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Search Results: 1 - 10 of 549991 matches for " Marina M de Paoli "
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HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania
Sebalda C Leshabari, Astrid Blystad, Marina de Paoli, Karen M Moland
Human Resources for Health , 2007, DOI: 10.1186/1478-4491-5-18
Abstract: A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.'The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession.The findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.Infant feeding counselling based on international guidelines is considered a cornerstone in the prevention of mother-to-child transmission of HIV. Whereas perinatal anti-retroviral prophylaxis currently administered through
Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counselling tools in the Kilimanjaro Region, Tanzania
Sebalda C Leshabari, Peggy Koniz-Booher, Anne N ?str?m, Marina M de Paoli, Karen M Moland
Implementation Science , 2006, DOI: 10.1186/1748-5908-1-22
Abstract: Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review.An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and as take home material for the mother.The study underscores the importance of formative research and a systematic theory based approach to developing an intervention aimed at improving counselling and changing customary feeding practices. The identification of perceived barriers and facilitators for change contributed to developing the key counselling messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their significant others.The documentation of breastfeeding as a sou
Ways ahead: protecting, promoting and supporting breastfeeding in the context of HIV
Karen Moland, Penny van Esterik, Daniel W Sellen, Marina M de Paoli, Sebalda C Leshabari, Astrid Blystad
International Breastfeeding Journal , 2010, DOI: 10.1186/1746-4358-5-19
Abstract: As a final note, let us return to breastfeeding for a moment and discuss how to counteract the pressures that have been exerted against breastfeeding in the context of HIV. As history shows, the threats to breastfeeding have changed over time. During the last decade the greatest threat to breastfeeding has been the confusion over infant feeding in the wake of the HIV pandemic. Through national and local PMTCT programmes and HIV information campaigns, the global community has learnt that breastfeeding in HIV-infected mothers may be a risk to child survival and should, if possible, be avoided. The uncertainty that this has generated is illustrated in this thematic series. In the early phase of the national and local PMTCT programme implementation, breastfeeding advocacy groups were accused of having their "heads in the sand" about the transmission of HIV through breastfeeding. The existing evidence of the superiority of breastfeeding in terms of infant survival, and the 2010 infant feeding guidelines promoting breastfeeding as the first choice of infant feeding method, have demonstrated that the advocacy groups were right in their firm and concerted action to protect breastfeeding. One lesson is learnt: replacement feeding has substantial negative unintended consequences for the individual mother, for her infant, for households and for health systems. In the aftermath of a decade of trial and error in developing guidelines and implementing postnatal PMTCT programmes, the trust in breastfeeding thus needs to be restored. The challenge is how to 'turn the tide' or change the mindset of PMTCT counsellors, mothers and significant others towards breastfeeding as the safest way to feed an infant. The research studies reported in this thematic series suggest that this may prove challenging given the legacy of efforts to implement earlier guidelines. In the first concluding remarks we focused on global policy documents and lessons learnt [1]. Now in this final paper we consid
Breastfeeding and HIV: experiences from a decade of prevention of postnatal HIV transmission in sub-Saharan Africa
Karen Moland, Marina M de Paoli, Daniel W Sellen, Penny van Esterik, Sebalda C Leshabari, Astrid Blystad
International Breastfeeding Journal , 2010, DOI: 10.1186/1746-4358-5-10
Abstract: The papers in this thematic series highlight the multiple challenges to infant feeding that have surfaced within the framework of postnatal prevention of mother to child transmission of HIV (PMTCT). The focus is in particular on the implementation of the global HIV and infant feeding guidelines at the local level in various settings in sub-Saharan Africa. The symposium which preceded this publication dwelt on lessons learnt through the past decade of experiences with the implementation of the PMTCT programme. The symposium took place between 2 and 4 September 2008, in Rosendal, western Norway and was an interdisciplinary endeavour with students and scholars from eastern and southern Africa, Canada and Norway. The event offered an opportunity for dissemination of results from Masters, PhD and post-doctoral studies on the PMTCT challenge. The seven research papers included in this issue report on the experiences of women and their partners, of PMTCT counsellors and of policy makers in selected countries in sub-Saharan Africa between 2001 and 2009. During this period the WHO 2001 HIV and infant feeding guidelines [1] were launched and implemented. These guidelines which provide concrete recommendations on 'safer infant feeding options' were to become very influential in the following decade.Mother to child transmission (MTCT) of HIV is a field of health and health care that dramatically demonstrates the inequality between the global north and the global south. The best available official data indicate that "more than 90% of children living with HIV acquired the virus during pregnancy, birth or breastfeeding -- forms of HIV transmission that can be prevented" [[2] p. 37]. The epidemiology and the burden of disease vary greatly across regions [3], and nearly 90% of the almost half a million children who yearly become infected with HIV through their mothers live in sub-Saharan Africa [2]. The region has the highest indicators of food insecurity, highest prevalence of adul
