having three overarching forms: structural, symbolic, and interpersonal. It is important to understand the intersecting nature of gendered forms of symbolic, structural and interpersonal violence, and their impact on the mental health of forced migrant women in order to develop holistic IPV and resettlement programs and interventions. This article adopts an ecological framework of violence and qualitative methods with mental health service providers and survivors of IPV to understand the intersections of different forms of violence and their impact on mental health as they relate to the lived experiences of Arabic-speaking forced migrant survivors currently residing in Melbourne, Australia. Our research has three key findings: (1) that forced migrant women living in Melbourne, Australia experience intersecting forms of violence during resettlement (2) Structural and symbolic violence against forced migrant women persists regardless of marital status (3) Autonomy and independence plays a vital role in the mental health and wellbeing of forced migrant women. Our findings reveal that structural and symbolic violence increase the risk of IPV for forced migrant women during resettlement and that even when forced migrant women leave IPV situations, structural and symbolic violence persist and exacerbate mental ill-health. This article also reveals the importance autonomy and independence in both the perpetration of violence and in healing and recovery.
Collapse
|
9
|
Suha M, Murray L, Warr D, Chen J, Block K, Murdolo A, Quiazon R, Davis E, Vaughan C. Reproductive coercion as a form of family violence against immigrant and refugee women in Australia. PLoS One 2022; 17:e0275809. [PMID: 36327211 PMCID: PMC9632814 DOI: 10.1371/journal.pone.0275809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Reproductive coercion (RC), generally considered a form of intimate partner violence (IPV), refers to perpetrator behaviours and actions that are intended to interfere with and control the autonomous decision-making of a person regarding their reproductive health. To date there are few studies that document RC as experienced by immigrant and refugee women. In this article, we explore cases of RC as described by women who were part of a larger qualitative study investigating violence against immigrant and refugee women in southern Australia. The study aimed to identify the types of RC detailed in immigrant and refugee women’s narratives, and to illustrate the contexts in which these experiences occurred. Analysis followed Baxter and Jack’s (2008) case study methodology; whereby particular “cases” are used to describe a phenomenon in context. Thirteen women from seven countries described experiences that fit definitions of RC. The cases describe various types of RC including violence during pregnancy with the intent of causing miscarriage, forced abortion, contraception sabotage and forced pregnancy. As well as intimate partners, some women described multiple perpetrators being complicit in their experience of RC, especially in regard to controlling women’s access to, and interactions with health services. More information is needed about immigrant and refugee women’s experiences of RC, and how vulnerability to multi-perpetrator violence affects health service access. In particular knowledge about how multi-perpetrator RC can affect consent processes for women who already face barriers to health care requires attention. Further research is required to address knowledge gaps about appropriate prevention and advocacy work about RC in refugee and migrant communities, and what training is needed for professionals in the family violence sector, women’s health services, women’s organisations, multicultural and ethno-specific services.
Collapse
Affiliation(s)
- Mariyam Suha
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Melbourne, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Linda Murray
- College of Health, Massey University, Wellington, New Zealand
- * E-mail:
| | - Deborah Warr
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jasmin Chen
- Multicultural Centre for Women’s Health, Melbourne, Australia
| | - Karen Block
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Adele Murdolo
- Multicultural Centre for Women’s Health, Melbourne, Australia
| | - Regina Quiazon
- Multicultural Centre for Women’s Health, Melbourne, Australia
| | - Erin Davis
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
10
|
Idrees T, Zabala ZE, Moreno EM, Gerges A, Urrutia MA, Ruiz JG, Vaughan C, Vellanki P, Pasquel FJ, Peng L, Umpierrez GE. LBSUN215 Evaluation Of Glycemic Control By Continuous Glucose Monitoring Among Hospitalized Older Adults With Type-2 Diabetes And Frailty. J Endocr Soc 2022. [PMCID: PMC9624962 DOI: 10.1210/jendso/bvac150.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Recent observational and meta-analyses have reported a frailty prevalence between 10% and 25% in people with diabetes, in particular in those older than 60 years of age. The impact of frailty on hospital glycemic control and glycemic variability (GV) by continuous glucose monitoring (CGM) in insulin-treated older adults with type 2 diabetes (T2D) is not known. Accordingly, we reviewed data from 3 inpatient randomized clinical trials using CGM in insulin-treated patients with T2D. The validated laboratory-based frailty index (FI-LAB) scale was used for frailty assessment, and participants were categorized into three groups [non-frail: (0-<0.1), pre-frail (≥0.1-<0.21), and frail (≥0.21)] in 84 older adults. | There were no differences on admission clinical characteristics between the non-frail/pre-frail older adults and the frail older adults except for Creatinine (BMI: 32.4 ± 9 vs. 36.83± 13, p=0.21; HbA1c%: 9.3 ± 2 vs. 8.72± 2, p=0.18; Admission BG: 227 ± 114 vs. 194. 07± 75 mg/dl, p=0.26; Cr: 1.16 ± 1 vs. 1.65± 1. 0). There were no differences in GV by coefficient of variation (CV), amplitude of glucose excursion (MAGE), and standard deviation (SD) between the two groups. The correlation between FI-LAB score and percent time with CGM <70 was 0.204 (p=0. 064) and the correlation between FI-LAB score and percent time with percent time with CGM<54 was 0.217 (p=0. 049). Results from standard linear regression and zero-inflated Beta regression further suggest that frail old patients with higher frailty scores may be associated with larger percent time with CGM below range <70 and CGM <54 mg/dL. Conclusion Our results indicate that older adults with T2D with higher frailty score experience more time in hypoglycemia during their hospital stay despite having comparable mean daily blood glucose, time in range and glycemic variability compared to non-frail or pre-frail older adults. A larger prospective study is needed to confirm these findings and determine the impact of frailty on clinical outcome. Providers should be vigilant when using insulin or insulin secretagogues in hospitalized older adults with diabetes and frailty. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
Collapse
Affiliation(s)
- Thaer Idrees
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - Z E Zabala
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - E M Moreno
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - A Gerges
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - M A Urrutia
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - J G Ruiz
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - C Vaughan
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - P Vellanki
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - F J Pasquel
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - L Peng
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| | - G E Umpierrez
- Division of Endocrinology, Emory University School of Medicine , Atlanta, GA , USA
| |
Collapse
|
11
|
Alisic E, Vaughan C, Morrice H, Joy K, Chavez KM. A double taboo? Children bereaved by domestic homicide. The Lancet Public Health 2022; 7:e810. [DOI: 10.1016/s2468-2667(22)00228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
|
12
|
Henderson H, da Silva AM, da Silva M, Soares Xavier HA, Mendonca SA, de Araújo RM, Vaughan C, Bohren MA. Participatory Qualitative Research in a Multilingual Context: The Use of Panel Translation to Better Understand and Improve Sexual and Reproductive Health in Timor-Leste. Qual Health Res 2022; 32:1498-1513. [PMID: 35758872 PMCID: PMC9411783 DOI: 10.1177/10497323221110800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Understanding and respecting different linguistic and socio-cultural needs of health service users is critical to design, adapt and provide appropriate health services. We explored access to male family planning methods in The Democratic Republic of Timor-Leste, a linguistically and culturally diverse nation, by conducting 14 participatory group discussions (PGDs) with 175 participants across seven municipalities. Participants (84 men and 91 women, aged 18 to 72) spoke 13 different languages. PGDs were audio-recorded and translated to English using a multilingual panel translation approach that enabled rigorous and reflexive discussion and learning between researchers about context and meaning. Planning for language diversity helped us to centre participant voices and to hear perspectives that may have otherwise been excluded or misrepresented. Our study affirms the need for research teams to include diverse members who help ensure meaning and voice is not lost across cultural and linguistic differences. Linguistic respect, inclusion and transparency are required to realise improved health and development outcomes.
