Characteristics of hormone use by travestis and transgender women of the Brazilian Federal District

ABSTRACT Introduction: Travestis and transgender women resort to the use of hormones for body modification. Due to restrictions in the access to health services, self-medication is frequent. The aim of this study was to describe the self-reported prevalence of hormones used by travestis and transgender women in the Federal District. Method: This is a cross-sectional study with Respondent Driven Sampling (RDS) and Knowledge, Attitudes and Practices questionnaire (KAP) along with travestis and transgender women over 18 years in the FD. Prevalence was calculated using the RDS-II estimator. Logistic models were used to investigate the associated factors. A total of 201 volunteers participated. Results: There was a young sample (median age of 24 years). The overall prevalence of continuous use of hormones was 64.5%. The most used formulation was the combination of estrogen and progesterone (86.2%) by injectable (75.1%) and oral (66%) administration. Most participants (84%) got the hormones without a prescription. Guidance on the use of these hormones came from their peers in 41% of the cases. We observed that the continuous use of hormones is associated with race, income and age, as well as the search for guidance of healthcare professionals, which is also associated with schooling. Discussion: The reality of the process of hormone use by these people in the quest for femininity is reflected in high rates of self-medication. Conclusion: This study contributes to the visibility of the need to improve the access conditions of these people to health services.

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Determinants of Sexual and Reproductive Health among Brazilian youth (aged 18 to 29 years old)

Acta Scientiarum Health Sciences ◽

10.4025/actascihealthsci.v38i2.31011 ◽

2016 ◽

Vol 38 (2) ◽

pp. 211

Author(s):

Miguel Barbosa Fontes ◽

Rdrigo Campos Crivelaro ◽

Alice Margini Scartezini ◽

David Duarte Lima ◽

Alexandre De Araújo Garcia ◽

...

Keyword(s):

Reproductive Health ◽

Health Services ◽

Sexual And Reproductive Health ◽

Unwanted Pregnancy ◽

Federal District ◽

Vulnerable Groups ◽

Linear Regression Models ◽

Access To Health Services ◽

Attitudes And Practices ◽

Main Determinants

This study assessed the main determinants of sexual and reproductive health of Brazilian youth. It was approved by the Ethics Committee of the Medicine Faculty of the University of Brasília, and it received support from Paho and Brazilian Ministry of Health. 1.208 youngsters (18 to 29 years old) in 15 states and Federal District were interviewed at their residences, during the second semester of 2011. Margin of error, adjusted regional and nationally, was 2.8% (CI: 95%), regarding the assessed sample. A KAP scale (knowledge, attitudes, and practices) with 17 questions (-17 to +17 points) was generated. A questionnaire was pre-tested for consistency and validity analysis was performed. KAP scale was used as dependent variable in adjusted linear regression models. Mean KAP score was 5.65 points. Gaps in KAP were: 70% of the youth do not know when the fertility period of a woman is. 42% of youth do not recognize condoms as a method to prevent unwanted pregnancy and STDs. The main factors associated to explaining variances in KAP are gender, education, religion, access to health services, having had sexual intercourse in the last 12 months, and having friends as the main personal reference (p < 0.05). Youngsters with higher education, women, non-Protestant, who claim to know where to find health services have better KAP level of reproductive health. Studies are necessary to support public policies that increase the KAP levels in sexual and reproductive health of the most vulnerable groups, such as the segment comprising low education, men and Protestants.

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Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil

International Journal for Equity in Health ◽

10.1186/s12939-021-01541-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Beo Oliveira Leite ◽

Danielle Souto de Medeiros ◽

Laio Magno ◽

Francisco Inácio Bastos ◽

Carolina Coutinho ◽

...

Keyword(s):

