Sensitivity analysis as an aid in modelling and control of (poorly-defined) ecological systems. [closed ecological systems

NASA Technical Reports Server (NTRS)

Hornberger, G. M.; Rastetter, E. B.

1982-01-01

A literature review of the use of sensitivity analyses in modelling nonlinear, ill-defined systems, such as ecological interactions is presented. Discussions of previous work, and a proposed scheme for generalized sensitivity analysis applicable to ill-defined systems are included. This scheme considers classes of mathematical models, problem-defining behavior, analysis procedures (especially the use of Monte-Carlo methods), sensitivity ranking of parameters, and extension to control system design.

Patient Self-Defined Goals: Essentials of Person-Centered Care for Serious Illness.

PubMed

Schellinger, Sandra Ellen; Anderson, Eric Worden; Frazer, Monica Schmitz; Cain, Cindy Lynn

2018-01-01

This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical-making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years. Care guides explored what was most important to patients and documented their self-defined goals on a medical record flow sheet. Using definitions of an expanded set of whole-person domains adapted from the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 999 goals and their associated plans were deductively coded and examined. Four themes were identified-medical, nonmedical, multiple, and global. Forty percent of goals were coded into the medical domain; 40% were coded to nonmedical domains-social (9%), ethical (7%), family (6%), financial/legal (5%), psychological (5%), housing (3%), legacy/bereavement (3%), spiritual (1%), and end-of-life care (1%). Sixteen percent of the goals were complex and reflected a mix of medical and nonmedical domains, "multiple" goals. The remaining goals (4%) were too global to attribute to an NCP domain. Self-defined serious illness goals express experiences beyond physical health and extend into all aspects of whole person. It is feasible to elicit and record serious illness goals. This approach to goals can support meaningful person-centered care, decision-making, and planning that accords with individual preferences of late life.

Non-AIDS-defining cancers in New Orleans.

PubMed

Ruiz, Marco; Johnson, Daniel; Reske, Tom; Cefalu, Charles; Estrada, John

2013-01-01

Non-AIDS-defining cancers in HIV-infected patients in the highly active antiretroviral therapy era have increased. To our knowledge a comprehensive review of non-AIDS-related malignancies in New Orleans has not yet been conducted. Databases from main institutions in New Orleans were queried retrospectively for the years 2001 to 2011. The International Classification of Diseases, Ninth Revision codes were used to search for HIV infection and cancer comorbidity. A total of 16 patients were diagnosed with lung cancer (mean age 50 years) with 81% of the patients presenting with advanced stages. In all, 20 (mean age 47 years) were diagnosed with anal cancer, and 35% presented in late stages. In all, 14 patients (mean age 42 years) were diagnosed with Hodgkin Lymphoma, and 64% were diagnosed at late stage. A total of 5 women (mean age 44 years) were diagnosed with breast cancer with 40% of them presenting at late stage. Malignancies were diagnosed at late stages in the majority of the cases, presented with worse outcomes, and had higher recurrence rates. The role of HIV and other viruses (Epstein Barr virus, human papillomavirus) and the potential mechanisms or pathways of oncogene activation also need to be clarified.

Foundations for Creativity in the Writing Process: Rhetorical Representations of Ill-Defined Problems.

ERIC Educational Resources Information Center

Carey, L. J.; Flower, Linda

This report examines the composing processes of expert writers to determine which cognitive processes in expository writing produce an opportunity for a creative response. The first section considers how the ill-defined nature of many writing problems and the cognitive processes experts use to solve these problems interact to provide an…

Developing Ill-defined problem-solving for the context of “South Sumatera”

NASA Astrophysics Data System (ADS)

Arifin, S.; Zulkardi; Putri, R. I. I.; Hartono, Y.; Susanti, E.

2017-12-01

This study aims to produce a valid and practical ill-defined problem-solving for context South Sumatera. The subject of the research is three students of the first semester of undergraduate students in the mathematics department of Raden Fatah State Islamic University. This study use development studies that consist of preliminary and prototyping. In preliminary stage have been analysis content curricula, indicator, and strategies of problem-solving. Meanwhile, in prototyping stage only consist of self-evaluation, expert review, and one-to-one. The data were collected through a walkthrough, interview, and test. The data were validated using expert review, but in practice, the data were obtained from test and interview to subject of the research. This studies produced two valid and practical problem-solving. The first problem is about “Benteng Kuto Besak”, and the second problem is about “Monpera”. From the expert review, the conclusion can be drawn that two problems which are developing are ill-defined problem-solving, and valid from content, construct, and its language. Besides that, the problems are practical because all students know and understand what the problems goal, but not the solutions.

Student Financial Aid: Monitoring Aid Greater Than Federally Defined Need Could Help Address Student Loan Indebtedness. Report to the Honorable Rod Paige, Secretary of Education.

ERIC Educational Resources Information Center

Ashby, Cornelia M.

This study was conducted to determine how often federal financial aid recipients received aid that was greater than their federally defined need and what cost or other implications might result from changing the Higher Education Act (HEA) to limit such aid. Data came from the 1999-2000 National Postsecondary Student Aid Study for full-time,…

Relationships between poverty and AIDS Illness in South Africa: an investigation of urban and rural households in KwaZulu-Natal.

PubMed

Steinert, Janina Isabel; Cluver, Lucie; Melendez-Torres, G J; Herrero Romero, Rocio

2017-09-01

The association between poverty and HIV/AIDS in Sub-Saharan Africa remains contested. A better understanding of the relationship between the prevalence of poverty and the disease is essential for addressing prevention, treatment, and care. The present study interrogates this relationship, using a cross-sectional survey of 2477 households in urban and rural KwaZulu-Natal, South Africa. Structural equation modelling was employed to estimate the correlations between poverty and AIDS illness. The analysis revealed a correlation of r pb  = 0.23, denoting that a higher level of household poverty was associated with a higher likelihood of being AIDS-unwell. Post hoc t-test showed that receipt of a disability grant by AIDS-affected households was associated with significantly lower poverty, compared to AIDS-affected households not receiving the grant, t(654) = 3.67, p < .01. Geographic location was found to confound the correlation: the strength of the relationship between poverty and AIDS was decreased to r pb  = 0.15 (p < .001) for the urban and r pb  = 0.16 (p < .001) for the rural sub-population. Findings suggest the importance of two sets of policies: those that address the potential upstream risk of poverty through economic interventions, and those that alleviate the impoverishing effects of AIDS illness for affected households.

Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS.

PubMed

Carter, Allison J; Bourgeois, Sonya; O'Brien, Nadia; Abelsohn, Kira; Tharao, Wangari; Greene, Saara; Margolese, Shari; Kaida, Angela; Sanchez, Margarite; Palmer, Alexis K; Cescon, Angela; de Pokomandy, Alexandra; Loutfy, Mona R

2013-01-11

The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care. A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines. The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women "where they are"; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research. This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV

Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS

PubMed Central

Carter, Allison J; Bourgeois, Sonya; O'Brien, Nadia; Abelsohn, Kira; Tharao, Wangari; Greene, Saara; Margolese, Shari; Kaida, Angela; Sanchez, Margarite; Palmer, Alexis K; Cescon, Angela; de Pokomandy, Alexandra; Loutfy, Mona R

2013-01-01

Introduction The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care. Methods A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines. Results and discussion The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research. Conclusions This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately

What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature.

PubMed

Goldberg, Rachel E; Short, Susan E

2016-03-01

Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long

What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature

PubMed Central

Goldberg, Rachel E.; Short, Susan E.

2016-01-01

ABSTRACT Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long

AIDS (image)

MedlinePlus

AIDS (acquired immune deficiency syndrome) is caused by HIV (human immunodeficiency virus), and is a syndrome that ... life-threatening illnesses. There is no cure for AIDS, but treatment with antiviral medicine can suppress symptoms. ...

Undergraduate Performance in Solving Ill-Defined Biochemistry Problems

PubMed Central

Sensibaugh, Cheryl A.; Madrid, Nathaniel J.; Choi, Hye-Jeong; Anderson, William L.; Osgood, Marcy P.

2017-01-01

With growing interest in promoting skills related to the scientific process, we studied performance in solving ill-defined problems demonstrated by graduating biochemistry majors at a public, minority-serving university. As adoption of techniques for facilitating the attainment of higher-order learning objectives broadens, so too does the need to appropriately measure and understand student performance. We extended previous validation of the Individual Problem Solving Assessment (IPSA) and administered multiple versions of the IPSA across two semesters of biochemistry courses. A final version was taken by majors just before program exit, and student responses on that version were analyzed both quantitatively and qualitatively. This mixed-methods study quantifies student performance in scientific problem solving, while probing the qualitative nature of unsatisfactory solutions. Of the five domains measured by the IPSA, we found that average graduates were only successful in two areas: evaluating given experimental data to state results and reflecting on performance after the solution to the problem was provided. The primary difficulties in each domain were quite different. The most widespread challenge for students was to design an investigation that rationally aligned with a given hypothesis. We also extend the findings into pedagogical recommendations. PMID:29180350

Expertise in ill-defined problem-solving domains as effective strategy use.

PubMed

Schunn, Christian D; McGregor, Mark U; Saner, Lelyn D

2005-12-01

Expertise consists of many different cognitive structures. Lemaire and Siegler (1995) have proposed a four-layered account of expertise from a strategies perspective: Experts have better strategies, tend to use strategies that are better overall more often, are better able to select the circumstances to which a strategy best applies, and are better able to execute a given strategy. Originally, this account came from work in simple, well-defined domains. We explored this account in the complex, ill-defined domain of platoon leadership. In Experiment 1A, we elicited free-text responses to leadership scenarios from novices, intermediates, and experts, finding expertise effects for strategy base rates and choice, but not for strategy existence or the number of strategies used. In Experiment 1B, we used a new group of experts to gather ratings of the execution accuracy of the responses in Experiment 1A and found expertise differences in the ability to execute the same strategies. We propose several elaborations to the original four-layered strategies account of expertise on the basis of these results.

Using Weighted Constraints to Diagnose Errors in Logic Programming--The Case of an Ill-Defined Domain

ERIC Educational Resources Information Center

Le, Nguyen-Thinh; Menzel, Wolfgang

2009-01-01

In this paper, we introduce logic programming as a domain that exhibits some characteristics of being ill-defined. In order to diagnose student errors in such a domain, we need a means to hypothesise the student's intention, that is the strategy underlying her solution. This is achieved by weighting constraints, so that hypotheses about solution…

Mental Illness Training on the Internet for Nurse Aides: A Replication Study

PubMed Central

Irvine, A. Blair; Billow, Molly B.; McMahon, Edward; Eberhage, Mark G.; Seeley, John R.; Bourgeois, Michelle

2013-01-01

Internet training courses for Nurse Aides (NA) in long term care facilities (LTCs) have been shown to be effective., Little is known, however, about Internet training effects on NAs in a non-research context, or about continued utilization of an available training program. In this research, a replication study was conducted with the Internet training program Caring Skills: Working with Mental Illness. Three LTCs provided the training to all NAs, each within a one-month interval scheduled during consecutive months. Supervisors were interviewed subsequently about their experiences organizing and supervising the training. Participants in all three LTCs showed positive pre-posttests effects with large effect sizes on situational knowledge and self-efficacy, and knowledge about mental illness. Users rated the program highly, and they indicated that it would improve quality of their resident care. Supervisors praised the training, and they said NAs were using recommended training behaviors. Although available to all staff, nursing and other staff made little use of the training in subsequent months. Training for NAs on the internet thus appears feasible, and it is perceived to be beneficial for resident care. Plans for continued utilization and dissemination of best practices to other staff, however, should be integrated when planning for staff training on the Internet. PMID:23379724

Mental illness stigma and disclosure in college students.

PubMed

Corrigan, Patrick W; Kosyluk, Kristin A; Markowitz, Fred; Brown, Robyn Lewis; Conlon, Bridget; Rees, Jo; Rosenberg, Jessica; Ellefson, Sarah; Al-Khouja, Maya

2016-06-01

The aim of this study was to investigate the relationship between mental illness identity, shame, secrecy, public stigma, and disclosure amongst college students. Participants included 1393 college students from five postsecondary institutions. Structural equation modeling was used to examine two path models predicting disclosure and desire to join a program aiding with disclosure. Variables found to be significant in predicting disclosure included mental illness identity and public stigma. In turn, desire for disclosure predicted desire to join a program aiding in disclosure. Gender and race/ethnic differences were observed, with men and Whites more likely to want to disclose a mental illness or join a program aiding with disclosure compared with women and non-Whites, respectively. These findings suggest that some college students may find programs aiding in disclosure useful in assisting them to achieve their desire to be "out" with their mental illness.