Collapse
Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Dili, Timor-Leste
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- MSI Asia Pacific, Melbourne, Victoria, Australia
| | | | | | | | | | | | - Cathy Vaughan
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
13
|
Habito CM, Morgan A, Vaughan C. 'Direct' and 'instant': the role of digital technology and social media in young Filipinos' intimate relationships. Cult Health Sex 2022; 24:657-672. [PMID: 33600276 DOI: 10.1080/13691058.2021.1877825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Young people today grow up in a social landscape in which digital technology and social media are ubiquitous in daily life and interpersonal relations, including intimate (romantic and sexual) relationships. This study sought to study Filipino young people's relationship motivations and contexts in the digital age. We found that digital technology and social media are transforming the way Filipino young people approach and behave in intimate relationships. Digital technology and social media are making it easier for young people to engage in social comparison with their peers and role models, expanding possibilities for social interaction, facilitating rapid relationship progression, and enabling digital togetherness and self-expression in a context where conservative religious and sociocultural norms and sexual double standards remain dominant. This social environment brings opportunities to engage in relationships in new ways but also exposure to risks that may lead to poor sexual and reproductive health outcomes. Our findings underscore the importance of comprehensive sexuality education in schools and at home, and highlight the need for critical dialogue about the social norms and stereotypes that perpetuate gender-based violence and inequality in online and offline spaces.
Collapse
Affiliation(s)
- Christine Marie Habito
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Maher L, Collins V, McCullagh J, McGarrigle A, Vaughan C. Assessment of Newer Radiation Dose Reduction Techniques During Coronary Angiography. Ir Med J 2022; 115:558. [PMID: 35532344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aims To evaluate the impact of Allura Clarity technology on radiation exposure in patients undergoing diagnostic coronary angiography. Methods A retrospective analysis was undertaken of invasive coronary angiograms performed by a single experienced operator in Cork University Hospital (CUH) (Allura Xper FD10 angiography system). In order to reduce operator variability, we also analysed cases performed by the same operator in the Bon Secours Hospital Cork (BSHC) (Allura Clarity FD10 angiography system). Cases were selected consecutively, having excluded those involving percutaneous coronary intervention, graft studies, aortography, ventriculography, right heart studies or fractional flow reserve studies. Results A total of 178 patients were included, equally distributed between the CUH arm (n=89) and the BSHC arm (n=89). Cohorts were very well matched in terms of age, gender, Body Mass Index, and procedural approach. The median radiation dose in CUH was a Dose Area Product (DAP) of 10,460 mGy.cm2 vs. median DAP of 12,795 mGy.cm2 in BSHC (p=0.148). The median fluoroscopy time in CUH was 2.25mins vs. median fluoroscopy time of 2.17mins in BSHC (p=0.675). Conclusion The use of the Allura Clarity system for diagnostic coronary angiography did not result in a significant difference in radiation dose or fluoroscopy time when compared to the reference Allura Xper system. Further research is needed to investigate the benefit of this new image noise reduction technology in diagnostic coronary angiography.
Collapse
Affiliation(s)
- L Maher
- Department of Cardiology, Cork University Hospital, Ireland
| | - V Collins
- Department of Radiology, Bon Secours Hospital, Cork, Ireland
| | - J McCullagh
- Department of Medical Physics, Cork University Hospital, Ireland
| | - A McGarrigle
- Cork Radiation Protection Services, Cork, Ireland
| | - C Vaughan
- Department of Cardiology, Cork University Hospital, Ireland
- Department of Cardiology, Bon Secours Hospital, Cork, Ireland
| |
Collapse
|
15
|
Ahern S, Vaughan C. Factors Influencing Ambulance Usage in Acute Coronary Syndrome. Ir Med J 2022; 115:539. [PMID: 35416473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aims The aims of this study are to identify the proportion of ACS patients using an ambulance to transport to hospital and to explore the factors influencing mode of transport. Methods A retrospective, observational cohort design was utilised in this study. Data concerning cases of ACS in a university hospital over a 9-year period was obtained from the Coronary Heart Attack Ireland Register. Descriptive statistics were used to detail demographic and clinical data, as well as to establish the proportion of ambulance usage among ACS patients. Chi-square and t-tests were used to differentiate between groups at baseline. Factors influencing mode of transport were analysed by binary logistic regression. Results 4,229 cases were obtained. Exclusion and inclusion criteria were applied, leaving 1,964 cases for overall analysis. 533 (27%) patients directly used an ambulance, 1,098 (56%) patients presented initially to their GP while 333 (17%) went directly to A&E. Logistic regression showed that age, clinical factors, smoking status and diagnosis each had a statistically significant effect on ambulance usage. Conclusions Ambulance services are underutilised by ACS patients, despite clear benefits of their use. Several factors impacted patients' mode of transport. Knowledge of these is essential in guiding future awareness campaigns to promote ambulance usage in ACS.
Collapse
Affiliation(s)
- S Ahern
- Department of Cardiothoracic Surgery, Cork University Hospital
| | - C Vaughan
- Department of Cardiology, Mercy University Hospital, Cork
| |
Collapse
|
16
|
Moulton JE, Corona MIV, Vaughan C, Bohren MA. Women's perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis. PLoS One 2021; 16:e0261551. [PMID: 34932570 PMCID: PMC8691598 DOI: 10.1371/journal.pone.0261551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Reproductive coercion and abuse is a major public health issue, with significant effects on the health and well-being of women. Reproductive coercion and abuse includes any form of behaviour that intentionally controls another person's reproductive choices. The aim of this qualitative evidence synthesis is to explore women's experiences of reproductive coercion and abuse globally, to broaden understanding of the different ways reproductive coercion and abuse is perpetrated, perceived and experienced across settings and socio-cultural contexts. METHOD We searched Medline, CINAHL and Embase for eligible studies from inception to 25th February 2021. Primary studies with a qualitative study design that focused on the experiences and perceptions of women who have encountered reproductive coercion and abuse were eligible for inclusion. Titles and abstracts, and full texts were screened by independent reviewers. We extracted data from included studies using a form designed for this synthesis and assessed methodological limitations using CASP. We used Thomas and Harden's thematic analysis approach to analyse and synthesise the evidence, and the GRADE-CERQual approach to assess confidence in review findings. RESULTS We included 33 studies from twelve countries in South Asia, the Asia Pacific, North America, South America, Africa and Europe. Most studies used in-depth interviews and focus group discussions to discuss women's experiences of reproductive coercion and abuse. Reproductive coercion and abuse manifested in a range of behaviours including control of pregnancy outcome, pregnancy pressure or contraceptive sabotage. There were a range of reasons cited for reproductive coercion and abuse, including control of women, rigid gender roles, social inequalities and family pressure. Women's different responses to reproductive coercion and abuse included using covert contraception and feelings of distress, anger and trauma. Across contexts, perpetration and experiences of reproductive coercion and abuse were influenced by different factors including son preferences and social exclusion. CONCLUSIONS We reflect on the importance of socio-cultural factors in understanding the phenomenon of reproductive coercion and abuse and how it affects women, as well as how the mechanisms of power and control at both individual and societal levels work to perpetuate the incidence of reproductive coercion and abuse against women.
Collapse
Affiliation(s)
- Jessica E. Moulton
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Martha Isela Vazquez Corona
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Cathy Vaughan
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
17
|
Wong HTH, Jin D, Wang P, Sun Y, Mao L, Zhang Y, Ogilvie E, Vujcich D, Newman C, O'Connor CC, Vaughan C, Carter A. Using Videoconferencing Focus Groups in Sexual and Reproductive Health Research With Chinese Im/Migrants in Australia. Qual Health Res 2021; 31:2757-2769. [PMID: 34636281 DOI: 10.1177/10497323211043823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Videoconferencing focus groups have emerged as a popular method for collecting qualitative data. However, its use in sexual and reproductive health research is still very much in its infancy. Based on participants' feedback and researchers' reflections on using videoconferencing focus groups to collect sexual and reproductive health data with 39 heterosexual and non-heterosexual Chinese im/migrants in Australia, we discuss some of the key lessons learned, and considerations involved in shifting from face-to-face to online focus groups. Overall, videoconferencing focus groups appeared to be a highly feasible and acceptable way to discuss "sensitive" topics with Chinese im/migrants. Importantly, researchers need to be both creative and reflexive during the research process and must not forget that the success of a study lies not only in troubleshooting technical issues but also in cultivating and maintaining a trusting relationship with research participants.