Multivariate Analysis ◽

Health Services ◽

Hiv Testing ◽

Transgender Women ◽

Northeastern Brazil ◽

Northeast Brazil ◽

Access To Health Services ◽

Cross Sectional ◽

Medical Visits ◽

Gender Based

Abstract Background Gender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. The aim of this study was to investigate the association between gender-based discrimination and medical visits, as well as with HIV testing among transgender women in the last 12 months in northeast Brazil. Methods This is a cross-sectional study of 864 transgender women recruited using Respondent-Driven Sampling in three cities in northeastern Brazil in 2016. A socio-behavioral questionnaire was applied. Multivariate analyses were performed using logistic regression, with odds ratio and respective 95% confidence intervals estimation, to estimate the effect of gender-based discrimination on two outcomes: i) medical visits and ii) HIV testing in the last 12 months. Results 547 transgender women (67·0%) had medical visits, and 385 (45·8%) underwent HIV testing in the last 12 months. In the multivariate analysis, gender-based discrimination was associated with a reduced likelihood of medical visits (OR: 0·29; 95%CI: 0·14–0·63) and HIV testing (OR: 0·41; 95%CI: 0·22–0·78) in the last 12 months. Conclusion Gender-based discrimination played an essential role in reducing the access of TGW to medical visits and HIV testing services. Furthermore, by confirming the association between gender-based discrimination and medical visits and HIV testing in the multivariate analysis, we have demonstrated how this predictive variable can affect by reducing access to health services. The findings point to the need for non-discriminatory policies based on the defense and promotion of human rights that may foster the access of transgender women to Brazilian health services.

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Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study

The Lancet ◽

10.1016/s0140-6736(12)60278-5 ◽

2012 ◽

Vol 379 (9818) ◽

pp. 805-814 ◽

Cited By ~ 332

Author(s):

Qun Meng ◽

Ling Xu ◽

Yaoguang Zhang ◽

Juncheng Qian ◽

Min Cai ◽

...

Keyword(s):

Health Services ◽

Cross Sectional Study ◽

Financial Protection ◽

Sectional Study ◽

Access To Health Services ◽

Cross Sectional ◽

Access To Health

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Patient adherence to ischemic heart disease treatment

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.03.252 ◽

2017 ◽

Vol 63 (3) ◽

pp. 252-260 ◽

Cited By ~ 1

Author(s):

Moacyr Roberto Cuce Nobre ◽

Rachel Zanetta de Lima Domingues

Keyword(s):

Heart Disease ◽

Health Services ◽

Ischemic Heart Disease ◽

Patient Adherence ◽

Ischemic Heart ◽

Sociocultural Factors ◽

Multidisciplinary Teams ◽

Access To Health Services ◽

Cross Sectional ◽

Caregiver Support

Summary Introduction: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. Method: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. Results: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. Conclusion: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

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Knowledge, Attitudes and Practices Related to HIV Stigma and Discrimination Among Healthcare Workers in Oman

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2020.20.01.005 ◽

2020 ◽

Vol 20 (1) ◽

pp. 29

Author(s):

Samir Shah ◽

Ali Elgalib ◽

Adil Al-Wahaibi ◽

Maha Al-Fori ◽

Prasanna Raju ◽

...

Keyword(s):

Work Experience ◽

Healthcare Workers ◽

Social Stigma ◽

Healthcare Providers ◽

High Rate ◽

Access To Health Services ◽

Cross Sectional ◽

Attitudes And Practices ◽

Stigma And Discrimination ◽

Knowledge Attitudes And Practices

Objectives: Stigma and discrimination undermine the quality of life of people with HIV and their access to health services. This study aimed to assess HIV-related knowledge, attitudes and practices among healthcare workers (HCWs) in Oman. Methods: This cross-sectional study took place between July and November 2016. A questionnaire was distributed to 1,400 government HCWs to determine HIV-related knowledge, attitudes and practices. Results: A total of 1,281 HCWs participated (response rate = 92%). Routine tasks, such as dressing wounds, drawing blood and touching clothes, were a cause of concern for 24–52% of HCWs. Only 69% correctly answered questions regarding the transmission of HIV via eating/drinking and mosquito bites. Compared to other HCWs, doctors had significantly higher knowledge (mean = 0.46, 95% confidence interval [CI]: 0.19 to 0.73; P <0.001), attitude (mean = 0.77, 95% CI: 0.31 to 1.24; P = 0.001) and practice (mean = 2.07, 95% CI: 1.59 to 2.55; P <0.001) scores. Expatriates also scored significantly higher in knowledge (mean = 1.08, 95% CI: 0.93 to 1.23; P <0.001), attitude (mean = 1.23, 95% CI: 0.98 to 1.48; P <0.001) and practice (mean = 1.08, 95% CI: 0.82 to 1.34; P <0.001) compared to Omani nationals. Finally, those with >15 years’ work experience scored significantly higher on knowledge (mean = −0.60, 95% CI: −1.12 to −0.08; P = 0.025) and attitude (mean = −0.99, 95% CI: −1.87 to −0.10; P = 0.029) compared to those with less experience. Conclusion: The high rate of HIV-related stigma among HCWs in Oman should be rectified in order to achieve the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS.Keywords: HIV; Social Stigma; Social Discrimination; Knowledge; Attitude; Professional Practice; Healthcare Providers; Oman.