Ending AIDS as a Public Health Threat: Treatment-as-Usual Risk Reduction Services for Persons With Mental Illness in Brazil.

PubMed

Wainberg, Milton L; McKinnon, Karen; Norcini-Pala, Andrea; Hughes, Olivia K; Schrage, Ezra; Erby, Whitney; Mann, Claudio G; Cournos, Francine

2018-04-01

Persons with mental illness have higher HIV infection rates than the general population. Little is known about whether care systems for this population are effectively participating in global efforts to end AIDS as a public health threat. This study examined treatment-as-usual HIV risk reduction services within public mental health settings. The authors interviewed 641 sexually active adults attending eight public psychiatric clinics in Rio de Janeiro about participation in a sexual risk reduction program, HIV testing, HIV knowledge, and sexual behaviors. Nine percent reported participation in a risk reduction program in the past year, and 75% reported having unprotected sex in the past three months. Program participants had greater HIV knowledge (p=.04) and were more likely to have had HIV testing in the past three months (p=.02), compared with nonparticipants. Participation was not associated with sexual behaviors. Including persons with mental illness in efforts to end AIDS requires a greater commitment to implementing effective interventions in public mental health systems.

Suicide in the Medically Ill.

ERIC Educational Resources Information Center

Hughes, Douglas; Kleespies, Phillip

2001-01-01

The relationship between medical illness and suicide seems to be multi-faceted. While medical illness is not the sole determinant of suicide, certain illnesses, such as HIV/AIDS and brain cancers, do appear to elevate the risk of suicide. Possible effective prevention efforts include education of primary care providers, and improved medication…

Best practices: a review of company activity on HIV / AIDS in South Africa.

PubMed

Michael, K

1999-01-01

This article presents the 1998 survey results conducted by the Health Economics and HIV/AIDS Research Division of the University of Natal in South Africa with the goal of documenting the best practices of managing HIV/AIDS in the workplace. The five key areas of the study are: HIV prevention; managing ill health; human resource development and industrial relations; employee benefits and survivor support; monitoring and planning for change in the workplace. The research comprised 14 companies used during the case studies. A few notable cases were observed among companies attempting to create awareness about HIV/AIDS. The Best Practice Survey highlighted issues about the private sectors in South Africa and their HIV management. First, companies conceptualize AIDS as either a health or poverty problem. Second, the environment is affected by the hazards of economic downturns, labor action, and economic inflation while the AIDS problem is neglected. Third, indirect costs were not considered and most companies feel that the conversion to a defined contribution arrangement compensates against escalating payouts for benefits. Fourth, long-term plans of the companies did not utilize the ill health statistics for the past 5 years.

Defining Mental Illness: The Relationship between College Students' Beliefs about the Definition of Mental Illness and Tolerance.

ERIC Educational Resources Information Center

Granello, Darcy Haag; Granello, Paul F.

2000-01-01

Investigates the relationship between college undergraduate students' (N=102) beliefs about the definition of mental illness and their tolerance toward individuals with mental illnesses. Results show that students with broad and inclusive definitions of mental illness had more benevolent, less authoritarian, and less socially restrictive attitudes…

Computational modeling of psychiatric illnesses via well-defined neurophysiological and neurocognitive biomarkers.

PubMed

Siekmeier, Peter J

2015-10-01

A good deal of recent research has centered on the identification of biomarkers and endophenotypic measures of psychiatric illnesses using in vivo and in vitro studies. This is understandable, as these measures-as opposed to complex clinical phenotypes-may be more closely related to neurobiological and genetic vulnerabilities. However, instantiation of such biomarkers using computational models-in silico studies-has received less attention. This approach could become increasingly important, given the wealth of detailed information produced by recent basic neuroscience research, and increasing availability of high capacity computing platforms. The purpose of this review is to survey the current state of the art of research in this area. We discuss computational approaches to schizophrenia, bipolar disorder, Alzheimer's disease, fragile X syndrome and autism, and argue that it represents a promising and underappreciated research modality. In conclusion, we outline specific avenues for future research; also, potential uses of in silico models to conduct "virtual experiments" and to generate novel hypotheses, and as an aid in neuropsychiatric drug development are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Diagnosis and Management of a Pancreaticopleural Fistula in a Patient with AIDS and a Large Pleural Effusion.

PubMed

Blayney, Margaret J; Nguyen, Andy; Aboulafia, David M

2016-11-01

Pleural effusions typically present with nonspecific pulmonary complaints in the setting of either acute or chronic diseases. In the general population, these illnesses include congestive heart failure, infection, and malignancy. However, in people living with HIV/AIDS (PLWHA), pleural effusions often result from opportunistic infections and AIDS-defining malignancies, such as Kaposi sarcoma and non-Hodgkin lymphoma. Since the introduction of highly active antiretroviral therapy, there has been a decline in the frequency of AIDS-defining opportunistic infections and AIDS-defining cancers and an increase in certain non-AIDS-defining malignancies including lung cancer. Throughout this period, longer life expectancy in PLWHA has contributed to an increased risk of those chronic diseases that can result in pleural effusions. This case describes an HIV-infected man who was an active cigarette smoker and alcoholic and who presented with a large pleural effusion of uncertain etiology. The authors review several important noncardiac risk factors associated with pleural effusions in PLWHA. The authors also emphasize the importance of obtaining a detailed medical history and the use of appropriate imaging and laboratory tests in order to identify an underlying cause and to provide optimal treatment. © The Author(s) 2016.

Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal.

PubMed

Mocroft, Amanda; Sterne, Jonathan A C; Egger, Matthias; May, Margaret; Grabar, Sophie; Furrer, Hansjakob; Sabin, Caroline; Fatkenheuer, Gerd; Justice, Amy; Reiss, Peter; d'Arminio Monforte, Antonella; Gill, John; Hogg, Robert; Bonnet, Fabrice; Kitahata, Mari; Staszewski, Schlomo; Casabona, Jordi; Harris, Ross; Saag, Michael

2009-04-15

The extent to which mortality differs following individual acquired immunodeficiency syndrome (AIDS)-defining events (ADEs) has not been assessed among patients initiating combination antiretroviral therapy. We analyzed data from 31,620 patients with no prior ADEs who started combination antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for sex, HIV transmission group, number of antiretroviral drugs initiated, regimen, age, date of starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation of combination antiretroviral therapy. ADEs that occurred in <50 patients were grouped together to form a "rare ADEs" category. During a median follow-up period of 43 months (interquartile range, 19-70 months), 2880 ADEs were diagnosed in 2262 patients; 1146 patients died. The most common ADEs were esophageal candidiasis (in 360 patients), Pneumocystis jiroveci pneumonia (320 patients), and Kaposi sarcoma (308 patients). The greatest mortality hazard ratio was associated with non-Hodgkin's lymphoma (hazard ratio, 17.59; 95% confidence interval, 13.84-22.35) and progressive multifocal leukoencephalopathy (hazard ratio, 10.0; 95% confidence interval, 6.70-14.92). Three groups of ADEs were identified on the basis of the ranked hazard ratios with bootstrapped confidence intervals: severe (non-Hodgkin's lymphoma and progressive multifocal leukoencephalopathy [hazard ratio, 7.26; 95% confidence interval, 5.55-9.48]), moderate (cryptococcosis, cerebral toxoplasmosis, AIDS dementia complex, disseminated Mycobacterium avium complex, and rare ADEs [hazard ratio, 2.35; 95% confidence interval, 1.76-3.13]), and mild (all other ADEs [hazard ratio, 1.47; 95% confidence interval, 1.08-2.00]). In the combination antiretroviral therapy era, mortality rates subsequent to an ADE depend on the specific diagnosis. The

Predictors of quality of life in AIDS patients.

PubMed

Kemppainen, J K

2001-01-01

While much work has been completed in relation to measuring and defining the varying dimensions of quality of life in HIV/AIDS, very little research attention has been directed toward identifying factors that influence or enhance quality of life. This study examined whether variables relating to demographic characteristics, severity of illness, psychological status, or level of engagement in nursing care would predict quality of life in persons with advanced or late stage HIV/AIDS. A convenience sample of 162 hospitalized male and female patients with AIDS participated in this study. The participants completed the HIV Symptom Checklist, the Beck Depression Inventory, the HIV-QAM (a measure of changes in the status of hospitalized AIDS patients due to nursing care), and two measures of engagement in nursing care. The Living With HIV Scale was used as the measure of quality of life. The two components of this scale were analyzed independently. The strongest predictor of decreased quality of life scores was depression (accounting for 23% of the variance), with symptoms accounting for 9.75% and female gender accounting for an additional 8%. Two measures of patient engagement with nursing care providers contributed a total of 13.44% of the variance in quality of life scores. The findings emphasize the importance of recognizing and treating depression in persons with HIV/AIDS. The number of symptoms and their frequency also has a profound effect on quality of life. Although modest, study findings suggest that quality of life for an acutely ill, hospitalized patient with AIDS is enhanced through more active involvement or engagement in the process of nursing care.

Poverty, AIDS and child health: identifying highest-risk children in South Africa.

PubMed

Cluver, Lucie; Boyes, Mark; Orkin, Mark; Sherr, Lorraine

2013-10-11

Identifying children at the highest risk of negative health effects is a prerequisite to effective public health policies in Southern Africa. A central ongoing debate is whether poverty, orphanhood or parental AIDS most reliably indicates child health risks. Attempts to address this key question have been constrained by a lack of data allowing distinction of AIDS-specific parental death or morbidity from other causes of orphanhood and chronic illness. To examine whether household poverty, orphanhood and parental illness (by AIDS or other causes) independently or interactively predict child health, developmental and HIV-infection risks. We interviewed 6 002 children aged 10 - 17 years in 2009 - 2011, using stratified random sampling in six urban and rural sites across three South African provinces. Outcomes were child mental health risks, educational risks and HIV-infection risks. Regression models that controlled for socio-demographic co-factors tested potential impacts and interactions of poverty, AIDS-specific and other orphanhood and parental illness status. Household poverty independently predicted child mental health and educational risks, AIDS orphanhood independently predicted mental health risks and parental AIDS illness independently predicted mental health, educational and HIV-infection risks. Interaction effects of poverty with AIDS orphanhood and parental AIDS illness were found across all outcomes. No effects, or interactions with poverty, were shown by AIDS-unrelated orphanhood or parental illness. The identification of children at highest risk requires recognition and measurement of both poverty and parental AIDS. This study shows negative impacts of poverty and AIDS-specific vulnerabilities distinct from orphanhood and adult illness more generally. Additionally, effects of interaction between family AIDS and poverty suggest that, where these co-exist, children are at highest risk of all.

Non-AIDS-Defining Cancer Mortality: Emerging Patterns in the Late HAART Era.

PubMed

Zucchetto, Antonella; Virdone, Saverio; Taborelli, Martina; Grande, Enrico; Camoni, Laura; Pappagallo, Marilena; Regine, Vincenza; Grippo, Francesco; Polesel, Jerry; Dal Maso, Luigino; Suligoi, Barbara; Frova, Luisa; Serraino, Diego

2016-10-01

Non-AIDS-defining cancers (non-ADCs) have become the leading non-AIDS-related cause of death among people with HIV/AIDS. We aimed to quantify the excess risk of cancer-related deaths among Italian people with AIDS (PWA), as compared with people without AIDS (non-PWA). A nationwide, population-based, retrospective cohort study was carried out among 5285 Italian PWA, aged 15-74 years, diagnosed between 2006 and 2011. Date of death and multiple-cause-of-death data were retrieved up to December 2011. Excess mortality, as compared with non-PWA, was estimated using sex- and age-standardized mortality ratios (SMRs) and the corresponding 95% confidence intervals (CIs). Among 1229 deceased PWA, 10.3% reported non-ADCs in the death certificate, including lung (3.1%), and liver (1.4%), cancers. A 7.3-fold (95% CI: 6.1 to 8.7) excess mortality was observed for all non-ADCs combined. Statistically significant SMRs emerged for specific non-ADCs, ie, anus (5 deaths, SMR = 227.6, 95% CI: 73.9 to 531.0), Hodgkin lymphoma (12 deaths, SMR = 122.0, 95% CI: 63.0 to 213.0), unspecified uterus (4 deaths, SMR = 52.5, 95% CI: 14.3 to 134.5), liver (17 deaths, SMR = 13.2, 95% CI: 7.7 to 21.1), skin melanoma (4 deaths, SMR = 10.9, 95% CI: 3.0 to 27.8), lung (38 deaths, SMR = 8.0, 95% CI: 5.7 to 11.0), head and neck (9 deaths, SMR = 7.8, 95% CI: 3.6 to 14.9), leukemia (5 deaths, SMR = 7.6, 95% CI: 2.4 to 17.7), and colon-rectum (10 deaths, SMR = 5.4, 95% CI: 2.6 to 10.0). SMRs for non-ADCs were particularly elevated among PWA infected through injecting drug use. This population-based study documented extremely elevated risks of death for non-ADCs among PWA. These findings stress the need of preventive interventions for both virus-related and non-virus-related cancers among HIV-infected individuals.

