objectives HIV-positive and HIV-vulnerable pregnant adolescent girls and adolescent mothers face significant barriers and vulnerabilities. Infants born to adolescent mothers are also more likely to die and be exposed to life-threatening conditions. This paper presents findings from an evaluation of a programme that used a home visitation model and offered a case-management, team-focused approach to increase family and community supportiveness to enhance health and social service uptake among pregnant adolescent girls and adolescent mothers in Kenya.methods The study used a quasi-experimental design with before and after comparisons among a non-randomised population to examine the effectiveness of bi-monthly household visits to 384 enrolled pregnant adolescent girls, adolescent mothers (ages 10-19) and their infants (0-24 months) between March 2018 and February 2019 in three counties in Kenya.results During the programme, household support increased from 57% to 85%, while 100% of eligible participants were on ART and virally suppressed (total of 20 adolescents). Nearly all pregnant adolescent girls (94%) delivered under skilled care vs. 78% of those who were post-partum at the time of enrolment (P < 0.001); 100% of infants (total of 17 infants) had an up-to-date PCR test with no seroconversions. Uptake of modern family planning increased from 39% at baseline to 64% at end line (P < 0.001). The referral rate declined from 84% to 78% from baseline to end line with low uptake of referrals for mental health services (17.3%).conclusions A team-focused approach of home visits to HIV-vulnerable and HIV-positive pregnant and post-partum adolescent girls and their infants combined with efforts to reduce stigma and increase supportiveness of households and the community can help address critical socio-cultural and behavioural barriers to accessing and using health and social services. keywords pregnancy, post-partum, HIV, adolescents, infants, home visiting Sustainable Development Goals (SDGs): good health and well-being; reduced inequalities; end preventable deaths of newborns and under-fives; gender equality *Contributed equally 640
shotgun fired at close quarters during military duty into the anterior lower thorax. The lower chest wall, liver, pericardium, base of right lung and heart were impregnated with shot pellets, giving the classical multiple ''star burst '' appearance. (fig. 1a). Extensive debridement of the chest wall wound was performed, with the removal of numerous lead shots. Intracardiac and intrapulmonary shots were left in situ and successfully managed conservatively [5]. He remained asymptomatic. Injuries were monitored by serial CT scans and echocardiograms, which later showed evidence of embolisation of multiple shots into the lung ( fig. 1b) Impact factor and its role in academic promotionTo the Editors:The following statement was adopted unanimously at the May 17, 2009, meeting of the International Respiratory Journal Editors Roundtable.In our collective experience as editors of international peerreviewed journals, we propose that the impact factor calculated for individual journals should not be used as a basis for evaluating the significance of an individual scientist's past performance or scientific potential. There are several reasons not to equate the impact factor of a journal in which the scientist publishes with the quality of the scientist's research. For example, as revealed by several recently published analyses of the impact factor [1-6]:1) A journal's impact factor is determined by a decided minority of its published manuscripts. Thus the impact factor correlates poorly with the citations of an individual manuscript.2) The impact factor does not consider the number of scientists actively producing research in a given specialty field. Indeed, some journals feel the need to serve constituencies with relatively small numbers of participants who continue to address important questions even though the number of scientists available for citations is limited.3) A journal's impact factor can be inflated by certain journal practices, such as publication of many review articles.4) Impact factor measures only the frequency of citations which cannot be assumed to always equate with quality.There are alternative and we believe more valid measures of the quality and impact of an individual scientist's published contributions. First, a citation record for the individual candidate is readily available via several types of Internet search engines. Second, the time-honoured practice of soliciting evaluations concerning the significance of a candidate's work from scientific peers who are carefully selected to be both highly qualified as well as clearly ''arms-length'' from the candidate should be rigorously applied.
Throughout the rapid and intense changes that adolescents experience, their parents retain important influence over how they interact with the complex factors that shape their development. How parents care for their adolescent children has a deep and lasting impact on their well-being and development. Yet, parents often require support to meet their own and their adolescent children's needs, which can be achieved through parenting support programmes. Parenting support programmes are delivered to parents of younger children across different contexts and populations, but the benefit of these programmes for parents of adolescents is not wellrecognised or prioritised. Given the clear need for these interventions during adolescence and the substantial evidence for effectiveness in this age group, it is time to move the field forward. Increased resources to support parents of adolescents would maximise adolescents' developmental potential and promote their well-being. We highlight four pressing areas for action: including parents of adolescents in parenting initiatives; involving parents in adolescent programming; strengthening efforts to address poverty and inequality, violence, and gender inequality; and engaging in strategic research to intensify the impact of programming.
Background Understanding mental health treatment preferences of adolescents and youth is particularly important for interventions to be acceptable and successful. Person-centered care mandates empowering individuals to take charge of their own health rather than being passive recipients of services. Methods We conducted a discrete choice experiment to quantitatively measure adolescent treatment preferences for different care characteristics and explore tradeoffs between these. A total of 153 pregnant adolescents were recruited from two primary healthcare facilities in the informal urban settlement of Nairobi. We selected eight attributes of depression treatment option models drawn from literature review and previous qualitative work. Bayesian d-efficient design was used to identify main effects. A total of ten choice tasks were solicited per respondent. We evaluated mean preferences using mixed logit models to adjust for within subject correlation and account for unobserved heterogeneity. Results Respondents showed a positive preference that caregivers be provided with information sheets, as opposed to co-participation with caregivers. With regards to treatment options, the respondents showed a positive preference for 8 sessions as compared to 4 sessions. With regards to intervention delivery agents, the respondents had a positive preference for facility nurses as compared to community health volunteers. In terms of support, the respondents showed positive preference for parenting skills as compared to peer support. Our respondents expressed negative preferences of ANC service combined with older mothers as compared to adolescent friendly services and of being offered refreshments alone. A positive preference was revealed for combined refreshments and travel allowance over travel allowance or refreshments alone. A number of these suggestions were about enhancing their experience of maternity clinical care experience. Conclusion This study highlights unique needs of this population. Pregnant adolescents’ value responsive maternity and depression care services offered by nurses. Participants shared preference for longer psychotherapy sessions and their preference was to have adolescent centered maternal mental health and child health services within primary care.
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