Collapse
Affiliation(s)
- Horas T H Wong
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Defeng Jin
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Pan Wang
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Yingli Sun
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Limin Mao
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Ye Zhang
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Erin Ogilvie
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | | | - Christy Newman
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | | | - Cathy Vaughan
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Allison Carter
- University of New South Wales Sydney, Sydney, New South Wales, Australia
- Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
18
|
Carter A, Bateson D, Vaughan C. Reproductive coercion and abuse in Australia: what do we need to know? Sex Health 2021; 18:436-440. [PMID: 34731597 DOI: 10.1071/sh21116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022]
Abstract
Reproductive coercion and abuse refers to patterns of controlling and manipulative behaviours used to interfere with a person's reproductive health and decision-making. Unintended pregnancy, forced abortion or continuation of a pregnancy, and sexually transmissible infections all may result from reproductive coercion, which is closely associated with intimate partner and sexual violence. Clinicians providing sexual and reproductive healthcare are in a key position to identify and support those affected. Yet, reproductive coercion and abuse is not currently screened for in most settings and addressing disclosures poses many challenges. This article discusses what reproductive coercion and abuse is, who it affects, how it impacts, and potential strategies to improve identification and response.
Collapse
Affiliation(s)
- Allison Carter
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; and Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia; and Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Deborah Bateson
- Family Planning New South Wales, Sydney, NSW, Australia; and Speciality of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW, Australia
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| |
Collapse
|
19
|
Devine A, Shields M, Dimov S, Dickinson H, Vaughan C, Bentley R, LaMontagne AD, Kavanagh A. Australia's Disability Employment Services Program: Participant Perspectives on Factors Influencing Access to Work. Int J Environ Res Public Health 2021; 18:11485. [PMID: 34770000 PMCID: PMC8582653 DOI: 10.3390/ijerph182111485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022]
Abstract
Disability employment programs play a key role in supporting people with disability to overcome barriers to finding and maintaining work. Despite significant investment, ongoing reforms to Australia's Disability Employment Services (DES) are yet to lead to improved outcomes. This paper presents findings from the Improving Disability Employment Study (IDES): a two-wave survey of 197 DES participants that aims to understand their perspectives on factors that influence access to paid work. Analysis of employment status by type of barrier indicates many respondents experience multiple barriers across vocational (lack of qualifications), non-vocational (inaccessible transport) and structural (limited availability of jobs, insufficient resourcing) domains. The odds of gaining work decreased as the number of barriers across all domains increased with each unit of barrier reported (OR 1.22, 95% CI 1.07, 1.38). Unemployed respondents wanted more support from employment programs to navigate the welfare system and suggest suitable work, whereas employed respondents wanted support to maintain work, indicating the need to better tailor service provision according to the needs of job-seekers. Combined with our findings from the participant perspective, improving understanding of these relationships through in-depth analysis and reporting of DES program data would provide better evidence to support current DES reform and improve models of service delivery.
Collapse
Affiliation(s)
- Alexandra Devine
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (M.S.); (S.D.); (C.V.); (R.B.); (A.K.)
| | - Marissa Shields
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (M.S.); (S.D.); (C.V.); (R.B.); (A.K.)
| | - Stefanie Dimov
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (M.S.); (S.D.); (C.V.); (R.B.); (A.K.)
| | - Helen Dickinson
- School of Business, University of New South Wales, Canberra 2610, Australia;
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (M.S.); (S.D.); (C.V.); (R.B.); (A.K.)
| | - Rebecca Bentley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (M.S.); (S.D.); (C.V.); (R.B.); (A.K.)
| | - Anthony D. LaMontagne
- School of Health and Social Development, Deakin University, Melbourne 3125, Australia;
| | - Anne Kavanagh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (M.S.); (S.D.); (C.V.); (R.B.); (A.K.)
| |
Collapse
|
20
|
Hourani J, Block K, Phillimore J, Bradby H, Ozcurumez S, Goodson L, Vaughan C. Structural and Symbolic Violence Exacerbates the Risks and Consequences of Sexual and Gender-Based Violence for Forced Migrant Women. Front Hum Dyn 2021. [DOI: 10.3389/fhumd.2021.769611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
While much attention is focused on rape as a weapon of war, evidence shows that forced migrant women and girls face increased risks of Sexual and Gender-Based Violence (SGBV) both during and following forced displacement. In this paper, we argue that gendered forms of structural and symbolic violence enable and compound the harms caused by interpersonal SGBV against forced migrant women and girls. These forms of violence are encountered in multiple contexts, including conflict and post-conflict settings, countries of refuge, and following resettlement. This paper illustrates the consequences of resultant cumulative harms for individuals and communities, and highlights the importance of considering these multiple, intersecting harms for policy and practice.
Collapse
|
21
|
Emerson E, Milner A, Aitken Z, Krnjacki L, Vaughan C, Llewellyn G, Kavanagh A. Overt acts of perceived discrimination reported by British working-age adults with and without disability. J Public Health (Oxf) 2021; 43:e16-e23. [PMID: 31876284 DOI: 10.1093/pubmed/fdz093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. METHODS Secondary analysis of de-identified cross-sectional data from the three waves of the UK's 'Life Opportunities Survey'. RESULTS In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. CONCLUSIONS Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.
Collapse
Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney NSW 1825, Australia.,Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Allison Milner
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Zoe Aitken
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Lauren Krnjacki
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Cathy Vaughan
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney NSW 1825, Australia
| | - Anne Kavanagh
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| |
Collapse
|
22
|
Habito CM, Morgan A, Vaughan C. Early union, 'disgrasya', and prior adversity and disadvantage: pathways to adolescent pregnancy among Filipino youth. Reprod Health 2021; 18:107. [PMID: 34039359 PMCID: PMC8157620 DOI: 10.1186/s12978-021-01163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies explore what it means to be an adolescent parent in the Philippines from the young parents' perspective. This study sought to improve understanding of how adolescent mothers and young fathers experienced pregnancy in Palawan, Philippines. METHODS We conducted narrative analysis of 27 semi-structured interviews with 15 Filipino young parents. FINDINGS Our findings point to three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: through early unions, through 'disgrasya' (accident) in romantic relationships, and when pregnancy is directly related to adversity and disadvantage. Some young people adopted agentic narratives and had intended pregnancies within early unions. Young people who had unintended pregnancies in romantic relationships recounted constrained choice narratives, taking responsibility for their decisions while emphasising external factors' influence on their decision-making. Other young mothers described the ways that prior adversity and disadvantage gave rise to unfavourable circumstances-including sexual violence-that led to unintended pregnancy but shared narratives showing how they had reclaimed agency in their lives. CONCLUSION Our findings highlight the need to (1) address underlying poverty and structural inequalities that limit Filipino young people's life choices and contribute to their pathways to adolescent pregnancy; (2) provide Filipino young people with access to essential sexual and reproductive health information, services, and supplies; and (3) change social norms to rectify gender-based power imbalances and sexual violence.