Cognitive representations of AIDS: a phenomenological study.

PubMed

Anderson, Elizabeth H; Spencer, Margaret Hull

2002-12-01

Cognitive representations of illness determine behavior. How persons living with AIDS image their disease might be key to understanding medication adherence and other health behaviors. The authors' purpose was to describe AIDS patients' cognitive representations of their illness. A purposive sample of 58 men and women with AIDS were interviewed. Using Colaizzi's (1978) phenomenological method, rigor was established through application of verification, validation, and validity. From 175 significant statements, 11 themes emerged. Cognitive representations included imaging AIDS as death, bodily destruction, and just a disease. Coping focused on wiping AIDS out of the mind, hoping for the right drug, and caring for oneself. Inquiring about a patient's image of AIDS might help nurses assess coping processes and enhance nurse-patient relationships.

Concepts, Structures, and Goals: Redefining Ill-Definedness

ERIC Educational Resources Information Center

Lynch, Collin; Ashley, Kevin D.; Pinkwart, Niels; Aleven, Vincent

2009-01-01

In this paper we consider prior definitions of the terms "ill-defined domain" and "ill-defined problem". We then present alternate definitions that better support research at the intersection of Artificial Intelligence and Education. In our view both problems and domains are ill-defined when essential concepts, relations, or criteria are un- or…

Orientation to Health Aide Careers Mini-Course & Home Health Aide Course.

ERIC Educational Resources Information Center

Novak, Kathy; And Others

Designed for use in a self-paced, open-entry/open-exit vocational training program for home health aides, this program guide is one of six for teachers of adult women offenders from a correctional institution. Module topic outlines are presented on eight topics: your career as a health aide; maintaining health; recognizing illness; positioning and…

If I Didn't Have HIV I'd Be Dead Now: Illness Narratives of Drug Users Living with HIV/AIDS

PubMed Central

Mosack, Katie E.; Abbott, Maryann; Singer, Merrill; Weeks, Margaret R.; Lucy, Rohena

2010-01-01

The purpose of this study was to illuminate the experiences of poor, urban HIV-positive drug users. Sixty participants were asked about HIV risk behaviors, the impact of HIV on their lives, religious beliefs, life plans, relationships, and work-related issues both prior to and since diagnosis. A theoretical framework was developed using Frank's (1995; 1998) Illness Narratives and Boss and Couden's (2002) Ambiguous Loss theories. Themes pertaining to both physical and emotional or spiritual dimensions were located within Benefit, Loss, or Status Quo orientations. The findings contribute to researchers' understanding of the HIV/AIDS illness experiences among the very marginalized and they have important implications for physical and mental health care professionals working with HIV-positive drug users. PMID:15802537

Defining Older Adults' Perceived Causes of Hypertension in the Brief Illness Perception Questionnaire

ERIC Educational Resources Information Center

Duwe, Elise A. G.; Koerner, Kari M.; Madison, Anna M.; Falk, Nikki A.; Insel, Kathleen C.; Morrow, Daniel G.

2014-01-01

Objectives: This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ--a pervasive quantitative measure for illness representation.…

Psychiatric Aide II. Instructor's Guide.

ERIC Educational Resources Information Center

Heimericks, Belinda K.

This instructor's guide is for a Psychiatric Aide II course intended to provide Psychiatric Aids Is who have demonstrated expertise in giving basic nursing care to the mentally ill with more advanced nursing interventions and techniques. (It is assumed that all nursing care the aides provide is under the direction of a Registered Nurse.)…

Iterative tensor voting for perceptual grouping of ill-defined curvilinear structures.

PubMed

Loss, Leandro A; Bebis, George; Parvin, Bahram

2011-08-01

In this paper, a novel approach is proposed for perceptual grouping and localization of ill-defined curvilinear structures. Our approach builds upon the tensor voting and the iterative voting frameworks. Its efficacy lies on iterative refinements of curvilinear structures by gradually shifting from an exploratory to an exploitative mode. Such a mode shifting is achieved by reducing the aperture of the tensor voting fields, which is shown to improve curve grouping and inference by enhancing the concentration of the votes over promising, salient structures. The proposed technique is validated on delineating adherens junctions that are imaged through fluorescence microscopy. However, the method is also applicable for screening other organisms based on characteristics of their cell wall structures. Adherens junctions maintain tissue structural integrity and cell-cell interactions. Visually, they exhibit fibrous patterns that may be diffused, heterogeneous in fluorescence intensity, or punctate and frequently perceptual. Besides the application to real data, the proposed method is compared to prior methods on synthetic and annotated real data, showing high precision rates.

[Consensus statement on the clinical management of non-AIDS defining malignancies. GeSIDA expert panel].

PubMed

Santos, Jesús; Valencia, Eulalia

2014-10-01

This consensus document has been prepared by a panel of experts appointed by GeSIDA. This paper reviews the recommendations on the most important non-AIDS defining malignancies that can affect patients living with AIDS. Lung cancer, hepatocellular carcinoma, anal carcinoma and other less frequent malignancies such as breast, prostate, vagina or colon cancers are reviewed. The aim of the recommendations is to make clinicians who attend to this patients aware of how to prevent, diagnose and treat this diseases. The recommendations for the use of antiretroviral therapy when the patient develops a malignancy are also presented. In support of the recommendations we have used the modified criteria of the Infectious Diseases Society of America. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Think fungus NOT just a crypto-meningitis in AIDS!

PubMed

Badiye, Amit; Patnaik, Mrinal; Deshpande, Alaka; Rajendran, C; Chandrashekara, K V

2012-12-01

Extrapulmonary cryptococcosis has been defined as AIDS defining illness in HIV infected people. Cryptococcal meningitis is the commonest meningitis with advanced immune deficiency. Therefore clinicians ask for tests only for detection of cryptococci which may be misleading. A prospective study of suspected fungal meningitis with CSF fungal culture is carried out. 70 ART naive cases of suspected fungal meningitis in HIV cases were subjected to CSF cytochemistry, smear exam and CSF fungal culture. The CSF culture was positive in 75.6% cases of these 21 were C. Neoformans as against 28 of Rhodotorula. In addition candida, aspergillus, geotrichum, trichosporon were isolated. Apart from c. neoformans, other fungi also cause meningitis. Each case of suspected fungal meningitis, may be subjected for CSF fungal culture for proper and adequate management. If facility for fungal culture is not available and if CSF smear shows evidence of fungal infection then standard therapy with Amphotericin may be instituted earlier to reduce mortality. This is the largest series isolating Rhodotorula from CSF in AIDS patients.

Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: a case/control study.

PubMed

Shoemaker, Ritchie C; House, Dennis; Ryan, James C

2010-01-01

Ciguatoxins are extremely potent neurotoxins, produced by tropical marine dinoflagellates, that persistently enter into our food web. Over 100,000 people annually experience acute ciguatera poisoning from consuming toxic fish. Roughly 5% of these victims will develop chronic ciguatera (CC), a widespread, multisymptom, multisystem, chronic illness that can last tens of years. CC is marked by disproportionate disability and non-specific refractory symptoms such as fatigue, cognitive deficits and pain, and is suggestive of other illnesses. Its unknown pathophysiology makes both diagnosis and treatment difficult. We wanted to compare objective parameters of visual contrast sensitivity testing, measures of innate immune response and genetic markers in cases to controls to assess the potential for the presence of persistent inflammatory parameters that are demonstrated in other biotoxin associated illnesses at a single specialty clinic. Using 59 CC cases and 59 controls we present in retrospective review, in all cases, abnormalities in immune responses paralleling the chronic systemic inflammatory response syndrome seen in several other chronic diseases. This study defines a preliminary case definition using medical history, total symptoms, visual contrast sensitivity, HLA DR genotype analysis, reduction of regulatory neuropeptides VIP and MSH, and multiple measures of inflammatory immune response, especially C4a and TGFβ1, thereby providing a basis for identification and targeted therapy. CC provides a model for chronic human illness associated with initiation of inflammatory responses by biologically produced neurotoxins. Copyright © 2010 Elsevier Inc. All rights reserved.

Update on non-acquired immunodeficiency syndrome-defining malignancies.

PubMed

Chiao, Elizabeth Y; Krown, Susan E

2003-09-01

Since the introduction of highly active antiretroviral therapy (HAART), the natural history of human immunodeficiency virus (HIV) infection has changed. Early in the acquired immunodeficiency syndrome (AIDS) epidemic, epidemiologic studies showed that HIV-infected patients were at higher risk for developing specific AIDS-defining malignancies. More recent studies linking HIV/AIDS databases to cancer registries have shown that HIV-infected patients are also at higher risk of developing non-AIDS-defining malignancies. We review the most recent data regarding clinical presentation, pathology, and treatment outcomes for these non-AIDS-defining malignancies. Recent large cohort studies linking HIV/AIDS databases to cancer registries have shown that HIV-infected patients are also at higher risk of developing non-AIDS-defining malignancies. Besides anal cancer and Hodgkin disease, the cohort studies have identified other malignancies that appear to occur at a higher rate in the HIV-infected population as compared with the general population. These malignancies include lung cancer, skin cancer, germ cell tumors, leiomyosarcomas, cancers of the head and neck, conjunctival cancer, multiple myeloma, and leukemias. As the epidemiology of non-AIDS-defining malignancies continues to evolve, it is unclear whether the appropriate treatments and outcomes for these or other malignancies are changed for HIV-infected patients treated with HAART.

The Stigma of Mental Illness

ERIC Educational Resources Information Center

Overton, Stacy L.; Medina, Sondra L.

2008-01-01

Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its…

Cumulative HIV viremia and non-AIDS-defining malignancies among a sample of HIV-infected male veterans.

PubMed

Kowalkowski, Marc A; Day, Rena S; Du, Xianglin L; Chan, Wenyaw; Chiao, Elizabeth Y

2014-10-01

Research suggests that cumulative measurement of HIV exposure is associated with mortality, AIDS, and AIDS-defining malignancies. However, the relationship between cumulative HIV and non-AIDS-defining malignancies (NADMs) remains unclear. The aim of this study was to evaluate the effect of different HIV measures on NADM hazard among HIV-infected male veterans. We performed a retrospective cohort study using Veterans Affairs HIV Clinical Case Registry data from 1985 to 2010. We analyzed the relationship between HIV exposure (recent HIV RNA, % undetectable HIV RNA, and HIV copy-years viremia) and NADM. To evaluate the effect of HIV, we calculated hazard ratios for 3 common virally associated NADM [ie, hepatocarcinoma (HCC), Hodgkin lymphoma (HL), and squamous cell carcinoma of the anus (SCCA)] in multivariable Cox regression models. Among 31,576 HIV-infected male veterans, 383 HCC, 211 HL, and 373 SCCA cases were identified. In multivariable regression models, cross-sectional HIV measurement was not associated with NADM. However, compared with <20% undetectable HIV, individuals with ≥80% had decreased HL [adjusted hazard ratio (aHR) = 0.62; 95% confidence interval (CI): 0.37 to 1.02] and SCCA (aHR = 0.64; 95% CI: 0.44 to 0.93). Conversely, each log10 increase in HIV copy-years was associated with elevated HL (aHR = 1.22; 95% CI: 1.06 to 1.40) and SCCA (aHR = 1.36; 95% CI: 1.21 to 1.52). Model fit was best with HIV copy-years. Cumulative HIV was not associated with HCC. Cumulative HIV was associated with certain virally associated NADM (ie, HL and SCCA), independent of measured covariates. Findings underline the importance of early treatment initiation and durable medication adherence to reduce cumulative HIV burden. Future research should prioritize how to best apply cumulative HIV measures in screening for these cancers.

Trends in AIDS incidence and AIDS-related mortality in British Columbia between 1981 and 2013

PubMed Central

Lima, Viviane D.; Lourenço, Lillian; Yip, Benita; Hogg, Robert S.; Phillips, Peter; Montaner, Julio S.G.