Reflections on global policy documents and the WHO's infant feeding guidelines: lessons learnt
Astrid Blystad, Penny van Esterik, Marina M de Paoli, Daniel W Sellen, Sebalda C Leshabari, Karen Marie I Moland
International Breastfeeding Journal , 2010, DOI: 10.1186/1746-4358-5-18
Abstract: We close this thematic series titled 'HIV and infant feeding: lessons learnt and ways ahead' by reflecting first, in the present paper, on the lessons learnt during the past decade of PMTCT programme implementation and then, in the subsequent paper, by briefly discussing ways ahead. With an attempt to grasp the meaning and significance of the unexpected and disturbing outcomes of previous PMTCT infant feeding guidelines documented in the papers of this issue we will reflect on them as part of a growing body of policy and implementation documents operating on the global arena. A brief discussion of the production, ideological underpinnings and effects of such documents can, we believe, enhance our understanding of some of the central dynamics at work in efforts to prevent MTCT. The grounded qualitative studies of PMTCT clients and providers presented in this issue reveal the complex and often troubled relationship between such policy guidelines and the 'local', and their particular cultural and political underpinnings and historical provenance.Dorothy Smith has written extensively about the production of what she calls 'global texts' and documents in organisations such as the UN and the World Bank. Her writings reveal how such texts make the co-ordination of thought and action across multiple local settings and times possible [1]. The policy documents are produced by people in one setting while read and implemented by people in multiple other local settings [1]. From a particular text or document produced globally it is possible to trace sequences of action locally, and one can identify where and how the text attempts to 'standardize action' and coordinate people's activities across multiple local sites.Smith argues that 'global documents', in the sense we are talking about here, are constructed through processes of consensus building and produce texts that appear as shared and that create a common ground [1]. The processes that produce such global documents that are
The ARV roll out and the disability grant: a South African dilemma?
de Paoli Marina,Mills Elizabeth,Gr?nnings?ter Arne
Journal of the International AIDS Society , 2012, DOI: 10.1186/1758-2652-15-6
Abstract: Background Prior to the antiretroviral (ARV) drug roll out in 2004, people living with HIV (PLHIV) in South Africa received disability grants when they were defined as "AIDS-sick". In the absence of available and effective medication, a diagnosis of AIDS portended disability. The disability grant is a critical component of South Africa's social security system, and plays an important role in addressing poverty among PLHIV. Given the prevalence of unemployment and poverty, disability grants ensure access to essential resources, like food, for PLHIV. Following the ARV roll out in South Africa, PLHIV experienced improved health that, in turn, affected their grant eligibility. Our aim is to explore whether PLHIV reduced or stopped treatment to remain eligible for the disability grant from the perspectives of both PLHIV and their doctors. Methods A mixed-methods design with concurrent triangulation was applied. We conducted: (1) in-depth semi-structured interviews with 29 PLHIV; (2) in-depth semi-structured interviews with eight medical doctors working in the public sector throughout the Cape Peninsula; (3) three focus group discussions with programme managers, stakeholders and community workers; and (4) a panel survey of 216 PLHIV receiving ARVs. Results Unemployment and poverty were the primary concerns for PLHIV and the disability grant was viewed as a temporary way out of this vicious cycle. Although loss of the disability grant significantly affected the well-being of PLHIV, they did not discontinue ARVs. However, in a number of subtle ways, PLHIV "tipped the scales" to lower the CD4 count without stopping ARVs completely. Grant criteria were deemed ad hoc, and doctors struggled to balance economic and physical welfare when assessing eligibility. Conclusions It is crucial to provide sustainable economic support in conjunction with ARVs in order to make "positive living" a reality for PLHIV. A chronic illness grant, a basic income grant or an unemployment grant could provide viable alternatives when the PLHIV are no longer eligible for a disability grant.
"It is her responsibility": partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania
Falnes Eli,Moland Karen,Tyllesk?r Thorkild,de Paoli Marina
Journal of the International AIDS Society , 2011, DOI: 10.1186/1758-2652-14-21
Abstract: Background Partner involvement has been deemed fundamental in prevention of mother to child transmission (PMTCT) programmes, but is difficult to achieve. This study aimed to explore acceptability of the PMTCT programme components and to identify structural and cultural challenges to male involvement. Methods The study was conducted during 2007-2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania. Mixed methods were used, and included focus group discussions with fathers and mothers, in-depth interviews with fathers, mothers and health personnel, and a survey of 426 mothers bringing their four-week-old infants for immunization at five reproductive and child health clinics. Results Routine testing for HIV of women at the antenatal clinic was highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. Very few men joined their wives for testing and thus missed out on PMTCT counselling. The main barriers reported were that women did not have the authority to request their husbands to test for HIV and that the arena for testing, the antenatal clinic, was defined as a typical female domain where men were out of place. Conclusions Deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering women remains a huge challenge. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritized for the PMTCT programme to achieve its potential.