Collapse
Affiliation(s)
- Christine Marie Habito
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia. .,Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
| |
Collapse
|
23
|
Azzopardi PS, Vaughan C, Patton GC, Humphries-Waa K, Binder G, Comrie-Thomson L, Kennedy E. Gender norms and the wellbeing of girls and boys - Author's reply. Lancet Glob Health 2021; 9:e399. [PMID: 33740404 DOI: 10.1016/s2214-109x(20)30554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Peter S Azzopardi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Centre for Adolescent Health, Population Health Theme, Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - George C Patton
- Centre for Adolescent Health, Population Health Theme, Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Gerda Binder
- East Asia and Pacific Regional Office, UNICEF, Bangkok, Thailand
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| |
Collapse
|
24
|
Moosad L, Vaughan C. Care, collaboration and critique: The intersection of creativity and wellbeing in older women. Intnl J Wellbeing 2020. [DOI: 10.5502/ijw.v10i5.1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
25
|
Vaughan C, Gill‐Atkinson L, Devine A, Zayas J, Ignacio R, Garcia J, Bisda K, Salgado J, Marco MJ. Enabling Action: Reflections upon Inclusive Participatory Research on Health with Women with Disabilities in the Philippines. Am J Community Psychol 2020; 66:370-380. [PMID: 33078846 PMCID: PMC7821201 DOI: 10.1002/ajcp.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
People with disabilities experience health disparities arising from social, environmental, and system-level factors. Evidence from a range of settings suggests women with disabilities have reduced access to health information and experience barriers to screening, prevention, and care services. This results in greater unmet health needs, particularly in relation to sexual and reproductive health. Women with disabilities are also more likely to experience physical and sexual violence than women without disabilities, further undermining their health. Community-based participatory research (CBPR) can generate knowledge and underpin action to address such health disparities and promote health equity. However, the potential and challenges of disability inclusion in CBPR, particularly in contexts of poverty and structural inequality such as those found in low- and middle-income countries, are not well documented. In this paper, we reflect on our experience of implementing and evaluating W-DARE, a three-year program of disability-inclusive CBPR aiming to increase access to sexual and reproductive health and violence-response services for women with disabilities in the Philippines. We discuss strategies for increasing disability inclusion in research and use a framework of reflexive solidarity to consider the uneven distribution of the benefits, costs, and responsibilities for action arising from the W-DARE program.
Collapse
Affiliation(s)
- Cathy Vaughan
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
| | - Liz Gill‐Atkinson
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
| | - Alexandra Devine
- Nossal Institute for Global HealthThe University of MelbourneMelbourneVic.Australia
| | - Jerome Zayas
- Social Development Research CenterDe La Salle UniversityManilaPhilippines
| | - Raquel Ignacio
- Center for Women’s Studies FoundationUniversity of the PhilippinesQuezon CityPhilippines
| | | | | | - Joy Salgado
- Likhaan Center for Women’s HealthQuezon CityPhilippines
| | - M. Jesusa Marco
- Social Development Research CenterDe La Salle UniversityManilaPhilippines
| |
Collapse
|
26
|
Emerson E, Aitken Z, Krnjacki L, Vaughan C, Llewellyn G, Kavanagh A. Correspondence. J Public Health (Oxf) 2020; 42:e575-e577. [PMID: 31789375 DOI: 10.1093/pubmed/fdz161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric Emerson
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Sydney LA1 4YW Australia.,Faculty of Health & Medicine, Centre for Disability Research, Lancaster University, Lancaster NSW 2140 UK
| | - Zoe Aitken
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010 Australia
| | - Lauren Krnjacki
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010 Australia
| | - Cathy Vaughan
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010 Australia
| | - Gwynnyth Llewellyn
- Faculty of Health Sciences, Centre for Disability Research and Policy, University of Sydney, Sydney LA1 4YW Australia
| | - Anne Kavanagh
- Melbourne School Population and Global Health, The University of Melbourne, Victoria 3010 Australia
| |
Collapse
|
27
|
Kennedy E, Binder G, Humphries-Waa K, Tidhar T, Cini K, Comrie-Thomson L, Vaughan C, Francis K, Scott N, Wulan N, Patton G, Azzopardi P. Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region. Lancet Glob Health 2020; 8:e1473-e1488. [PMID: 33091371 DOI: 10.1016/s2214-109x(20)30354-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND By adulthood, gender inequalities in health and wellbeing are apparent. Yet, the timing and nature of gender inequalities during childhood and adolescence are less clear. We describe the emergence of gender inequalities in health and wellbeing across the first two decades of life. METHODS We focused on the 40 low-income and middle-income countries in Asia and the Pacific. A measurement framework was developed around four key domains of wellbeing across the first two decades: health, education and transition to employment, protection, and a safe environment. Specific measurement constructs were then defined by considering gender indicator frameworks, the Sustainable Development Goals, indicator frameworks for child and adolescent health and wellbeing, and key stakeholder input. Available data were then mapped to define 87 indicators, subsequently populated using databases (UN agencies and the Global Burden of Diseases, Injuries, and Risk Factors Study) and nationally representative surveys. Where possible, estimates in girls were compared with boys to report relative risks. FINDINGS Although son preference is evident in some settings-as shown by higher than expected male-to-female sex ratios at birth in India, Vietnam, and China (all >1·10 compared with an expected ratio of 1·05) and excess mortality of girl children in some South Asian and Pacific nations-it is during early adolescence where marked gender inequalities consistently emerged. Adolescent girls face considerable disadvantage in relation to sexual and reproductive health (notably in South Asia and the Pacific), with high rates of child marriage (≥30% of women aged 20-24 years married before 18 years in Bangladesh, Nepal, and Afghanistan), fertility (≥65 livebirths per 1000 girls in Nauru, Laos, Afghanistan, Nepal, Marshall Islands, Bangladesh, Vanuatu, and Papua New Guinea), and intimate partner violence (>20% in Timor Leste, Afghanistan, Pakistan, and Myanmar). Despite educational parity in many countries, females aged 15-24 years were less likely than males to be in education, employment, or training in 17 of 19 countries for which data were available. Compared with girls, adolescent boys experienced excess all-cause mortality and substantially higher mortality due to unintentional injury, interpersonal violence, alcohol and other drugs, and suicide, and higher prevalence of harmful drinking and tobacco smoking. INTERPRETATION These findings call for a focus on gender policy and programming in later childhood and early adolescence before gender inequalities become embedded. FUNDING UNICEF.
Collapse
Affiliation(s)
- Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Gerda Binder
- East Asia and Pacific Regional Office, UNICEF, Bangkok, Thailand
| | | | - Tom Tidhar
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Karly Cini
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate Francis
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Nisaa Wulan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - George Patton
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter Azzopardi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia; Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute and School of Medicine, University of Adelaide, Adelaide, SA, Australia.
| |
Collapse
|
28
|
Emerson E, Milner A, Aitken Z, Vaughan C, Llewellyn G, Kavanagh AM. Exposure to discrimination and subsequent changes in self-rated health: prospective evidence from the UK's Life Opportunities Survey. Public Health 2020; 185:176-181. [PMID: 32640384 DOI: 10.1016/j.puhe.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 02/10/2020] [Accepted: 04/30/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We sought to estimate risk of poor self-rated health (SRH) following exposure to disability-related and other forms of overt discrimination in a cohort of working age adults. STUDY DESIGN The study design is a population-based cohort survey. METHODS Secondary analysis of data collected in Waves 1 and 2 of the UK's Life Opportunities Survey which at Wave 2 involved the participation of 12,789 working age adults. Adjusted prevalence rate ratios were used to estimate the impact of exposure to disability and non-disability discrimination on two measures of SRH at Wave 2, controlling for SRH status at Wave 1. RESULTS Exposure to disability discrimination in the previous year was reported by 3.9% of working age British adults. Other forms of discrimination were reported less frequently (age: 3.7%, ethnicity: 2.5%, gender: 1.6%, religion: 0.8%, sexual orientation: 0.4%). In all analyses, there were stronger associations between exposure to disability discrimination and poor SRH at Wave 2 when compared with exposure to other forms of discrimination. CONCLUSIONS Disability discrimination represents a violation of human rights. It is also likely to be a major contributor to the health inequities experienced by working age adults with disability.