2015-01-01

Background Appropriate use of highly active antiretroviral therapy (HAART) can markedly decrease the risk of progression to acquired immunodeficiency syndrome (AIDS) and of premature mortality. We aimed to characterize the trends between 1981 and 2013 in AIDS-defining illnesses (ADIs) and in the number AIDS-related deaths in British Columbia (BC), Canada. Methods We included data of 3550 HIV-positive individuals, aged 19 years or older, from different administrative databases in BC. We estimated the relative risk of developing an ADI over time using a Negative Binomial model, and we investigated trends in the percentage of all deaths associated with AIDS using generalized additive models. Findings The number of ADIs has decreased dramatically to its lowest level in 2013. The peak of the AIDS epidemic in BC happened in 1994 with 696 ADIs being reported (rate 42 ADIs per 100 person-years). Since 1997, the number of ADIs decreased from 253 (rate 7 per 100 person-years) to 84 cases in 2013 (rate 1 per 100 person-years) (p-value equals to zero for the trend in the number of ADIs). We have also shown that out of 22 ADIs considered, only PCP maintained its prominent ranking (albeit with much reduced overall prevalence). Finally, we observed that over time very few deaths were related to AIDS-related causes, especially in the most recent years. Interpretation We showed that the number of new ADIs and AIDS-related mortality have been decreasing rapidly over time in BC. These results provide further evidence that integrated comprehensive free programs that facilitate testing, and deliver treatment and care to this population can be effective in markedly decreasing AIDS-related morbidity and mortality, thus suggesting that controlling and eventually ending AIDS is possible. Funding The British Columbia Ministry of Health, the US National Institutes of Health, the US National Institute on Drug Abuse, the Canadian Institutes of Health Research, and the Michael Institute for

Sexually-transmitted diseases, AIDS and traditional healers in Mozambique.

PubMed

Green, E C; Jurg, A; Dgedge, A

1993-08-01

Qualitative research was conducted with traditional healers in Manica Province, Mozambique to develop an empirical, culturally-appropriate strategy for communication between government and traditional healers related to the prevention of STDs including AIDS. Most Manica healers regard AIDS as a new disease for which they lack medicines. However, when questioned on other sexually transmitted diseases, as defined by healers themselves, relatively complex disease taxonomies based on fine distinctions between symptoms emerged. Manica healers recognize two broad categories of STDs: siki and nyoka-related. The former seems to correspond with the more serious common STDs of Western biomedicine--syphilis, gonorrhea, chlamydia and chancroid--and is believed to be caused by a common invisible, microscopic agent, khoma. Nyoka-related illnesses are understood in terms of traditional ideas of pollution, and denote less serious, self-limiting genito-urinary conditions. Healers express great faith in the efficacy of traditional medicines. Based on the ethnomedical research findings, a culturally-sensitive and -specific AIDS/STD health education strategy for Manica indigenous healers was developed and began operating in a week-long workshop held in Chimoio, Mozambique in November 1991.

The Impact of Illness Identity on Recovery from Severe Mental Illness.

PubMed

Yanos, Philip T; Roe, David; Lysaker, Paul H

2010-04-01

The impact of the experience and diagnosis of mental illness on one's identity has long been recognized; however, little is known about the impact of illness identity, which we define as the set of roles and attitudes that a person has developed in relation to his or her understanding of having a mental illness. The present article proposes a theoretically driven model of the impact of illness identity on the course and recovery from severe mental illness and reviews relevant research. We propose that accepting a definition of oneself as mentally ill and assuming that mental illness means incompetence and inadequacy impact hope and self-esteem, which further impact suicide risk, coping, social interaction, vocational functioning, and symptom severity. Evidence supports most of the predictions made by the model. Implications for psychiatric rehabilitation services are discussed.

Feasibility and acceptability of a decision aid designed for people facing advanced or terminal illness: a pilot randomized trial.

PubMed

Matlock, Dan D; Keech, Tarah A E; McKenzie, Marlene B; Bronsert, Michael R; Nowels, Carolyn T; Kutner, Jean S

2014-02-01

Patients nearing the end of their lives face an array of difficult decisions. This study was designed to assess the feasibility and acceptability of a decision aid (DA) designed for patients facing advanced or terminal illness. We conducted a pilot randomized clinical trial of Health Dialog's Looking Ahead: choices for medical care when you're seriously ill DA (booklet and DVD) applied to patients on a hospital-based palliative care (PC) service. University of Colorado Hospital - December 2009 and May 2010. All adult, English-speaking patients or their decision makers were potentially eligible. Patients were not approached if they were in isolation, did not speak English or if any provider felt that they were not appropriate because of issues such as family conflict or actively dying. All participants received a standard PC consultation. Participants in the intervention arm also received a copy of the DA. Measurements Primary outcomes included decision conflict and knowledge. Participants in the intervention arm also completed an acceptability questionnaire and qualitative exit interviews. Of the 239 patients or decision makers, 51(21%) enrolled in the trial. The DA had no significant effect on decision conflict or knowledge. Exit interviews indicated it was acceptable and empowering, although they wished they had access to the DA earlier. While the DA was acceptable, feasibility was limited by late-life illness challenges. Future trials of this DA should be performed on patients earlier in their illness trajectory and should include additional outcome measures such as self-efficacy and confidence. © 2011 John Wiley & Sons Ltd.

Defining guilt in depression: a comparison of subjects with major depression, chronic medical illness and healthy controls.

PubMed

Ghatavi, Kayhan; Nicolson, Rob; MacDonald, Cathy; Osher, Sue; Levitt, Anthony

2002-04-01

Although guilt is a widely accepted feature of depression, there is limited and inconsistent data defining the nature of this symptom. The purpose of the current study was to examine the specificity and nature of guilt in subjects with major depression as compared to patients with another chronic medical illness and healthy controls. Outpatients with current major depressive episode (MDE; n=34), past-MDE (n=22), chronic cardiac illness (n=20) and healthy controls (n=59) were administered the following measures: The Guilt Inventory (GI), State Shame and Guilt Scale (SSGS), 17-item Hamilton Rating Scale for Depression (Ham-D) and the Structured Clinical Interview for DSM-IV. Overall multivariate analysis of covariance comparing mean scores for the six guilt subscales [state-guilt, trait-guilt, moral standards (from the GI); state-guilt, -pride, and -shame (from the SSGS)] across the four groups was significant (F=9.1, df=6:121, p<0.0001). Post-hoc analysis revealed the following differences (each at least p<0.01): for state-guilt (GI), current-MDE>past-MDE>cardiac=healthy controls; for trait-guilt (GI), current-MDE=past-MDE>cardiac=healthy controls; for state-shame, -guilt and -pride (SSGS), current-MDE>past-MDE, past-MDE=cardiac, past-MDE>healthy, cardiac=healthy controls. Among depressed patients, there was significant correlation between Ham-D score and all guilt sub-scales (p<0.01), except moral standards. The cardiac group may have less illness burden than currently depressed. State expression of guilt, shame and low pride distinguish acutely depressed from all other groups, and are highly influenced by severity of depression. Trait-guilt does not differentiate acute from past depressed. Data suggests guilt may represent both an enduring and fluctuating feature of depressive illness over its longitudinal course.

Rational Suicide and AIDS: Considerations for the Psychotherapist.

ERIC Educational Resources Information Center

Werth, James L., Jr.

1992-01-01

Reviews literature on suicide and terminal illnesses. Examines suicide rate for persons with Acquired Immune Deficiency Syndrome (AIDS). Explores physical and psychosocial factors that may contribute to decision by person with AIDS to commit suicide. Applies Siegel's criteria for rational suicide to case of person with AIDS. Examines role of…

Defining and refining international donor support for combating the AIDS pandemic.

PubMed

Attaran, A; Sachs, J

2001-01-06

The international aid effort against AIDS is greatly incommensurate with the severity of the epidemic. Drawing on the data that international aid donors self-reported to the Organization for Economic Cooperation and Development (OECD), we find that, between 1996 and 1998, finance from all rich countries to sub-Saharan Africa for projects designated as AIDS control averaged US $69 million annually, and, assuming a safe margin for under-reporting and misreporting, we estimate that total donor spending on HIV/AIDS control was perhaps twice that at most. Since the late 1980s, aid levels have dropped relative to the prevalence of HIV infection, and stood recently at about $3 per HIV-infected person. Lack of finance is now the primary constraint on progress against AIDS, notwithstanding the widespread belief that a lack of interest from the goveements of poor countries is limiting. We argue that to produce a meaningful response to the pandemic, international assistance must be based on grants, not loans, for the poorest countries; be increased within the next 3 years to a minimum of $7.5 billion or more; be directed toward funding projects which are proposed and desired by the affected countries themselves, and which are judged as having epidemiological merit against the pandemic by a panel of independent scientific experts; and fund concurrent needs, including prevention, drug treatment (such as highly active antiretroviral therapy), and blocking mother-to-child HIV transmission. An effort of this scope and scale will both radically alter the prospects for intervention against AIDS in poor countries, and together with comparable efforts to control other infectious diseases, is easily afforded by the OECD donor economies, whose aggregate national income recently surpassed $21 trillion annually.

Contextualising AIDS and human development: Long-term illness and death among adults in labouring low-caste groups in India.

PubMed

Priya, R; Sathyamala, C

2007-01-01

This study compared evidence from two low caste labouring communities in India: a relatively modernized urban group and a rural group in a backward region. It explored their levels of ill health, their capacities to respond to adult illness and the support they received. In each region, a baseline survey of approximately 1,000 households provided background quantitative evidence with qualitative evidence was collected from about 55 families. HIV infection and AIDS deaths were found to occur in the 'less poor' segments of the study group in both regions. In keeping with the official data, they formed a small proportion of the overall mortality and morbidity in this group. Stigma and discrimination were found to be low but fear of stigma was high, generated by the medical response to AIDS and used opportunistically for personal gains. The study provides insights into the structural determinants of health and coping mechanisms in these communities. The best conditions for a healthy life were found in the group that had a rooted community setting, collective political power, migrant economic support and improved working conditions--the less poor rural group. While improved economic status was associated with better health status, this relationship was stronger when combined with the presence of improved working conditions, with social cohesion at family and community levels and with political power as indicated by levels of organized collective representation and identity formation in workplace, local- and state-level politics. However, the traditional forms of social cohesion are under stress and new forms, moderated by commercial relations, are proving inadequate to meet major household shocks, like adult mortality.

Death and AIDS: A Review of the Medico-Legal Literature.

ERIC Educational Resources Information Center

Huber, Jeffrey T.

1993-01-01

Notes that diagnosis of Acquired Immune Deficiency Syndrome (AIDS) continues to denote death sentence. Contends that AIDS is unique terminal illness in that no other single disease in history of American legal system has generated more litigation than AIDS. Examines medico-legal issues associated with AIDS-related death: estate planning,…

Defining "peerness": Developing peer supports for parents with mental illnesses.

PubMed

Nicholson, Joanne; Valentine, Anne

2018-06-01

This article addresses critical considerations in the development of peer supports for parents with mental illnesses, focusing on the question of what makes a peer a peer in the parent peer specialist domain. The implementation and testing of parent peer supports requires specification of the critical components of the model, including the qualities, characteristics, and unique contributions of the parent peer specialist. Themes emerged in Parent Peer Specialist Project Advisory Group discussions, with members drawing from lived experience, practice expertise, and conversations with experts. In addition to literature review, strategic stakeholder interviews were conducted. Lived experience of mental illness and family life, training, and ongoing support for parent peer specialists, along with key ingredients conveyed by perceived peer-parent similarity, will likely enhance the benefits of peer supports to parents and promote job satisfaction and career advancement for parent peer specialists. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Moral Development, HIV/AIDS Knowledge, and Attitude toward HIV/AIDS among Counseling Students in the United States

ERIC Educational Resources Information Center

Joe, J. Richelle; Foster, Victoria A.

2017-01-01

People living with HIV/AIDS will likely require services from mental health professionals to address the complex psychosocial effects of the illness. In the United States, counseling students are not likely to be well prepared to serve clients affected by HIV/AIDS, and little is known about their HIV-related knowledge and attitudes. The present…

How to develop a company AIDS policy.