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HUBUNGAN PENDIDIKAN, AKSES PELAYANAN KESEHATAN DAN DUKUNGAN KELUARGA DENGAN PEMANFAATAN PELAYANAN KESEHATAN PENDERITA TB PARU BTA+ DI PUSKESMAS JANTI KOTA MALANG

Preventia : The Indonesian Journal of Public Health ◽

10.17977/um044v4i1p1-14 ◽

2019 ◽

Vol 4 (1) ◽

pp. 1

Author(s):

Alfreda Dinayu Purbantari ◽

Roesdiyanto Roesdiyanto ◽

Nurnaningsih Herya Ulfah

Keyword(s):

Public Health ◽

Health Service ◽

Health Services ◽

Health Center ◽

Family Support ◽

Access To Health Services ◽

Cross Sectional ◽

Education Access ◽

Utilization Of Health Services ◽

Access To Health

Abstract: Tuberculosis (TB) is a contagious disease that is still the world's attention, Until now, there is not a single country that is free of TB (Kemenkes 2011). Public Health Center (puskesmas) Janti is a puskesmas where the number of TB BTA+ sufferers increases every year while the number of treatment success rate at Puskesmas Janti decreases every year. In 2013 is 96%, in 2014 is 87,50% and in 2015 is 85,37%. Increasing the number of patients and decreasing the number of success rates of treatment indicates that the utilization of health services is less. This study aims to find out the relationship of Education, Health Service Access and Family Support with Health Service Utilization of BTA+ Pulmonary TB Patients at Public Health Center (puskesmas) Janti Malang. The design of this study is quantitative correlation with samples of all patients with TB Paru + BTA who are still doing treatment at Puskesmas Janti in September 2016 until April 2017. The analysis used correlation test and logistic regression test with cross sectional approach. The results of the research analysis found that there is a significant relationship between education, access to health services and family support together with the utilization of health services of patients Tb Paru BTA+. Based on the results of determination coefficient R2 (Nagelkerke) of 0.619, this means that education (X1), access to health services (X2), and family support (X3) has contributed 61.9% to the utilization of health services of patients with TB Paru BTA+ at Puskesmas Janti.Keywords: education, access, family support, health service utilizationAbstrak: Tuberkulosis (TB) adalah penyakit menular yang masih menjadi perhatian dunia, hingga saat ini, belum ada satu negara pun yang bebas TB (Kemenkes 2011). Puskesmas Janti adalah satu puskesmas yang berada di Kota Malang dengan jumlah pasien TB Paru BTA+ yang paling tinggi dan meningkat setiap tahun diantara puskesmas yang lain di Kota Malang, sedangkan jumlah angka keberhasilan pengobatan di Puskesmas Janti mengalami penurunan setiap tahun. Tahun 2013 sebesar 96%, pada tahun 2014 sebesar 87,50% dan pada tahun 2015 sebesar 85,37%. Peningkatan jumlah penderita dan penurunan jumlah angka keberhasilan pengobatan menunjukkan bahwa pemanfaatan pelayanan kesehatan kurang. Penelitian ini bertujuan untuk mengetahui Hubungan Pendidikan, Akses Pelayanan Kesehatan dan Dukungan Keluarga dengan Pemanfaatan Pelayanan Kesehatan Penderita TB Paru BTA+ di Puskesmas Janti Kota Malang. Rancangan penelitian ini adalah kuantitatif korelasional dengan sampel seluruh penderita TB Paru BTA+ yang masih melakukan pengobatan di Puskesmas Janti pada bulan September 2016 sampai dengan April 2017. Analisis menggunakan uji korelasi dan uji regresi logistik dengan pendekatan cross sectional. Hasil analisis penelitian di dapatkan ada hubungan yang dignifikan antara pendidikan, akses pelayanan kesehatan dan dukungan keluarga secara bersama-sama dengan pemanfaatan pelayanan kesehatan penderita Tb Paru BTA+. Berdasarkan hasil koefisien determinasi R2 (Nagelkerke) sebesar 0,619, hal ini berarti bahwa pendidikan (X1), akses pelayanan kesehatan (X2), dan dukungan keluarga (X3) memiliki kontribusi sebesar 61,9% terhadap pemanfaatan pelayanan kesehatan penderita TB Paru BTA+ di Puskesmas Janti.Kata Kunci: pendidikan, akses pelayanan kesehatan, dukungan keluarga, pemanfaatan pelayanan kesehatan penderita TB Paru BTA+

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The Evaluation of the Awareness, Attitude and Practice of the Elderly Toward Self-Medication: A Cross-Sectional Study