Collapse
Affiliation(s)
- E Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia; Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, UK.
| | - A Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Z Aitken
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - C Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - G Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia.
| | - A M Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| |
Collapse
|
29
|
Comrie-Thomson L, Mavhu W, Makungu C, Nahar Q, Khan R, Davis J, Stillo E, Hamdani S, Luchters S, Vaughan C. Male involvement interventions and improved couples' emotional relationships in Tanzania and Zimbabwe: 'When we are walking together, I feel happy'. Cult Health Sex 2020; 22:722-739. [PMID: 31429674 DOI: 10.1080/13691058.2019.1630564] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 06/07/2019] [Indexed: 06/10/2023]
Abstract
Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men's and women's experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples' emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men's behaviour change, to improve care-seeking and home care practices. Men's and women's subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships - both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions.
Collapse
Affiliation(s)
- Liz Comrie-Thomson
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Webster Mavhu
- Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe
- International Public Health Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rasheda Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
30
|
Devine A, Vaughan C, Kavanagh A. If I had stable housing I would be a bit more receptive to having a job. Factors influencing the effectiveness of Disability Employment Services reform. Work 2020; 65:775-787. [DOI: 10.3233/wor-203130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexandra Devine
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anne Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
31
|
Devine A, Vaughan C, Kavanagh A, Dickinson H, Byars S, Dimov S, Gye B, Brophy L. 'I'm proud of how far I've come. I'm just ready to work': mental health recovery narratives within the context of Australia's Disability Employment Services. BMC Public Health 2020; 20:325. [PMID: 32164650 PMCID: PMC7068916 DOI: 10.1186/s12889-020-8452-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Employment is recognised as facilitating the personal and clinical recovery of people with psychosocial disability. Yet this group continue to experience considerable barriers to work, and, constitute a significant proportion of individuals engaged with Disability Employment Services (DES). Recognition of the role of recovery-oriented practice within DES remains limited, despite these approaches being widely promoted as best-practice within the field of mental health. Methods The Improving Disability Employment Study (IDES) aims to gather evidence on factors influencing employment outcomes for Australians with disability. Descriptive analysis and linear regression of IDES survey data from 369 DES participants, alongside narrative analysis of data collected through 56 in-depth interviews with 30 DES participants with psychosocial disability, allowed us to explore factors influencing mental health, well-being and personal recovery within the context of DES. Results Psychosocial disability was reported as the main disability by 48% of IDES respondents. These individuals had significantly lower scores on measures of mental health and well-being (44.9, 48.4 respectively, p ≤ 0.01), compared with respondents with other disability types (52.2, 54.3 p ≤ 0.01). Within this group, individuals currently employed had higher mental health and well-being scores than those not employed (47.5 vs 36.9, 55.5 vs 45.4 respectively, p ≤ 0.01). Building on these findings, our qualitative analysis identified five personal recovery narratives: 1) Recovery in spite of DES; 2) DES as a key actor in recovery; 3) DES playing a supporting role in fluctuating journeys of recovery; 4) Recovery undermined by DES; and, 5) Just surviving regardless of DES. Narratives were strongly influenced by participants’ mental health and employment status, alongside the relationship with their DES worker, and, participants’ perspectives on the effectiveness of services provided. Conclusion These findings re-iterate the importance of work in supporting the mental health and well-being of people with psychosocial disability. Alongside access to secure and meaningful work, personal recovery was facilitated within the context of DES when frontline workers utilised approaches that align with recovery-orientated practices. However, these approaches were not consistently applied. Given the number of people with psychosocial disability moving through DES, encouraging greater consideration of recovery-oriented practice within DES and investment in building the capacity of frontline staff to utilise such practice is warranted.
Collapse
Affiliation(s)
- Alexandra Devine
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anne Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business, University of New South Wales, Canberra, Australia
| | - Sean Byars
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Stefanie Dimov
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bill Gye
- Community Mental Health Australia, Sydney, Australia
| | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| |
Collapse
|
32
|
González-Agüero M, Chenhall R, Basnayake P, Vaughan C. Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health. Med Anthropol Q 2019; 34:210-226. [PMID: 31637732 DOI: 10.1111/maq.12555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
Abstract
While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge.
Collapse
Affiliation(s)
| | - Richard Chenhall
- Melbourne School of Population and Global Health, The University of Melbourne
| | - Prabhathi Basnayake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne
| | - Cathy Vaughan
- Gender and Women's Health Unit, Melbourne School of Population and Global Health, The University of Melbourne
| |
Collapse
|
33
|
Habito CM, Vaughan C, Morgan A. Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines? BMC Public Health 2019; 19:1142. [PMID: 31429733 PMCID: PMC6701073 DOI: 10.1186/s12889-019-7451-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background Adolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example. Methods This study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS. Results This study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use. Conclusions In the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood. Electronic supplementary material The online version of this article (10.1186/s12889-019-7451-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christine Marie Habito
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia.
| | - Cathy Vaughan
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Alison Morgan
- Maternal, Sexual and Reproductive Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
34
|
Sutherland G, Easteal P, Holland K, Vaughan C. Mediated representations of violence against women in the mainstream news in Australia. BMC Public Health 2019; 19:502. [PMID: 31053066 PMCID: PMC6500010 DOI: 10.1186/s12889-019-6793-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/09/2019] [Indexed: 11/12/2022] Open
Abstract
Background How the mainstream news media report violence against women is significant if levels of violence are to be reduced and ultimately eliminated. Media reporting is an important indicator through which to measure progress towards shifting social and cultural norms that reinforce or challenge the place of violence against women in our society. The current study, therefore, aimed to establish a baseline picture of the extent and nature of reporting of violence against women by the mainstream Australian news media. Methods Descriptive and content analysis of media reports on violence against women that were collected over four months in three states of Australia. Reports were from newspapers, broadcast (television and radio) and online news sites. Results Coverage of violence against women in the mainstream news media was extensive. Explicitly situating violent experiences for women within a broader social context was infrequent. Few news reports included information for women on where to seek help. Additionally, news reports rarely elevated the voices of survivors, advocates and other experts, with a disproportionate emphasis on law enforcement, political and criminal justice perspectives. Conclusions Despite readiness among journalists and readers to engage in news about violence against women, reporting that promotes public understanding of the issue is not always the norm.
Collapse
Affiliation(s)
- Georgina Sutherland
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.
| | - Patricia Easteal
- Faculty of Business, Government and Law, University of Canberra, ACT, Bruce, Australia
| | - Kate Holland
- Senior Research Fellow, News and Media Research Centre, Faculty of Arts and Design, University of Canberra, ACT, Bruce, Australia
| | - Cathy Vaughan
- Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
35
|
Hocking JS, Vaughan C, Lau A, Machalek DA, Graham S. Reducing the burden of sexually transmissible infections in Papua New Guinea requires strengthening of clinical services and engaging men. Sex Health 2018. [PMID: 28636865 DOI: 10.1071/sh16058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this edition of Sexual Health, Vallely et al. report the results of a cross-sectional prevalence survey of sexually transmissible infections (STIs) among women attending their first antenatal visit in three provinces of Papua New Guinea (PNG). This Editorial examines potential reasons for these high prevalence estimates and discusses strategies for addressing high STIs rates in PNG.
Collapse
Affiliation(s)
- Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia
| | - Andrew Lau
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia
| | - Dorothy A Machalek
- Department of Molecular Microbiology, Royal Women's Hospital, 30 Flemington Road, Parkville, Vic. 3052, Australia
| | - Simon Graham
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia
| |
Collapse
|
36
|
Pray C, Vaughan C, Kerins D. P6525Prevalence of bendopnea in an outpatient population with heart failure with reduced ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Pray
- University College Cork, School of Medicine, Cork, Ireland
| | - C Vaughan
- Mercy University Hospital, Cardiology, Cork, Ireland
| | - D Kerins
- University College Cork, Pharmacology and Therapeutics, Cork, Ireland
| |
Collapse
|
37
|
Easteal P, Holland K, Breen MD, Vaughan C, Sutherland G. Australian Media Messages: Critical Discourse Analysis of Two Intimate Homicides Involving Domestic Violence. Violence Against Women 2018; 25:441-462. [PMID: 30001682 DOI: 10.1177/1077801218780364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study uses critical discourse analysis to examine news reporting of two cases of intimate partner violence in Australia. The fine-grained analysis of newswriting and news-editing practices focuses particularly on the lexical features and referential strategies used to represent the perpetrator and the victim, the crime, and the location of the crime. Findings show that reporting often omits social context, sensationalizes, and acts to shift blame in ways that do not increase public understanding of the nature of domestic violence. These results build on international findings and add to the evidence base about media reporting of violence against women.