PubMed

Bompey, S H

1986-07-01

It is for most businesses only a matter of time before they will have experience with Acquired Immune Deficiency Syndrome (AIDS), and the experience could be very costly for companies which fail to implement an effective AIDS policy. Potential AIDS problems include: antidiscrimination suits based on firing or failing to hire an individual who had AIDS or carries the AIDS virus antibodies; defamation suits from employees who are wrongly identified; disability claims that do not fit the pattern for other diseases; civil rights penalties in some situations when AIDS victims are prevented from working; and run-ins with the Occupational Safety and Health Administration or the National Labor Relations Board if healthy workers refuse to work alongside AIDS victims. A company needs to think through its AIDS policy, but that does not mean establishing a "special" AIDS policy which may create paranoia among employees. The best approach is to develop a health policy that includes all catastrophic illnesses, not just AIDS. There have been few court decisions involving AIDS because AIDS is a recent illness, victims often do not live long enough to pursue the matter, and it often pays to settle AIDS cases out of court. Employers need to know that judges, administrative agencies, and arbitrators take the position that AIDS is a disability. As such, AIDS is treated under the anti-handicap discrimination laws on the books of most states. Additionally, the Federal Rehabilitation Act of 1973 prohibits discrimination against the disabled by companies that contract with the federal government or receive federal financial assistance. It usually is illegal to discriminate against the disabled workers, and in some states against workers who are perceived to have a disability. The best defense against the fear of working alongside and AIDs sufferer is education.

External validation of a prehospital risk score for critical illness.

PubMed

Kievlan, Daniel R; Martin-Gill, Christian; Kahn, Jeremy M; Callaway, Clifton W; Yealy, Donald M; Angus, Derek C; Seymour, Christopher W

2016-08-11

Identification of critically ill patients during prehospital care could facilitate early treatment and aid in the regionalization of critical care. Tools to consistently identify those in the field with or at higher risk of developing critical illness do not exist. We sought to validate a prehospital critical illness risk score that uses objective clinical variables in a contemporary cohort of geographically and temporally distinct prehospital encounters. We linked prehospital encounters at 21 emergency medical services (EMS) agencies to inpatient electronic health records at nine hospitals in southwestern Pennsylvania from 2010 to 2012. The primary outcome was critical illness during hospitalization, defined as an intensive care unit stay with delivery of organ support (mechanical ventilation or vasopressor use). We calculated the prehospital risk score using demographics and first vital signs from eligible EMS encounters, and we tested the association between score variables and critical illness using multivariable logistic regression. Discrimination was assessed using the AUROC curve, and calibration was determined by plotting observed versus expected events across score values. Operating characteristics were calculated at score thresholds. Among 42,550 nontrauma, non-cardiac arrest adult EMS patients, 1926 (4.5 %) developed critical illness during hospitalization. We observed moderate discrimination of the prehospital critical illness risk score (AUROC 0.73, 95 % CI 0.72-0.74) and adequate calibration based on observed versus expected plots. At a score threshold of 2, sensitivity was 0.63 (95 % CI 0.61-0.75), specificity was 0.73 (95 % CI 0.72-0.73), negative predictive value was 0.98 (95 % CI 0.98-0.98), and positive predictive value was 0.10 (95 % CI 0.09-0.10). The risk score performance was greater with alternative definitions of critical illness, including in-hospital mortality (AUROC 0.77, 95 % CI 0.7 -0.78). In an external validation cohort, a

Major Mental Illness in Those Who Sexually Abuse.

PubMed

Moulden, Heather M; Marshall, Liam E

2017-11-09

There is evidence showing an increasing prevalence of mental illness in those in conflict with the law. However, there are many factors affecting the detection, treatment, and management of criminals who are mentally ill. Sex offenders with major mental illness present many challenges to those providing treatment and management services. For example, it is important to consider whether sexually offensive behavior is the cause of criminal behavior or whether it is reflective of an antisocial orientation. Recent evidence suggests it may help better understand and inform risk assessment and management. This paper will review the literature on mental illness among sexual offenders, present a typology to aid in the assessment, treatment, and management of sexual offender with mental illness, and highlight important considerations when providing treatment to sexual offenders with mental illness.

Epigenetic regulation of HIV, AIDS, and AIDS-related malignancies.

PubMed

Verma, Mukesh

2015-01-01

Although epigenetics is not a new field, its implications for acquired immunodeficiency syndrome (AIDS) research have not been explored fully. To develop therapeutic and preventive approaches against the human immunodeficiency virus (HIV) and AIDS, it is essential to understand the mechanisms of interaction between the virus and the host, involvement of genetic and epigenetic mechanisms, characterization of viral reservoirs, and factors influencing the latency of the virus. Both methylation of viral genes and histone modifications contribute to initiating and maintaining latency and, depending on the context, triggering viral gene repression or expression. This chapter discusses progress made at the National Institutes of Health (NIH), recommendations from the International AIDS Society Scientific Working Group on HIV Cure, and underlying epigenetic regulation. A number of epigenetic inhibitors have shown potential in treating AIDS-related malignancies. Epigenetic drugs approved by the US Food and Drug Administration and their implications for the eradication of HIV/AIDS and AIDS-related malignancies also are discussed.Past and current progress in developing treatments and understanding the molecular mechanisms of AIDS and HIV infection has greatly improved patient survival. However, increased survival has been coupled with the development of cancer at higher rates than those observed among the HIV/AIDS-negative population. During the early days of the AIDS epidemic, the most frequent AIDS-defining malignancies were Kaposi's sarcoma and non-Hodgkin lymphoma (NHL). Now, with increased survival as the result of widespread use in the developed world of highly active antiretroviral therapy (HAART), non-AIDS defining cancers (i.e., anal, skin, and lung cancers, and Hodgkin disease) are on the increase in HIV-infected populations. The current status of AIDS-related malignancies also is discussed.

AIDS: acquired immunodeficiency syndrome.

PubMed Central

Gilmore, N. J.; Beaulieu, R.; Steben, M.; Laverdière, M.

1983-01-01

Acquired immunodeficiency syndrome, or AIDS, is a new illness that occurs in previously healthy individuals. It is characterized by immunodeficiency, opportunistic infections and unusual malignant diseases. Life-threatening single or multiple infections with viruses, mycobacteria, fungi or protozoa are common. A rare neoplasm, Kaposi's sarcoma, has developed in approximately one third of patients with AIDS. More than 800 cases of AIDS have been reported in North America, over 24 of them in Canada. The majority of patients are male homosexuals, although AIDS has also developed in abusers of intravenously administered drugs, Haitian immigrants, individuals with hemophilia, recipients of blood transfusions, prostitutes, and infants, spouses and partners of patients with AIDS. The cause of AIDS is unknown, but the features are consistent with an infectious process. Early diagnosis can be difficult owing to the nonspecific symptoms and signs of the infections and malignant diseases. Therefore, vigilance by physicians is of utmost importance. PMID:6342737

AIDS: acquired immunodeficiency syndrome *

PubMed Central

Gilmore, N.J.; Beaulieu, R.; Steben, M.; Laverdière, M.

1992-01-01

Acquired immunodeficiency syndrome, or AIDS, is a new illness that occurs in previously healthy individuals. It is characterized by immunodeficiency, opportunistic infections and unusual malignant diseases. Life-threatening single or multiple infections with viruses, mycobacteria, fungi or protozoa are common. A rare neoplasm, Kaposi's sarcoma, has developed in approximately one third of patients with AIDS. More than 800 cases of AIDS have been reported in North America, over 24 of them in Canada. The majority of patients are male homosexuals, although AIDS has also developed in abusers of intravenously administered drugs, Haitian immigrants, individuals with hemophilia, recipients of blood transfusions, prostitutes, and infants, spouses and partners of patients with AIDS. The cause of AIDS is unknown, but the features are consistent with an infectious process. Early diagnosis can be difficult owing to the nonspecific symptoms and signs of the infections and malignant diseases. Therefore, vigilance by physicians is of the utmost importance. PMID:1544049

Death Anxiety in Persons with HIV/AIDS: A Systematic Review and Meta-Analysis

ERIC Educational Resources Information Center

Miller, Audrey K.; Lee, Brittany L.; Henderson, Craig E.

2012-01-01

One of the most commonly cited psychological sequelae of HIV/AIDS is anxiety regarding death due to the illness (i.e., death anxiety; DA). However, extant research is inconclusive on several empirical issues, such as DA's relation to HIV/AIDS diagnostic status, the impact of illness-related symptoms on DA, and factors that may protect against DA.…

Incidence of AIDS-Defining and Other Cancers in HIV-Positive Children in South Africa: Record Linkage Study

PubMed Central

Bohlius, Julia; Maxwell, Nicola; Spoerri, Adrian; Wainwright, Rosalind; Sawry, Shobna; Poole, Janet; Eley, Brian; Prozesky, Hans; Rabie, Helena; Garone, Daniela; Technau, Karl-Günter; Maskew, Mhairi; Davies, Mary-Ann; Davidson, Alan; Stefan, D. Cristina; Egger, Matthias

2016-01-01

Background Little is known on the risk of cancer in HIV-positive children in sub-Saharan Africa. We examined incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa. Methods We linked the records of five ART programs in Johannesburg and Cape Town to those of pediatric oncology units, based on name and surname, date of birth, folder and civil identification numbers. We calculated incidence rates and obtained hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression models including ART, sex, age, and degree of immunodeficiency. Missing CD4 counts and CD4% were multiply imputed. Immunodeficiency was defined according to World Health Organization 2005 criteria. Results Data of 11,707 HIV-positive children were included in the analysis. During 29,348 person-years of follow-up 24 cancers were diagnosed, for an incidence rate of 82 per 100,000 person-years (95% CI 55-122). The most frequent cancers were Kaposi Sarcoma (34 per 100,000 person-years) and Non Hodgkin Lymphoma (31 per 100,000 person-years). The incidence of non AIDS-defining malignancies was 17 per 100,000. The risk of developing cancer was lower on ART (HR 0.29, 95%CI 0.09–0.86), and increased with age at enrolment (>10 versus <3 years: HR 7.3, 95% CI 2.2-24.6) and immunodeficiency at enrolment (advanced/severe versus no/mild: HR 3.5, 95%CI 1.1-12.0). The HR for the effect of ART from complete case analysis was similar but ceased to be statistically significant (p=0.078). Conclusions Early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in HIV-positive children in South Africa and elsewhere. PMID:26906162

Iterative Tensor Voting for Perceptual Grouping of Ill-Defined Curvilinear Structures: Application to Adherens Junctions

PubMed Central

Loss, Leandro A.; Bebis, George; Parvin, Bahram

2012-01-01

In this paper, a novel approach is proposed for perceptual grouping and localization of ill-defined curvilinear structures. Our approach builds upon the tensor voting and the iterative voting frameworks. Its efficacy lies on iterative refinements of curvilinear structures by gradually shifting from an exploratory to an exploitative mode. Such a mode shifting is achieved by reducing the aperture of the tensor voting fields, which is shown to improve curve grouping and inference by enhancing the concentration of the votes over promising, salient structures. The proposed technique is applied to delineation of adherens junctions imaged through fluorescence microscopy. This class of membrane-bound macromolecules maintains tissue structural integrity and cell-cell interactions. Visually, it exhibits fibrous patterns that may be diffused, punctate and frequently perceptual. Besides the application to real data, the proposed method is compared to prior methods on synthetic and annotated real data, showing high precision rates. PMID:21421432

Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.

PubMed

Austin, C Adrian; Mohottige, Dinushika; Sudore, Rebecca L; Smith, Alexander K; Hanson, Laura C

2015-07-01

Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population. To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making in serious illness, thereby (1) identifying tools relevant to the treatment decisions of seriously ill patients and their caregivers, (2) evaluating the quality of evidence for these tools, and (3) summarizing their effect on outcomes and accessibility for clinicians. We searched PubMed, CINAHL, and PsychInfo from January 1, 1995, through October 31, 2014, and identified additional studies from reference lists and other systematic reviews. Clinical trials with random or nonrandom controls were included if they tested print, video, or web-based tools for advance care planning (ACP) or decision aids for serious illness. We extracted data on the study population, design, results, and risk for bias using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Each tool was evaluated for its effect on patient outcomes and accessibility. Seventeen randomized clinical trials tested decision tools in serious illness. Nearly all the trials were of moderate or high quality and showed that decision tools improve patient knowledge and awareness of treatment choices. The available tools address ACP, palliative care and goals of care communication, feeding options in dementia, lung transplant in cystic fibrosis, and truth telling in terminal cancer. Five randomized clinical trials provided further evidence that decision tools improve ACP documentation, clinical decisions, and treatment received. Clinicians can access and use evidence-based tools to engage seriously ill patients in shared decision making. This field of research is in an early stage; future research is needed to develop novel decision aids for other serious diagnoses and key

Extenuating Circumstances in Perceptions of Suicide: Disease Diagnosis (AIDS, Cancer), Pain Level, and Life Expectancy.