Mothers' knowledge and utilization of prevention of mother to child transmission services in northern Tanzania
Falnes Eli,Tyllesk?r Thorkild,de Paoli Marina,Manongi Rachel
Journal of the International AIDS Society , 2010, DOI: 10.1186/1758-2652-13-36
Abstract: Background More than 90% of children living with HIV have been infected through mother to child transmission. The aims of our present study were to: (1) assess the utilization of the prevention of mother to child transmission (PMTCT) services in five reproductive and child health clinics in Moshi, northern Tanzania, after the implementation of routine counselling and testing; (2) explore the level of knowledge the postnatal mothers had about PMTCT; and (3) assess the quality of the counselling given. Methods This study was conducted in 2007 and 2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania. Mixed methods were used. We interviewed 446 mothers when they brought their four-week-old infants to five reproductive and child health clinics for immunization. On average, the urban clinics included in the study had implemented the programme two years earlier than the rural clinics. We also conducted 13 in-depth interviews with mothers and nurses, four focus group discussions with mothers, and four observations of mothers receiving counselling. Results Nearly all mothers (98%) were offered HIV testing, and all who were offered accepted. However, the counselling was hasty with little time for clarifications. Mothers attending urban antenatal clinics tended to be more knowledgeable about PMTCT than the rural attendees. Compared with previous studies in the area, our study found that PMTCT knowledge had increased and the counsellors had greater confidence in their counselling. Conclusions Routine counselling and testing for HIV at the antenatal clinics was greatly accepted and included practically every mother in this time period. However, the counselling was suboptimal due to time and resource constraints. We interpret the higher level of PMTCT knowledge among the urban as opposed to the rural attendees as a result of differences in the start up of the PMTCT programme and, thus, programme maturation. After comparison with earlier studies conducted in this setting, we conclude that when the programme has had time to get established, both its acceptance and the understanding of the topics dealt with during the counselling increases.
Particle Yields in Heavy Ion Collisions and the Influence of Strong Magnetic Fields
M. G. de Paoli,D. P. Menezes
Advances in High Energy Physics , 2014, DOI: 10.1155/2014/479401
Abstract: It is expected that the magnetic fields in heavy ion collisions are very high. In this work, we investigate the effects of a strong magnetic field on particle ratios within a thermal model of particle production. We model matter as a free gas of baryons and mesons under the influence of an external magnetic field varying from zero to through an?? fitting to some data sets of the STAR experiment. For this purpose, we use the Dirac, Rarita-Schwinger, Klein-Gordon, and Proca equations subject to magnetic fields in order to obtain the energy expressions and the degeneracy for spin 1/2, spin 3/2, spin 0, and spin 1 particles, respectively. Our results show that, if the magnetic field can be considered as slowly varying and leaves its signature on the particle yields, a field of the order of produces an improved fitting to the experimental data as compared to the calculations without magnetic field. 1. Introduction According to quantum chromodynamics, the quark-gluon plasma (QGP) phase refers to matter where quarks and gluons are believed to be deconfined and it probably takes place at temperatures of the order of 150 to 170?MeV. In large colliders around the world (RHIC/BNL, ALICE/CERN, GSI, etc.), physicists are trying to find a QGP signature looking at heavy ion collisions and, in the last years, it has become evident that a strong magnetic field dependence is present in all experimental processes. Moreover, it has also been shown that the QCD phase diagram is modified by the presence of a magnetic field. Its effects have been calculated both within relativistic models [1, 2] and lattice simulations [3]. Possible experiments towards the search for the QGP are Au-Au collisions at RHIC/BNL and Pb-Pb collisions at SPS/CERN. The hadron abundances and particle ratios are normally used in order to determine the temperature and baryonic chemical potential of the possibly present hadronic matter-QGP phase transition and this calculation is done through thermal equilibrium models [4, 5] Particle ratios are convenient quantities to be analysed because after the chemical freezeout they remain practically unaltered. In previous papers, a statistical model under chemical equilibration was used to calculate particle yields [4, 5] and in these works the densities of particles were obtained from free Fermi and Boson gas approximations. To achieve a better description of the data, an excluded volume term was assigned to all particles with the aim of mimicking the repulsive interactions between hadrons at small distances. Also, after thermal production, resonances and
Landau parameters for isospin asymmetric nuclear matter based on a relativistic model of composite and finite extension nucleons
R. M. Aguirre,A. L. De Paoli
Physics , 2006, DOI: 10.1103/PhysRevC.75.045207
Abstract: We study the properties of cold asymmetric nuclear matter at high density, applying the quark meson coupling model with excluded volume corrections in the framework of the Landau theory of relativistic Fermi liquids. We discuss the role of the finite spatial extension of composite baryons on dynamical and statistical properties such as the Landau parameters, the compressibility, and the symmetry energy. We have also calculated the low lying collective eigenfrequencies arising from the collisionless quasiparticle transport equation, considering both unstable and stable modes. An overall analysis of the excluded volume correlations on the collective properties is performed.
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