Collapse
|
38
|
Davis J, Vaughan C, Nankinga J, Davidson L, Kigodi H, Alalo E, Comrie-Thomson L, Luchters S. Expectant fathers' participation in antenatal care services in Papua New Guinea: a qualitative inquiry. BMC Pregnancy Childbirth 2018; 18:138. [PMID: 29739351 PMCID: PMC5941321 DOI: 10.1186/s12884-018-1759-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 04/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men‘s participation in antenatal care with their pregnant partner in PNG. Methods Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across four provinces of PNG. Fourteen key informant interviews were also conducted with health workers. Qualitative data generated were analysed thematically. Results While some men accompany their pregnant partners to the antenatal clinic and wait outside, very few men participate in antenatal consultations. Factors supporting fathers’ participation in antenatal consultations included feelings of shared responsibility for the unborn child, concern for the mother’s or baby’s health, the child being a first child, friendly health workers, and male health workers. Sociocultural norms and taboos were the most significant barrier to fathers’ participation in antenatal care, contributing to men feeling ashamed or embarrassed to attend clinic with their partner. Other barriers to men’s participation included fear of HIV or sexually transmitted infection testing, lack of separate waiting spaces for men, rude treatment by health workers, and being in a polygamous relationship. Building community awareness of the benefits of fathers participating in maternal and child health service, inviting fathers to attend antenatal care if their pregnant partner would like them to, and ensuring clinic spaces and staff are welcoming to men were strategies suggested for increasing fathers’ participation in antenatal care. Conclusion This study identified significant sociocultural and health service barriers to expectant fathers’ participation in antenatal care in PNG. Our findings highlight the need to address these barriers – through health staff training and support, changes to health facility layout and community awareness raising – so that couples in PNG can access the benefits of men’s participation in antenatal care. Electronic supplementary material The online version of this article (10.1186/s12884-018-1759-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jessica Davis
- Burnet Institute, Melbourne, Victoria, Australia. .,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Justine Nankinga
- United Nations Children's Fund (UNICEF), Papua New Guinea Country Office, Port Moresby, Papua New Guinea.,current FHI 360, Port Moresby, Papua New Guinea
| | | | | | - Eileen Alalo
- Catholic Church Health Services, Mingende, Port Moresby, Papua New Guinea
| | - Liz Comrie-Thomson
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.,International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
39
|
Lau AS, Mamais C, McChesney E, Upile NS, Vaughan C, Veitch J, Abbas JR, Markey A, Brown NG, Evans M, Thomas J, Gaines M, Shehata Z, Wilkie MD, Leong SC. The BeSMART (Best Supportive Management for Adults Referred with Tonsillopharyngitis) multicentre observational study. Ann R Coll Surg Engl 2017; 99:573-578. [PMID: 28853603 DOI: 10.1308/rcsann.2017.0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Tonsillopharyngitis is the most common ear, nose and throat emergency admission, with 80,000 episodes recorded in England in 2015-2016. Despite this, there is a paucity of evidence addressing the supportive management of tonsillopharyngitis in inpatients. The aim of this retrospective multicentre observational study was to consider the Best Supportive Management for Adults Referred with Tonsillopharyngitis (BeSMART) in the inpatient setting, and to establish any associations between practice and outcomes. Methods Seven hospitals in North West England and North East Scotland participated in the study. Overall, 236 adult patients admitted with tonsillopharyngitis were included. The main outcome measures were interval to return to soft diet, length of stay (LOS), pain scores and readmissions. Results Women were more likely to seek professional help before presenting to secondary care (p=0.04). Patients admitted at the weekend were more likely to have a shorter LOS (p=0.03). There was no relationship between day of admission and seniority or specialty of the doctor initially seen. Prescription of corticosteroid, analgesia and a higher initial intravenous fluid infusion rate were not related to a shorter LOS. Conclusions This study is the first to yield valuable insights into the inpatient management of tonsillopharyngitis. This work represents part of an ongoing project to establish the evidence for common medical interventions for sore throat. Patient and professional surveys as well as a prospective interventional study are planned for the future.
Collapse
Affiliation(s)
- A S Lau
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - C Mamais
- NHS Grampian , UK.,Mersey ENT Research Collaborative , UK
| | - E McChesney
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - N S Upile
- Wirral University Teaching Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - C Vaughan
- Mid Cheshire Hospitals NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - J Veitch
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK.,Mersey ENT Research Collaborative , UK
| | - J R Abbas
- Salford Royal NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - A Markey
- Warrington and Halton Hospitals NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - N G Brown
- NHS Grampian , UK.,Mersey ENT Research Collaborative , UK
| | - M Evans
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - J Thomas
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - M Gaines
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| | - Z Shehata
- Wirral University Teaching Hospital NHS Foundation Trust , UK
| | | | - S C Leong
- Aintree University Hospital NHS Foundation Trust , UK.,Mersey ENT Research Collaborative , UK
| |
Collapse
|
40
|
Caplice N, Devoe M, Choi J, Dahly D, Spitzer E, Van Guens R, Maher M, Tuite D, Kerins D, Kelly P, Kearney P, Curtin R, Vaughan C, Eustace J, McFadden E. P2125Randomised placebo controlled trial evaluating the safety and efficacy of intracoronary insulin like growth factor 1 post percutaneous intervention for acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Devine A, Ignacio R, Prenter K, Temminghoff L, Gill-Atkinson L, Zayas J, Marco MJ, Vaughan C. "Freedom to go where I want": improving access to sexual and reproductive health for women with disabilities in the Philippines. Reprod Health Matters 2017; 25:55-65. [PMID: 28784061 DOI: 10.1080/09688080.2017.1319732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Women with disabilities experience a range of violations of their sexual and reproductive rights. The Philippines ratified the United Nations Convention on the Rights of Persons with Disabilities and have laws in place to promote the rights to sexual and reproductive health and protection from violence. However, limited resourcing, and opposition to such laws undermine access to these rights for all women. Inadequate disability inclusion within policy and programming, and limited disability awareness of services, further impedes women with disabilities from attaining these rights. The W-DARE project (Women with Disability taking Action on REproductive and sexual health) was a three-year participatory action research program designed to (1) understand the sexual and reproductive health experiences and needs of women with disabilities; and (2) improve access to quality sexual and reproductive health, including violence response services, for women with disabilities in the Philippines. In response to the highlighted need for more information about sexual and reproductive health and greater access to services, the W-DARE team developed and implemented a pilot intervention focused on peer-facilitated Participatory Action Groups (PAGs) for women with disabilities. This paper focuses on the qualitative findings from the evaluation of this PAG intervention.