ERIC Educational Resources Information Center

Martin, Stephen K.; Range, Lillian M.

1991-01-01

Examined whether illness type, pain level, and life expectancy affected reactions of undergraduates (n=160) toward a terminal illness suicide with Acquired Immune Deficiency Syndrome (AIDS) or cancer. AIDS patients were more stigmatized than cancer patients; suicide was more tolerated if victim was suffering greater pain. (Author/ABL)

Dual Candida albicans and Cryptococcus neoformans fungaemia in an AIDS presenter: a unique disease association in the highly active antiretroviral therapy (HAART) era.

PubMed

Manfredi, Roberto; Calza, Leonardo; Chiodo, Francesco

2002-12-01

A case report of a patient who discovered his HIV infection concurrently with an advanced immunodeficiency and a dual Candida albicans and Cryptococcus neoformans fungaemia is discussed with reference to the changing epidemiology and clinical features of HIV infection and AIDS in the highly active antiretroviral therapy (HAART) era. The tendency to develop multiple concomitant AIDS-defining illnesses at the time of first hospitalisation seems to be an increasing feature in patients who remain unaware of or neglect their HIV disease and who are still at risk of opportunist infections even with the availability of HAART.

Confronting HIV/AIDS in a South African village: The impact of health-seeking behaviour1

PubMed Central

GOLOOBA-MUTEBI, FREDERICK; TOLLMAN, STEPHEN M.

2010-01-01

Much social science research on HIV/AIDS focuses on its impact within affected communities and how people try to cope with its consequences. Based on fieldwork in rural South Africa, this article shows ways in which the inhabitants of a village react to illness, in general, and the role their reactions play in facilitating the spread of communicable diseases such as HIV/AIDS. There is potentially a strong connection between the manner in which people respond to illness in general, and actual transmission of infection. By influencing the way villagers react to episodes of ill health, folk beliefs about illness and illness causation may create avenues for more people to become infected. This suggests that efforts to combat the HIV/AIDS pandemic cannot succeed without tackling the effects of folk beliefs. Therefore, in addressing the problem of HIV/AIDS, experts should focus on more than disseminating information about cause and transmission, and promoting abstinence, safe sex, and other technocratic fixes. Our findings suggest that people need information to facilitate not only decision-making about how to self-protect against infection, but also appropriate responses when infection has already occurred. PMID:17676520

Parental Involvement of Mothers with Chronic Illness and Children's Academic Achievement

ERIC Educational Resources Information Center

Chen, Yung-Chi; Fish, Marian C.

2013-01-01

This study examined how maternal chronic illnesses may affect children's academic achievement through parental involvement. A total of 189 mothers diagnosed with chronic illnesses, such as multiple sclerosis, diabetes, cancer, HIV/AIDS, chronic pain, asthma, myelodysplasic syndrome, and fibromyalgia, and with a child in middle school or high…

Financial Aid.

ERIC Educational Resources Information Center

Graves, Mary A.

This workbook assists college and vocational school bound American Indian students in determining their financial needs and in locating sources of financial aid. A checklist helps students assess the state of their knowledge of financial programs; a glossary defines terms pertinent to the realm of financial aid (i.e., graduate study programs,…

Health services utilization during terminal illness in Addis Ababa, Ethiopia

PubMed Central

Reniers, Georges; Tesfai, Rebbeca

2009-01-01

Objectives We describe modern and alternative health services use in terminal illness of adults, and assess whether utilization patterns of TB/AIDS patients are distinct from those of patients suffering from other illnesses. Methods Data are from post-mortem interviews with close relatives or caretakers of the deceased. We provide descriptive statistics of health care utilization in adults and discuss their covariates in multivariate analyses. Results Over 85% of terminally sick patients visited a modern medical facility, but less than 40% spent more than 24 hours in a medical facility and only 25% died in one. Traditional healer (11%) and holy water (46%) visits offer a common treatment and healing alternative, but these visits do not co-vary in any consistent manner with the utilization of modern medical services. In terms of the cause of death, we find a higher contact rate with both modern and alternative medical service providers among TB/AIDS patients compared with those suffering from other medical conditions. The duration of illness seems to account for a good share of that variability. Other covariates of health services utilization are socio-economic status, education and age. Conclusions The contact rate of adults with modern medical facilities in terminal illness is almost universal, but their usage intensity is rather low. Alternative curative options are less commonly used, and do not exclude modern health services use. This suggests that both types of services are considered complements rather than alternatives for each other. Because the contact rate with health service providers is greatest for TB/AIDS patients, it is unlikely that HIV/AIDS-related stigma is an impediment to seeking care. We cannot exclude, however, that it delays health-seeking behaviour. PMID:19372240

Health services utilization during terminal illness in Addis Ababa, Ethiopia.

PubMed

Reniers, Georges; Tesfai, Rebbeca

2009-07-01

OBJECTIVES We describe modern and alternative health services use in terminal illness of adults, and assess whether utilization patterns of TB/AIDS patients are distinct from those of patients suffering from other illnesses. METHODS Data are from post-mortem interviews with close relatives or caretakers of the deceased. We provide descriptive statistics of health care utilization in adults and discuss their covariates in multivariate analyses. RESULTS Over 85% of terminally sick patients visited a modern medical facility, but less than 40% spent more than 24 hours in a medical facility and only 25% died in one. Traditional healer (11%) and holy water (46%) visits offer a common treatment and healing alternative, but these visits do not co-vary in any consistent manner with the utilization of modern medical services. In terms of the cause of death, we find a higher contact rate with both modern and alternative medical service providers among TB/AIDS patients compared with those suffering from other medical conditions. The duration of illness seems to account for a good share of that variability. Other covariates of health services utilization are socio-economic status, education and age. CONCLUSIONS The contact rate of adults with modern medical facilities in terminal illness is almost universal, but their usage intensity is rather low. Alternative curative options are less commonly used, and do not exclude modern health services use. This suggests that both types of services are considered complements rather than alternatives for each other. Because the contact rate with health service providers is greatest for TB/AIDS patients, it is unlikely that HIV/AIDS-related stigma is an impediment to seeking care. We cannot exclude, however, that it delays health-seeking behaviour.

Caring for teens with chronic illness: risky business?

PubMed

Louis-Jacques, Jennifer; Samples, Cathryn

2011-08-01

With advances in medicine, more children with chronic illness are reaching adolescence and young adulthood. Research has shown that this group is not immune to the behavioral risks endorsed by healthy adolescents. Recent literature exploring the etiology of risk behaviors and their impact on chronic illness is presented. Risk taking may be the result of differential maturation of two distinct parts of the adolescent brain. Risk taking can be considered normal in adolescents with chronic illness, but there is some evidence that chronic illness affects normal psychosocial development. Moreover, evidence supports that chronic illness can lead to disparities in risk education and assessment because of disease focused management rather than a more comprehensive approach. Youth living with chronic illnesses face unique challenges in accomplishing the developmental tasks of adolescence. These challenges include risk behaviors, which jeopardize current and future health. The reasons for risk taking are multifactorial and require providers to make the adolescent and not the illness the center of management. More research is needed on how to improve developmentally appropriate and relevant interventions to aid in safe passage into adulthood.

Impact of a visual aid on discordance between physicians and family members about prognosis of critically ill patients.

PubMed

Burelli, Gabrielle; Berthelier, Chloé; Vanacker, Hélène; Descaillot, Léonard; Philippon-Jouve, Bénédicte; Fabre, Xavier; Kaaki, Mahmoud; Chakarian, Jean-Charles; Domine, Alexandre; Beuret, Pascal

2018-06-01

This study aimed to evaluate the impact of a visual aid on the discordance about prognosis between physicians and family members. The study was performed in a general intensive care department with two 6-bed units. In the unit A, family members could consult a visual aid depicting day by day the evolution of global, hemodynamic, respiratory, renal and neurological conditions of the patient on a 10-point scale. In the unit B, they only received oral medical information. On day 7 of the ICU stay, the physician and family members estimated the prognosis of the patient among four proposals (life threatened; steady state but may worsen; steady state, should heal; will heal). Then we compared the rate of discordance about prognosis between physicians and family members in the two units. Seventy-nine consecutive patients admitted in the intensive care department and still present at day 7, their family members and physicians, were enrolled. Patients in the two units were comparable in age, sex ratio, reason for admission, SAPS II at admission and SOFA score at day 7. In the unit A, physician-family members discordance about prognosis occurred for 12 out of 39 patients (31%) vs. 22 out of 40 patients (55%) in the unit B (P=0.04). In our study, adding a visual aid depicting the evolution of the condition of critically ill patients day by day to classic oral information allowed the family to have an estimate of the prognosis less discordant with the estimate of the physician. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Household illness, poverty and physical and emotional child abuse victimisation: findings from South Africa's first prospective cohort study.

PubMed

Meinck, Franziska; Cluver, Lucie D; Boyes, Mark E

2015-05-01

Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa. Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators. For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed. These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for

The Couples' Illness Communication Scale (CICS): development and evaluation of a brief measure assessing illness-related couple communication.

PubMed

Arden-Close, Emily; Moss-Morris, Rona; Dennison, Laura; Bayne, Louise; Gidron, Yori

2010-09-01

When one member of a couple has a chronic illness, communication about the illness is important for both patient and partner well-being. This study aimed to develop and test a brief self-report measure of illness-related couple communication. A combination of correlations and multiple regression were used to assess the internal consistency and validity of the Couples' Illness Communication Scale (CICS). A scale to provide insight into both patient and partner illness communication was developed. The CICS was then tested on patients with ovarian cancer (N=123) and their partners (N=101), as well as patients with early stage multiple sclerosis (MS) who had stable partnerships (N=64). The CICS demonstrated good acceptability, internal consistency, convergent validity (correlations with general couple communication and marital adjustment), construct validity (correlations with intrusive thoughts, social/family well-being, emotional impact of the illness, and psychological distress), and test-retest reliability. The CICS meets the majority of psychometric criteria for assessment measures in both a life-threatening illness (ovarian cancer) and a chronic progressive disease (MS). Further research is required to understand its suitability for use in other populations. Adoption of the CICS into couple-related research will improve understanding of the role of illness-related communication in adjustment to illness. Use of this short, simple tool in a clinical setting can provide a springboard for addressing difficulties with illness-related couple communication and could aid decision making for referrals to couple counselling.

Cumulative effects of HIV illness and caring for children orphaned by AIDS on anxiety symptoms among adults caring for children in HIV-endemic South Africa.

PubMed

Kuo, Caroline; Cluver, Lucie; Casale, Marisa; Lane, Tyler

2014-06-01

Adults caring for children in HIV-endemic communities are at risk for poor psychological outcomes. However, we still have a limited understanding of how various HIV impacts--including caregiver's own HIV illness, responsibilities of caring for a child orphaned by AIDS, or both--affect psychological outcomes among caregivers. Furthermore, few studies have explored the relationship between stigma, HIV, and psychological outcomes among caregivers of children in HIV-endemic communities. A cross-sectional survey conducted from 2009 to 2010 assessed anxiety among 2477 caregivers of children in HIV-endemic South Africa. Chi-square tested differences in anxiety among caregivers living with HIV, caregivers of a child orphaned by AIDS, and caregivers affected with both conditions. Multivariate logistic regressions identified whether the relationship between HIV impacts and anxiety remained after controlling for socio-demographic co-factors. Mediation analysis tested the relationship between stigma, HIV, and anxiety. The odds of meeting threshold criteria for clinically relevant anxiety symptoms were two and a half times greater among caregivers living with HIV compared to nonaffected caregivers. The odds of meeting threshold criteria for clinically relevant anxiety symptoms were greatest among caregivers living with HIV and caring for a child orphaned by AIDS. Exposure to AIDS-related stigma partially mediated the relationship between HIV and anxiety. Interventions are needed to address caregiver psychological health, particularly among caregivers affected with both conditions of living with HIV and caring for a child orphaned by AIDS.

