Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to est...Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.展开更多
New and compiled detrital zircon U-Pb ages from the southern Neoproterozoic-Cambrian Ribeira Belt,SE Brazil,demonstrate Laurentian affinity of the Embu Terrane which is statistically distinct from the adjoining Apia&#...New and compiled detrital zircon U-Pb ages from the southern Neoproterozoic-Cambrian Ribeira Belt,SE Brazil,demonstrate Laurentian affinity of the Embu Terrane which is statistically distinct from the adjoining Apiaíand São Roque terranes with cratonic affinity(e.g.,São Francisco Craton).Zircon provenance results indicate that the type-area of the Embu Terrane is dominated by detrital zircon age modes at ca.1200 Ma,1400 Ma,and 1800 Ma,with maximum depositional age of ca.1000 Ma.In contrast,the Apiaíand São Roque terranes are dominated by Paleoproterozoic detrital zircon ages(ca.2200-2000 Ma age dominant component),with maximum depositional ages of ca.1400 Ma and 1750 Ma,respectively.Multidimensional scaling(MDS)analysis of non-parametric similarity measurements on zircon age populations indicates for the first time that the Embu Terrane encompass two statistically distinct detrital zircon age spectra,which is also reflected in the metamorphic zircon age record.The statistical characterization of the Embu Terrane through populational metrics allow a quantitative comparison with surrounding tectonic domains and rock samples classified such as Embu-type.Our results clearly highlight the distinction between the statistically differentiated Embu Terrane from the Apiaíand São Roque terranes,supporting an allochthonous interpretation.In addition,we demonstrate that rocks samples previously classified as Embu-type are significantly dissimilar to the definition of Embu Terrane,failing to support alternative tectonic models(e.g.,intracontinental evolution).Detrital zircon age spectra reveal that the Apiaíand São Roque terranes have similar zircon provenance to domains sourced from the São Francisco Craton,whereas detrital zircon populations from the Embu Terrane have greater affinity with SW Laurentia basins(and their inferred sediment sources),consistent with previous findings.Therefore,we interpret the Embu Terrane as a Rodinia descendant developed along the active margin of the SW Laurentia that collided with the Ribeira Belt during early Neoproterozoic(810-760 Ma).展开更多
文摘Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.
基金the Australian Research Council(grant FL160100168 to PAC)the CNPq fellowship(307732/2019-3)+2 种基金FAPESP(grant 2018/10012-0)CNPq(grants 305701/2019-3,443439/2014-1)FAPESP(grants 01/13457-1,06/01327-0).
文摘New and compiled detrital zircon U-Pb ages from the southern Neoproterozoic-Cambrian Ribeira Belt,SE Brazil,demonstrate Laurentian affinity of the Embu Terrane which is statistically distinct from the adjoining Apiaíand São Roque terranes with cratonic affinity(e.g.,São Francisco Craton).Zircon provenance results indicate that the type-area of the Embu Terrane is dominated by detrital zircon age modes at ca.1200 Ma,1400 Ma,and 1800 Ma,with maximum depositional age of ca.1000 Ma.In contrast,the Apiaíand São Roque terranes are dominated by Paleoproterozoic detrital zircon ages(ca.2200-2000 Ma age dominant component),with maximum depositional ages of ca.1400 Ma and 1750 Ma,respectively.Multidimensional scaling(MDS)analysis of non-parametric similarity measurements on zircon age populations indicates for the first time that the Embu Terrane encompass two statistically distinct detrital zircon age spectra,which is also reflected in the metamorphic zircon age record.The statistical characterization of the Embu Terrane through populational metrics allow a quantitative comparison with surrounding tectonic domains and rock samples classified such as Embu-type.Our results clearly highlight the distinction between the statistically differentiated Embu Terrane from the Apiaíand São Roque terranes,supporting an allochthonous interpretation.In addition,we demonstrate that rocks samples previously classified as Embu-type are significantly dissimilar to the definition of Embu Terrane,failing to support alternative tectonic models(e.g.,intracontinental evolution).Detrital zircon age spectra reveal that the Apiaíand São Roque terranes have similar zircon provenance to domains sourced from the São Francisco Craton,whereas detrital zircon populations from the Embu Terrane have greater affinity with SW Laurentia basins(and their inferred sediment sources),consistent with previous findings.Therefore,we interpret the Embu Terrane as a Rodinia descendant developed along the active margin of the SW Laurentia that collided with the Ribeira Belt during early Neoproterozoic(810-760 Ma).