Collapse
Affiliation(s)
- Alexandra Devine
- a Senior Research Officer, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Raquel Ignacio
- b Research Assistance, Social Development Research Centre, De La Salle University , Manila , Philippines
| | - Krystle Prenter
- c Research Intern, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC , Australia
| | - Lauren Temminghoff
- c Research Intern, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC , Australia
| | - Liz Gill-Atkinson
- d Research Assistant, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne , VIC , Australia
| | - Jerome Zayas
- b Research Assistance, Social Development Research Centre, De La Salle University , Manila , Philippines.,e Inclusive Development Advisor, Inclusive Development and Empowerment Agenda , Manila , Philippines
| | - Ma Jesusa Marco
- f Research Fellow, Social Development Research Centre, De La Salle University , Manila , Philippines
| | - Cathy Vaughan
- g Senior Lecturer, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne , VIC , Australia
| |
Collapse
|
42
|
Marella M, Devine A, Armecin GF, Zayas J, Marco MJ, Vaughan C. Rapid assessment of disability in the Philippines: understanding prevalence, well-being, and access to the community for people with disabilities to inform the W-DARE project. Popul Health Metr 2016; 14:26. [PMID: 27489509 PMCID: PMC4971707 DOI: 10.1186/s12963-016-0096-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International recognition that people with disabilities were excluded from the Millennium Development Goals has led to better inclusion of people with disabilities in the recently agreed Global Goals for Sustainable Development (SDGs) 2015-2030. Given the current global agenda for disability inclusion, it is crucial to increase the understanding of the situation of people with disabilities in the Philippines. The aim of this study was to estimate the prevalence of disability and compare the well-being and access to the community between people with and without disabilities. METHODS A population-based survey was undertaken in District 2 of Quezon City and in Ligao City. 60 clusters of 50 people aged 18 years and older were selected with probability proportion to size sampling from both locations. The Rapid Assessment of Disability (RAD) survey was used to identify people with disabilities based on their responses to activity limitations. The levels of well-being and access to the community for people with disabilities were compared with controls matched by age, gender, and cluster. Information on barriers to accessing the community was also collected. RESULTS The prevalence of disability was 6.8 (95 % CI: 5.9, 7.9) and 13.6 % (95 % CI: 11.4, 16.2) in Quezon City and Ligao City respectively. Psychological distress was the most commonly reported condition in both locations, although it was often reported with a co-morbid condition related to sensory, physical, cognitive, and communication difficulties. The prevalence of disability was associated with age and no schooling, but not associated with poverty. People with disabilities had significantly lower well-being scores and reduced access to health services, work, rehabilitation, education, government social welfare, and disaster management than people without disability. Having a disability and negative family attitudes were reported as barriers for people with disabilities participating in work, community meetings, religious activities, and social activities. CONCLUSIONS The prevalence of disability among adults in District 2 of Quezon City and in Ligao City is higher than the estimated national prevalence of disability derived from the 2010 Philippines census. Disability is also associated with lower well-being and reduced participation across a number of domains of community life.
Collapse
Affiliation(s)
- Manjula Marella
- Nossal Institute for Global Health, The University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3010 Melbourne, Australia
| | - Alexandra Devine
- Nossal Institute for Global Health, The University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3010 Melbourne, Australia
| | | | - Jerome Zayas
- Social Development Research Centre, De La Salle University, Manila, Philippines
| | - Ma Jesusa Marco
- Social Development Research Centre, De La Salle University, Manila, Philippines
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
43
|
Vaughan C. Book Reviews: Paul Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor Berkeley, CA: University of California Press, 2003. 402 pp. J Health Psychol 2016. [DOI: 10.1177/1359105307076241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cathy Vaughan
- London School of Economics and Political Science, UK
| |
Collapse
|
44
|
Mubarak A, Ahmed MS, Upile N, Vaughan C, Xie C, Sharma R, Acar P, McCormick MS, Paton JC, Mitchell T, Cunliffe N, Zhang Q. A dynamic relationship between mucosal T helper type 17 and regulatory T-cell populations in nasopharynx evolves with age and associates with the clearance of pneumococcal carriage in humans. Clin Microbiol Infect 2016; 22:736.e1-7. [PMID: 27256063 DOI: 10.1016/j.cmi.2016.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 12/13/2022]
Abstract
Pneumococcal carriage is common in young children, which may account for the high incidence of disease in this age group. Host factors determining the clearance of carriage in humans remain unclear. We aimed to study the relationships between T helper type 17 (Th17) and Foxp3(+) regulatory T (Treg) cells in nasopharynx-associated lymphoid tissue (NALT) and carriage in children and adults. Frequencies of Th17 and Treg cells in NALT were analysed by flow cytometry in association with age and pneumococcal carriage status. Cytokine responses following pneumococcal stimulation were analysed by cytometric beads array. The frequencies of Th17 and Treg cells in NALT were inversely correlated (R -0.60). Whereas Treg cell frequency decreased with age (R -0.63), both Th17 and the Th17: Treg ratio increased with age (R 0.62 and R 0.64, respectively). Also, the Th17: Treg ratio was higher in carriage-negative than in carriage-positive children (p <0.01). Pneumococcal stimulation of tonsillar cells increased both Th17 and Treg cell numbers, but the Th17: Treg ratio and pattern of cytokine responses differed between carriage-negative and carriage-positive children. The former showed markedly higher Th17: Treg and interleukin-17A: interleukin-10 ratios than in the latter (p <0.01). Pneumococcal stimulation also induces Th17, although the capacity of this Th17 differentiation from naive T cells of young children was low, but increased with age. We demonstrated a dynamic relationship between Th17 and Treg cells in human nasopharynx that evolves with age. The balance between Th17 and Treg cells in NALT appears to be a major host factor closely associated with the clearance of Streptococcus pneumoniae from the nasopharynx.
Collapse
Affiliation(s)
- A Mubarak
- Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, Liverpool, UK
| | - M S Ahmed
- Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, Liverpool, UK
| | - N Upile
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - C Vaughan
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - C Xie
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - R Sharma
- Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - P Acar
- Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK
| | - M S McCormick
- Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK
| | - J C Paton
- Institute of Infection, Research Centre for Infectious Diseases, School of Biomedical Sciences, University of Adelaide, Adelaide, Australia
| | - T Mitchell
- Institute of Microbiology and Infection and School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - N Cunliffe
- Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, Liverpool, UK
| | - Q Zhang
- Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, Liverpool, UK.
| |
Collapse
|
45
|
Emerson E, Krnjacki L, Llewellyn G, Vaughan C, Kavanagh A. Perceptions of safety and exposure to violence in public places among working age adults with disabilities or long-term health conditions in the UK: cross sectional study. Public Health 2016; 135:91-6. [PMID: 26976491 DOI: 10.1016/j.puhe.2015.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine perceptions of safety and exposure to violence in public places among working age adults with and without disabilities in the UK and to assess the extent to which any between-group differences may be moderated by gender and socio-economic situation. STUDY DESIGN Cross-sectional study. METHODS Secondary analysis of data collected in Wave 3 (2011-13) of Understanding Society. Data were extracted on a subsample of 5069 respondents aged 16 to 64 years (28% of whom had a disability/long-term health condition) who were administered a questionnaire module addressing experiences of harassment. Between-group comparisons were made on four self-reported indicators of safety. RESULTS Respondents with disabilities/long-term health conditions were significantly more likely to have been attacked (adjusted OR 2.30, 95%CI 1.17-4.50, P < 0.05), insulted (adjusted OR 1.48, 95%CI 1.16-1.90, P < 0.01) and to feel unsafe in public places (adjusted OR 1.32, 95%CI 1.16-1.56, P < 0.01) over the previous 12 months. There were no statistically significant differences between groups with regard to self-reported avoidance of public places. These associations were moderated by both gender and poverty status, with the increased risk of exposure to violence among people with disabilities being greater for both women and people living in poverty. CONCLUSIONS The data add further support to the growing evidence base suggesting that people with a disability/long-term health condition are at significantly increased risk of exposure to interpersonal violence, particularly if they are living in poverty or are women. As such, there is a clear need to develop interventions that are targeted to the particular circumstances and needs of these high risk groups.