Cumulative Effects of HIV Illness and Caring for Children Orphaned by AIDS on Anxiety Symptoms Among Adults Caring for Children in HIV-Endemic South Africa

PubMed Central

Cluver, Lucie; Casale, Marisa; Lane, Tyler

2014-01-01

Abstract Adults caring for children in HIV-endemic communities are at risk for poor psychological outcomes. However, we still have a limited understanding of how various HIV impacts—including caregiver's own HIV illness, responsibilities of caring for a child orphaned by AIDS, or both—affect psychological outcomes among caregivers. Furthermore, few studies have explored the relationship between stigma, HIV, and psychological outcomes among caregivers of children in HIV-endemic communities. A cross-sectional survey conducted from 2009 to 2010 assessed anxiety among 2477 caregivers of children in HIV-endemic South Africa. Chi-square tested differences in anxiety among caregivers living with HIV, caregivers of a child orphaned by AIDS, and caregivers affected with both conditions. Multivariate logistic regressions identified whether the relationship between HIV impacts and anxiety remained after controlling for socio-demographic co-factors. Mediation analysis tested the relationship between stigma, HIV, and anxiety. The odds of meeting threshold criteria for clinically relevant anxiety symptoms were two and a half times greater among caregivers living with HIV compared to nonaffected caregivers. The odds of meeting threshold criteria for clinically relevant anxiety symptoms were greatest among caregivers living with HIV and caring for a child orphaned by AIDS. Exposure to AIDS-related stigma partially mediated the relationship between HIV and anxiety. Interventions are needed to address caregiver psychological health, particularly among caregivers affected with both conditions of living with HIV and caring for a child orphaned by AIDS. PMID:24901465

Survival after diagnosis of AIDS: a prospective observational study of 2625 patients. Royal Free/Chelsea and Westminster Hospitals Collaborative Group.

PubMed Central

Mocroft, A.; Youle, M.; Morcinek, J.; Sabin, C. A.; Gazzard, B.; Johnson, M. A.; Phillips, A. N.

1997-01-01

OBJECTIVE: To estimate median survival and changes in survival in patients diagnosed as having AIDS. DESIGN: Prospective observational study. SETTING: Clinics in two large London hospitals. SUBJECTS: 2625 patients with AIDS seen between 1982 and July 1995. MAIN OUTCOME MEASURES: Survival, estimated using lifetable analyses, and factors associated with survival, identified from Cox proportional hazards models. RESULTS: Median survival (20 months) was longer than previous estimates. The CD4 lymphocyte count at or before initial AIDS defining illness decreased significantly over time from 90 x 10(6)/1 during 1987 or earlier to 40 x 10(6)/1 during 1994 and 1995 (P < 0.0001). In the first three months after diagnosis, patients in whom AIDS was diagnosed after 1987 had a much lower risk of death (relative risk 0.44, 95% confidence interval 0.22 to 0.86; P = 0.017) than patients diagnosed before 1987. When the diagnosis was based on oesophageal candidiasis or Kaposi's sarcoma, patients had a lower risk of death than when the diagnosis was based on Pneumocystis carinii pneumonia (0.21 (0.07 to 0.59). P = 0.0030 and 0.37 (0.16 to 0.83), P = 0.016). Three months after AIDS diagnosis, the risk of death was similar in patients whose diagnosis was made after and before 1987 (1.02 (0.79 to 1.31), P = 0.91). There were no differences in survival between patients diagnosed during 1988-90, 1991-3, or 1994-5. CONCLUSIONS: In later years, patients were much more likely to survive their initial illness, but long term survival has remained poor. The decrease in CD4 lymphocyte count at AIDS diagnosis indicates that patients are being diagnosed as having AIDS at ever more advanced stages of immunodeficiency. PMID:9040386

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses.

PubMed

Garrido, Melissa M; Prigerson, Holly G; Neupane, Suvam; Penrod, Joan D; Johnson, Christopher E; Boockvar, Kenneth S

2017-03-01

Psychosocial distress among patients with limited life expectancy influences treatment decisions, treatment adherence, and physical health. Veterans may be at elevated risk of psychosocial distress at the end of life, and understanding their mental healthcare needs may help identify hospitalized patients to whom psychiatric services should be targeted. To examine mental illness prevalence and mental health treatment rates among a national sample of hospitalized veterans with serious physical illnesses. Design, Subjects, and Measurements: This was a retrospective study of 11,286 veterans hospitalized in a Veterans Health Administration acute care facility in fiscal year 2011 with diagnoses of advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, and/or advanced HIV/AIDS. Prevalent and incident mental illness diagnoses during and before hospitalization and rates of psychotherapy and psychotropic use among patients with incident depression and anxiety were measured. At least one-quarter of the patients in our sample had a mental illness or substance use disorder. The most common diagnoses at hospitalization were depression (11.4%), followed by alcohol abuse or dependence (5.5%), and post-traumatic stress disorder (4.9%). Of the 831 patients with incident past-year depression and 258 with incident past-year anxiety, nearly two-thirds received at least some psychotherapy or guideline-concordant medication within 90 days of diagnosis. Of 191 patients with incident depression and 47 with incident anxiety at time of hospitalization, fewer than half received mental healthcare before discharge. Many veterans hospitalized with serious physical illnesses have comorbid mental illnesses and may benefit from depression and anxiety treatment.

Dependency in Critically Ill Patients

PubMed Central

Yang, Rumei

2016-01-01

By necessity, critically ill patients admitted to intensive care units (ICUs) have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a) antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b) attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c) outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients. PMID:28462328

AIDS: Children Too.

ERIC Educational Resources Information Center

Lejeune, Genevieve, Ed.

1994-01-01

This journal issue is devoted to the many problems faced by children with Acquired Immune Deficiency Syndrome (AIDS) who live in both developing and developed countries. Section 1 provides general information on the pandemic, defining AIDS and exploring the social aspects of the disease. It also addresses child health, child mortality, moral and…

Toward a theory of online communication in illness: concept analysis of illness blogs.

PubMed

Heilferty, Catherine McGeehin

2009-07-01

This paper is a report of a concept analysis of illness blogs and their relevance to nursing research on communication during illness. Blogs are being used by patients and family members to describe the experience of illness, but very little is known about this phenomenon. Seventeen English language databases and one Internet search engine were searched from 1990 to 2007 using the truncated term 'blog*'. Specific illness terms together with 'blog*', for example, blog* and diabetes; and blog* and cancer, were used to expand the search. Reports were included if they were of qualitative or quantitative research that included a definition of blogs or blogging and some identification or description of blog uses pertinent to the discipline. Specific emphasis was placed on blog use by individuals coping with illness experiences. 'Meta' writings by authors about their own blogging intentions and experiences were excluded. An illness blog is the online expression of the narrative of illness. Theoretical and operational definitions, defining attributes, uses, antecedents and consequences were developed. The literature search returned 45 works from 17 disciplines referring to the definition and uses of blogging. Support is offered from the review of literature and analysis of the concept for the development of a theory of online communication during illness. Reading and incorporating illness blogs into care will enhance patient-provider relationships. Analysis of the narratives being created online about the illness experience will contribute significantly to nursing's body of knowledge.

HIV and Mental Health Institutions. AIDS Technical Report, No. 4.

ERIC Educational Resources Information Center

Harvey, David C.

This technical report is part of a series on AIDS/HIV (Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus) and is intended to help link various legal advocacy organizations providing services to persons with mental illness or developmental disabilities. This paper examines AIDS policy issues in mental health institutions. The paper…

AIDS care: why and how should industry respond?

PubMed

Smart, R

2000-01-01

This article reports the AIDS care response of industries to the rising AIDS epidemic in South Africa. It has been reported that during 1993-99 the rate of hospital bed occupancy doubled to over 8/1000 and that 50% of ill-health retirements in 1998 were due to AIDS. Important issues to be considered by industries are the medical separation due to ill health, poor health care services. The focus of HIV/AIDS care should be on the patient, family, care giver, community, and health services, and must be based on the principles of decentralization and integration of sustainable and cost-effective HIV/AIDS services. The development of a care package must be based on six dimensions; namely, appropriateness, acceptability, accessibility, effectiveness, efficiency, and equity. On the other hand, identification of indicators in relation to the components of the care package must include support groups and networks of people living with HIV; the provision of home-based care; responsiveness of the health system; the existence and application of clinical guidelines; and the effectiveness of referrals. Any organization with a commitment in providing care should establish a Care Task Team to develop a care strategy. It should focus on who can have access to the care, what the care consists of, and who will cover the cost. In addition, a review of the existing HIV/AIDS services must be done to identify shortfalls and highlight priority gaps.

A case-control study of non-AIDS-defining cancers in a prospective cohort of HIV-infected patients.

PubMed

Rodríguez Arrondo, Francisco; von Wichmann, Miguel Ángel; Camino, Xabier; Goenaga, Miguel Ángel; Ibarguren, Maialen; Azcune, Harkaitz; Bustinduy, María Jesús; Ferrero, Oscar; Muñoz, Josefa; Ibarra, Sofía; Aguirrebengoa, Koldo; Goicoetxea, Josune; Bereciartua, Elena; Montejo, Miguel; García, M Asunción; Martínez, Eduardo; Portu, Joseba; Metola, Luis; Silvariño, Rafael; Sarasqueta, Cristina; Arrizabalaga, Julio; Iribarren, Jose Antonio

2018-04-23

We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Fatigue in HIV illness: relationship to depression, physical limitations, and disability.

PubMed

Ferrando, S; Evans, S; Goggin, K; Sewell, M; Fishman, B; Rabkin, J

1998-01-01

This study was conducted to investigate the prevalence of clinical fatigue reported by gay/bisexual men at all HIV illness stages, and whether fatigue, while associated with depression, independently contributes to limitations in physical function and disability. HIV- men, HIV+ men with CD4 counts >500, HIV+ men with CD4 counts 200 to 500, and men with AIDS were compared on prevalence of clinical fatigue, as defined by a standardized instrument. Among HIV+ men, the relationships among fatigue, depressed mood, major depressive disorder, HIV illness markers (including CD4 count and HIV RNA viral load), physical limitations, and disability were assessed at baseline and after 1 year. The prevalence of clinical fatigue in men with CD4 counts <500 was 14%, significantly higher than HIV- men and HIV+ men with CD4 counts >500. However, fatigue was not directly correlated with CD4 count or HIV RNA. Fatigue was a chronic symptom that was associated with depressed mood, major depressive disorder, physical limitations, and disability. After 1 year, an increase in depressive symptoms predicted a small amount of variance in fatigue; however, depressive symptoms were not associated with physical limitations or disability after controlling for fatigue. Fatigue is a chronic symptom that is more prevalent in advanced HIV illness, and which, although associated with depression, does not seem to be merely a symptom of depression. Because fatigue contributes independently to physical limitations and disability, it should be assessed and treated.

How to perform first aid.

PubMed

Gloster, Annabella Satu; Johnson, Phillip John

2016-01-13

RATIONALE AND KEY POINTS: This article aims to help nurses to perform first aid in a safe, effective and patient-centred manner. First aid comprises a series of simple, potentially life-saving steps that an individual can perform with minimal equipment. Although it is not a legal requirement to respond to an emergency situation outside of work, nurses have a professional duty to respond and provide care within the limits of their competency. First aid is the provision of immediate medical assistance to an ill or injured person until definitive medical treatment can be accessed. First aid can save lives and it is essential that nurses understand the basic principles. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Your skill in performing first aid and any areas where you may need to extend your knowledge. 2. How reading this article will change your practice. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

'Our Families are Killing Us': HIV/AIDS, Witchcraft and Social Tensions in the Caprivi Region, Namibia.

PubMed

Thomas, Felicity

2007-12-01

The importance of exploring 'indigenous' constructions of illness is vital when explanatory models of ill health differ markedly from dominant biomedical paradigms. In the Caprivi region of Namibia, an upsurge of witchcraft accusations can be seen as a direct reaction to increasing AIDS-related illness and deaths, and to changes in socio-economic attitudes and expectations. The mobilization of witchcraft narratives provides a socially acceptable explanation for illness, and can positively influence decisions regarding the care and identity of the ill person. However, drawing upon data collected at kin and village level, this paper demonstrates that while witchcraft accusations can avert stigma and blame away from the ill person, they can also result in significant disruption to livelihoods, and place considerable tension upon key social capital networks at a time when the household is particularly vulnerable. Such findings have significant implications for the effectiveness of HIV prevention and AIDS mitigation initiatives, and for livelihood security.

Mental illness--stigma and discrimination in Zambia.