Drug Research ◽

10.1055/a-0583-9896 ◽

2018 ◽

Vol 68 (08) ◽

pp. 475-480

Author(s):

Mohammad Heidari ◽

Mansureh Borujeni ◽

Mansour Ghafourifard ◽

Rahim Sheikhi

Keyword(s):

Rural Areas ◽

The Elderly ◽

Cross Sectional Study ◽

Average Score ◽

Self Medication ◽

Cross Sectional ◽

Attitudes And Practices ◽

Age Related ◽

Significant Difference ◽

Urban And Rural Areas

Abstract Introduction The prevalence of various diseases in the elderly has increased the use of drugs, which is coupled with age-related physiological changes and places the elderly at risk for multiple side effects. The present study aimed to determine awareness, attitudes and practices of elderly towards self-medication. Materials and Methods The sample included 300 participants over 60 years under any of the health centers in urban and rural areas of Abadeh city, who were selected based on stratified random sampling method. In order to collect data, the questionnaire including demographic information, awareness, attitude and performance of the elderly and the checklist of drug intractable consumption. Results Based on the results, 76% of the elderly reported drug consumption. Regarding lifestyle, the average score of the elderly’s awareness for the elderly who lived with and without families were 78.6±14.2 and 69.2±13.6, respectively. In other words, a significant difference was observed between these two groups. In addition, there was a significant between the elderly’s performance score with and without family members about the self-medication (p=0.001). Conclusion Considering the increase in self-medication among the elderly, adherence to prescription criteria for drug among this age group is recommended. Finally, designing and implementing various educational programs in health education center is necessary for the elderly and their families for the purpose of improving awareness and practice.

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Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-019-4441-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Siriwan Choojaturo ◽

Siriorn Sindhu ◽

Ketsarin Utriyaprasit ◽

Chukiat Viwatwongkasem

Keyword(s):

Quality Of Life ◽

Health Service ◽

Health Services ◽

Self Management ◽

Access To Health Services ◽

Patient Factors ◽

Cross Sectional ◽

Knee Oa ◽

Access To Health

Abstract Background The main purpose of health service systems is to improve patients’ quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients. Methods A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL. Results The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (β = .10, p = .01) and patient factors (β = .29, p = .00 for self-management and β = −.49, p = .00 for disease factors). Access to health services was determined by self-management (β = .10, p = .01), but it was not significantly associated with QoL (β = .00, p = 1.0). Conclusions This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient’s background, such as socioeconomic status, disease severity, and self-management skills.

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Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v7i1.735 ◽

2015 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Ayodeji M. Adebayo ◽

Michael C. Asuzu

Keyword(s):

Health Facility ◽

Low Income ◽

Sampling Technique ◽

Simple Random Sampling ◽

Access To Health Services ◽

Cross Sectional Survey ◽

Self Medication ◽

Community Based ◽

Cross Sectional ◽

North West

Background: Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities.Aim: To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria.Settings: A low-income community in Ibadan North West Local Government Area of Oyo State.Methods:A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents’ sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05.Results: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90%had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF.Conclusion: The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation.

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Investigating change in non-government mental health service organisations’ ‘smoke-free’ attitudes and practice in New Zealand

The Journal of Smoking Cessation ◽

10.1017/jsc.2014.9 ◽

2014 ◽

Vol 10 (2) ◽

pp. 124-134

Author(s):

Penny Marlowe ◽

Janine Paynter

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Logistic Models ◽

Cross Sectional ◽

Response Options ◽

Attitudes And Practices ◽

Quit Smoking ◽

Stop Smoking ◽

Service Staff

Smoking prevalence amongst service users from the mental health and addictions sectors is higher than the general population. Cross-sectional web- or paper-based surveys comprising open and closed response options were used to examine changes in prevailing attitudes and practices amongst non-government mental health service staff and users. Thematic analysis was used to interpret and present open response answers. Multi-variate logistic models were used to investigate which factors are associated with smoke-free attitudes and practices. Staff who smoke were found to be less likely to provide cessation support to clients (AOR 0.51, 95% CI 0.31–0.82) and gave significantly lower estimates of the percentage of clients who wish to stop smoking (30% vs 44%, p < 0.0001). Those who had completed cessation training also had more positive views about the importance of providing cessation support and service user desire to stop smoking. Staff who had not completed cessation training had significantly lower odds of reporting they carried out quit smoking support often and routinely (AOR 0.33, 95% CI 0.23–0.47) The results suggest that continuing improvement will be enabled by increasing rates of cessation training amongst staff of mental health and addictions non-government organisations. In addition, there is a need for increased incentive and support for staff who smoke to quit.

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