Collapse
Affiliation(s)
- E Emerson
- Centre for Disability Research and Policy, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - L Krnjacki
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Victoria 3010, Australia
| | - G Llewellyn
- Centre for Disability Research and Policy, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
| | - C Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Victoria 3010, Australia
| | - A Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Victoria 3010, Australia
| |
Collapse
|
46
|
Vaughan C, Murdolo A, Murray L, Davis E, Chen J, Block K, Quiazon R, Warr D. ASPIRE: A multi-site community-based participatory research project to increase understanding of the dynamics of violence against immigrant and refugee women in Australia. BMC Public Health 2015; 15:1283. [PMID: 26700303 PMCID: PMC4690281 DOI: 10.1186/s12889-015-2634-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in three women around the world are or have been subjected to violence. This includes in Australia, where violence against women is an urgent public health and human rights issue. Immigrant and refugee women who have resettled in Australia are known to face barriers accessing services aimed at preventing and responding to family violence. However there is little evidence about the contexts, nature and dynamics of violence against immigrant and refugee women to inform appropriate responses to enhance their safety and well-being. The ASPIRE project will address this gap by identifying opportunities for the development of responsive local and community-based interventions for family violence against immigrant and refugee women, contributing to the currently limited Australian research in this area. METHODS/DESIGN This participatory research project will work with communities in eight geographic locations (two inner-city, three outer-suburban, and three regional) across two states (Victoria and Tasmania), to generate evidence about immigrant and refugee women's experiences in a range of settings. The project will engage stakeholders and communities through extensive consultation prior to data collection and by facilitating community members' participation in generating and analysing data. A mix of qualitative methods will be used to generate rich data about the family, cultural and place-based contexts that shape the prevalence and dynamics of violence against immigrant and refugee women; women's prevention and help-seeking efforts; and community attitudes about and responses to violence across a range of cultural groups. Methods include in-depth interviews with women who have experienced family violence, key informant interviews with local community service providers, focus group discussions with men and women from predominant cultural groups that have migrated to areas covered by the research sites, and Photovoice with community leaders. Bilingual health educators will contribute to development of the research approach, the collection and analysis of data, and the dissemination of findings. DISCUSSION Findings from this two-year study will be disseminated to communities, service providers and policy-makers, providing evidence to inform culturally-appropriate prevention and support interventions, and building local communities' awareness and capacity to respond to violence against immigrant and refugee women.
Collapse
Affiliation(s)
- Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Adele Murdolo
- Multicultural Centre for Women's Health, Suite 207, Level 2, 134 Cambridge St, Collingwood, VIC, 3066, Australia.
| | - Linda Murray
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, 7005, Australia.
| | - Erin Davis
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Jasmin Chen
- Multicultural Centre for Women's Health, Suite 207, Level 2, 134 Cambridge St, Collingwood, VIC, 3066, Australia.
| | - Karen Block
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Regina Quiazon
- Multicultural Centre for Women's Health, Suite 207, Level 2, 134 Cambridge St, Collingwood, VIC, 3066, Australia.
| | - Deb Warr
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| |
Collapse
|
47
|
Lee K, Devine A, Marco MJ, Zayas J, Gill-Atkinson L, Vaughan C. Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines. BMC Womens Health 2015; 15:87. [PMID: 26466892 PMCID: PMC4606556 DOI: 10.1186/s12905-015-0244-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers' efforts to respond. This study aims to contribute to the available evidence by examining service providers' perceptions of disability and their experiences providing sexual and reproductive health services to women with disability. METHODS The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants' discussion of service provision to women with disability. RESULTS Analysis of service providers' accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse. CONCLUSION Recent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.
Collapse
Affiliation(s)
- Kira Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Alexandra Devine
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Ma Jesusa Marco
- Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004, Manila, Philippines.
| | - Jerome Zayas
- Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004, Manila, Philippines.
| | - Liz Gill-Atkinson
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| |
Collapse
|
48
|
Vaughan C, Zayas J, Devine A, Gill-Atkinson L, Marella M, Garcia J, Bisda K, Salgado J, Sobritchea C, Edmonds T, Baker S, Marco MJ. W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines. BMC Public Health 2015; 15:984. [PMID: 26419646 PMCID: PMC4588263 DOI: 10.1186/s12889-015-2308-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background In many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines. Design W-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research. Discussion This three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches.
Collapse
Affiliation(s)
- Cathy Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Jerome Zayas
- Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004, Manila, Philippines.
| | - Alexandra Devine
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Liz Gill-Atkinson
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Manjula Marella
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Joy Garcia
- WOWLEAP, 73 Edelweiss St., ESLA Urban Homes, Bgy. Sto. Domingo, Cainta, 1900, Rizal, Philippines.
| | - Krissy Bisda
- PARE, CAPWD, Bgy. Calamba EcoCenter, Calamba, 6000, Cebu City, Philippines.
| | - Joy Salgado
- Likhaan Center for Women's Health, 27 St., Ofelia Subdivision, Ofelia, Project 8, Quezon City, 1106, Metro Manila, Philippines.
| | - Carolyn Sobritchea
- University of the Philippines Center for Women's Studies Foundation, Magsaysay Ave., corner Ylanan St., Diliman, 1101, Quezon City, Philippines.
| | - Tanya Edmonds
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Sally Baker
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia.
| | - Ma Jesusa Marco
- Social Development Research Centre, De La Salle University, 2401 Taft Avenue, 1004, Manila, Philippines.
| |
Collapse
|
49
|
White S, Vaughan C, Raiff D, Eward W, Bolognesi M. Impact of Liposomal Bupivacaine Administration on Postoperative Pain in Patients Undergoing Total Knee Replacement. Pharmacotherapy 2015; 35:477-81. [DOI: 10.1002/phar.1587] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Cathy Vaughan
- Duke University Medical Center; Durham North Carolina
| | - Doug Raiff
- Duke University Medical Center; Durham North Carolina
| | - William Eward
- Duke Cancer Institute; Duke University Medical Center; Durham North Carolina
| | | |
Collapse
|
50
|
Raiff D, Vaughan C, McGee A. Impact of intraoperative acetaminophen administration on postoperative opioid consumption in patients undergoing hip or knee replacement. Hosp Pharm 2015; 49:1022-32. [PMID: 25673891 DOI: 10.1310/hpj4911-1022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Opioid utilization for acute pain has been associated with numerous adverse events, potentially resulting in longer inpatient stays and increased costs. OBJECTIVE To examine the effect of intravenous (IV) acetaminophen administered intraoperatively on postoperative opioid consumption in adult subjects who underwent hip or knee replacement. METHODS This retrospective cohort study evaluated postoperative opioid consumption in 176 randomly selected adult subjects who underwent hip or knee replacement at Duke University Hospital (DUH). Eighty-eight subjects received a single, intraoperative, 1 g dose of IV acetaminophen. The other subjects did not receive any IV acetaminophen. This study evaluated mean opioid consumption (in oral morphine equivalents) during the 24-hour postoperative period in the 2 groups. Other endpoints included length of stay in the postanesthesia care unit (PACU), incidence of oversedation, need for acute opioid reversal, and adjunctive analgesic utilization. RESULTS Subjects who were given a single dose of intraoperative acetaminophen received an average of 149.3 mg of oral morphine equivalents during the 24 hours following surgery compared to 147.2 mg in participants who were not exposed to IV acetaminophen (P = .904). The difference in average length of PACU stay between the IV acetaminophen group (163 minutes) and those subjects not exposed to IV acetaminophen (169 minutes) was not statistically significant (P = .588). No subjects in the study experienced oversedation or required acute opioid reversal. CONCLUSION There was not a statistically significant difference in postoperative opioid consumption between patients receiving and not receiving IV acetaminophen intraoperatively.
Collapse
Affiliation(s)
- Doug Raiff
- Clinical Pharmacists, Department of Pharmacy, Duke University Health System , Durham, North Carolina
| | - Cathy Vaughan
- Clinical Pharmacists, Department of Pharmacy, Duke University Health System , Durham, North Carolina
| | - Ann McGee
- Clinical Pharmacists, Department of Pharmacy, Duke University Health System , Durham, North Carolina. ; Director, Center for Medication Policy, Department of Pharmacy, Duke University Health System , Durham, North Carolina
| |
Collapse
|