PubMed

Kapungwe, A; Cooper, S; Mwanza, J; Mwape, L; Sikwese, A; Kakuma, R; Lund, C; Flisher, A J

2010-07-01

The aim of this qualitative study was to explore the presence, causes and means of addressing individual and systemic stigma and discrimination against people with mental illness in Zambia. This is to facilitate the development of tailor-made antistigma initiatives that are culturally sensitive for Zambia and other low-income African countries. This is the first in-depth study on mental illness stigma in Zambia. Fifty semi-structured interviews and 6 focus group discussions were conducted with key stakeholders drawn from 3 districts in Zambia (Lusaka, Kabwe and Sinazongwe). Transcripts were analyzed using a grounded theory approach. Mental illness stigma and discrimination is pervasive across Zambian society, prevailing within the general community, amongst family members, amid general and mental health care providers, and at the level of government. Such stigma appears to be fuelled by misunderstandings of mental illness aetiology; fears of contagion and the perceived dangerousness of people with mental illness; and associations between HIV/AIDS and mental illness. Strategies suggested for reducing stigma and discrimination in Zambia included education campaigns, the transformation of mental health policy and legislation and expanding the social and economic opportunities of the mentally ill. In Zambia, as in many other low-income African countries, very little attention is devoted to addressing the negative beliefs and behaviours surrounding mental illness, despite the devastating costs that ensue. The results from this study underscore the need for greater commitment from governments and policy-makers in African countries to start prioritizing mental illness stigma as a major public health and development issue.

Charitable Giving for HIV and AIDS: Results from a Canadian National Survey

PubMed Central

Allman, Dan; Calzavara, Liviana; Worthington, Catherine; Tyndall, Mark; Adrien, Alix; Walters, Melissa; White, Samantha; Jones, Marcella K.

2014-01-01

Background For the first time, a national survey of adults in Canada posed questions on charitable giving for HIV and AIDS. The objective of this analysis was to explore the behaviour and attitudes of this population in terms of charitable giving. Methods In 2011, individuals in Canada 16 years of age or older were recruited for a survey from an online panel supplemented by random digit dial telephone interviewing. The margin of error was +/−2.1 percentage points (95%). Chi-square tests were used to detect bivariate associations. A multivariate logistic regression model was fit to compare those who had donated to HIV and AIDS in the past 12 months with those who had donated to other disease or illness charities. Results 2,139 participated. 82.5% had donated to a charitable cause in the past 12 months. 22.2% had ever donated to HIV and AIDS, with 7.8% doing so in the past 12 months. Individuals who had donated to HIV and AIDS versus other disease or illness charities tended to be younger (p<0.05), single (p<0.005), more highly educated (p<0.001) and to self-identify as a member of a sexual minority group (p<0.001). Multivariate analysis revealed individuals who self-identified as a member of a sexual minority group were significantly much more likely to have donated to HIV and AIDS than to other disease or illness charities in the past 12 months (OR, 7.73; p<0.001; CI 4.32–13.88). Discussion Despite a generally philanthropic orientation, relatively few respondents had ever been involved in charitable giving for HIV and AIDS. Those who had could be understood relationally as individuals at closer social proximity to HIV and AIDS such as members of sexual minority groups. PMID:25153827

Does symptomatic primary HIV-1 infection accelerate progression to CDC stage IV disease, CD4 count below 200 x 10(6)/l, AIDS, and death from AIDS?

PubMed Central

Lindbäck, S.; Broström, C.; Karlsson, A.; Gaines, H.

1994-01-01

OBJECTIVE--To investigate the prognostic significance of symptomatic primary HIV-1 infection. DESIGN--Prospective study of homosexual men seroconverting to HIV in 1985 and 1986. Patients were followed up at least three times yearly with clinical examinations and T cell subset determinations for an average of 7.2 years. SETTING--Research project centred on attenders for treatment and screening for HIV at the Karolinska Institute, Stockholm. SUBJECTS--19 patients presenting with a glandular-fever-like illness associated with seroconversion to HIV and 29 asymptomatic seroconverters. MAIN OUTCOME MEASURES--Progression to Centers for Disease Control and Prevention stage IV disease, CD4 cell count below 200 x 10(6)/l, AIDS, and death from AIDS. RESULTS--Symptomatic seroconverters were significantly more likely to develop Centers for Disease Control and Prevention stage IV disease (95% v 66%), CD4 cell counts below 200 x 10(6)/l (84% v 55%), and AIDS (58% v 28%) and die of AIDS (53% v 7%). CONCLUSION--A glandular-fever-like illness associated with seroconversion to HIV-1 predicts accelerated progression to AIDS and other HIV related diseases. PMID:7819891

Aid-in-dying laws and the physician's duty to inform.

PubMed

Buchbinder, Mara

2017-10-01

On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont's law pertaining to patients' rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient-provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Career Issues and Concerns for Persons Living with HIV/AIDS

ERIC Educational Resources Information Center

Dahlbeck, David T.; Lease, Suzanne H.

2010-01-01

As the perception of HIV/AIDS continues to shift from a terminal illness to a manageable disease, persons living with HIV/AIDS (PLWHAs) are able to re-enter the workforce or remain in their current jobs for a longer period of time. Although this change is positive, it also raises many career concerns for PLWHAs. Using an ecological approach and…

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010

PubMed Central

Buchacz, Kate; Lau, Bryan; Jing, Yuezhou; Bosch, Ronald; Abraham, Alison G.; Gill, M. John; Silverberg, Michael J.; Goedert, James J.; Sterling, Timothy R.; Althoff, Keri N.; Martin, Jeffrey N.; Burkholder, Greer; Gandhi, Neel; Samji, Hasina; Patel, Pragna; Rachlis, Anita; Thorne, Jennifer E.; Napravnik, Sonia; Henry, Keith; Mayor, Angel; Gebo, Kelly; Gange, Stephen J.; Moore, Richard D.; Brooks, John T.

2016-01-01

Background. There are few recent data on the rates of AIDS-defining opportunistic infections (OIs) among human immunodeficiency virus (HIV)–infected patients in care in the United States and Canada. Methods. We studied HIV-infected participants in 16 cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) during 2000–2010. After excluding 16 737 (21%) with any AIDS-defining clinical events documented before NA-ACCORD enrollment, we analyzed incident OIs among the remaining 63 541 persons, most of whom received antiretroviral therapy during the observation. We calculated incidence rates per 100 person-years of observation (hereafter, “person-years”) with 95% confidence intervals (CIs) for the first occurrence of any OI and select individual OIs during 2000–2003, 2004–2007, and 2008–2010. Results. A total of 63 541 persons contributed 261 573 person-years, of whom 5836 (9%) developed at least 1 OI. The incidence rate of any first OI decreased over the 3 observation periods, with 3.0 cases, 2.4 cases, and 1.5 cases per 100 person-years of observation during 2000–2003, 2004–2007, and 2008–2010, respectively (Ptrend<.001); the rates of most individual OIs decreased as well. During 2008–2010, the leading OIs included Pneumocystis jiroveci pneumonia, esophageal candidiasis, and disseminated Mycobacterium avium complex or Mycobacterium kansasii infection. Conclusions. For HIV-infected persons in care during 2000–2010, rates of first OI were relatively low and generally declined over this time. PMID:27559122

[A social diagnosis of HIV/AIDS infection and endogenous prevention strategies in Gaoua, Burkina Faso].

PubMed

Somé, Donmozoun Télesphore

2008-04-01

Despite sensitising and prevention messages, women still remain concerned about AIDS in developing countries. How do they perceive the illness and methods of prevention? The objective of this study was to assess the social diagnosis of HIV/AIDS, and endogenous strategies developed by women from Gaoua. A qualitative approach was adopted, involving four focus group discussions with women from the Lobi, Birifor, Dioula and Dagara ethnic groups. An interview guide was developed for the discussions, which were carried out in local languages, tape recorded, transcribed verbatim and analysed in detail. Specific descriptions of HIV/AIDS related to signs/symptoms were given. These were: _Kpéré tchi_ (lose weight and die) _gbè yirè_ (twig feet) _sii dan_ (end of life) _gbè milè_ (thin feet), respectively for Lobi, Birifor, Dioula and Dagara. The major signs of AIDS mentioned were weight loss, appetite for meat, good meals, curly hair, large spots on the body, high fever, diarrhoea, and redness of lips. In relation to these signs, some endogenous strategies were developed by women to protect themselves against the illness, including "observation" and hot spiced meals for a few days for a partner who was absent for a long time, as well as early marriage for young girls. The social diagnosis of HIV/AIDS by a specific group like women demonstrates the gap between perceptions of the illness and prevention messages. This could help to understand that it is important to take account of communities' perceptions of illness in elaboration of prevention messages.

AIDS and the law: opportunities and limitations.

PubMed

Kirby, M

1995-01-01

Laws can only partially succeed in modifying behavior, especially with regard to sex, drug use, and other human pleasures. Effective and just laws to slow the spread of AIDS must therefore be based upon a thorough knowledge of the issues, not upon ignorance, fear, political expediency, or to meet the emotional demands of an often ignorant general population. Good laws, like good ethics, are founded in good data. The most effective response to the AIDS epidemic is neither prohibition nor punishment of individual behavior, but laws designed to truly affect human behavior and shape a society in which the spread of HIV is minimized. Central to an appropriate legislative response is the imperative of protecting the basic rights of individuals infected with HIV. An example of an enlightened, rational, and nondiscriminatory approach to checking the spread of HIV/AIDS while guaranteeing individual freedoms and rights is found in a report commissioned for the State Government of New South Wales. The following measures are recommended to bring state laws into harmony with the national HIV/AIDS strategy: decriminalize brothels, set regulations and public health standards for sex workers, cover sex workers under the Industrial Relations Act, ensure the privacy of HIV/AIDS patients and improve their redress against discrimination in the workplace, repeal laws which make it illegal to possess and administer drugs to oneself, investigate the therapeutic use of marijuana as a prescribed treatment for HIV/AIDS and other terminal illnesses, abandon compulsory testing for HIV in prisons, make condoms available to prisoners and sexually active children, establish a Natural Death Act to allow terminally ill patients to die with dignity, and give legal status to permanent relationships between homosexual couples.

AIDS and Chemical Dependency.

ERIC Educational Resources Information Center

Pohl, Melvin I.

After defining HIV and the AIDS disease and outlining symptoms and means of infection, this fact sheet lists the ways alcohol and drugs are involved with the AIDS epidemic, noting that needle-sharing transmits the virus; that alcohol or mood-altering drugs like crack cocaine cause disinhibition, increase sex drive, encourage sex for drugs, and…

[Between the fear of HIV contamination and the symbolic representations of AIDS: the specter of contemporary despair].

PubMed

Meneghin, P

1996-12-01

Lack of knowledge and misinformations on HIV/AIDS are predictors of emotional responses as fear of contagion, homophobia, avoidance and excessive precautions. Fear of contagion is an affective stress response to the neurocognitive activity that leads to a perceived threat of AIDS in connection with the symbolic meanings os illness. Focused interviews were conducted with an opportunistic sample of 31 young people to know the affective responses and behaviors after blood screening for HIV antibody testing. The findings confirm the relationship of symbolic representation of illness as mystery, death, punishment and sexuality to fear of contagion and mitic conception of AIDS.

Access to Aid-in-Dying in the United States: Shifting the Debate From Rights to Justice.

PubMed

Buchbinder, Mara

2018-06-01

Much of the literature on aid-in-dying (AID) has drawn heavily on rights-based ethical and legal frameworks that emphasize patients' rights of self-determination in end-of-life decision-making. Less attention has focused on how terminally ill people actually experience such putative rights once they are legally authorized. This analytic essay draws on findings from the Vermont Study on Aid-in-Dying, an ethnographic study of the implementation of AID in Vermont (2015-2017). First, I show that terminally ill people can face a range of barriers to accessing AID in permissive jurisdictions, and that access to AID is mediated by various inequalities endemic to US health care, as well as some that are unique to AID. I then build on these findings to examine the utility of the concept of justice for public health scholarship on AID. By integrating empirical, ethical, and policy analysis, I reframe rights-based frameworks that emphasize the role of individual choice and decision-making at the end of life. In doing so, I draw attention to health care justice as a neglected issue in public health perspectives on AID.

A systematic review of decision aids that facilitate elements of shared decision-making in chronic illnesses: a review protocol.

PubMed

Wieringa, Thomas H; Kunneman, Marleen; Rodriguez-Gutierrez, Rene; Montori, Victor M; de Wit, Maartje; Smets, Ellen M A; Schoonmade, Linda J; Spencer-Bonilla, Gabriela; Snoek, Frank J

2017-08-07

Shared decision-making (SDM) is a patient-centred approach in which clinicians and patients work side-by-side to decide together on the best course of action for each patient's particular situation. Six key elements of SDM can be distinguished: situation diagnosis, choice awareness, option clarification, discussion of harms and benefits, deliberation of patient preferences and making the decision. Decision aids (DAs) are tools that facilitate SDM. The impact of DAs for chronic illnesses on SDM, clinical and patient reported outcomes remains uncertain. We will perform a systematic review aiming to describe (a) which SDM elements are incorporated in DAs for adult patients with chronic conditions and (b) the effects of DA use on SDM, clinical and patient reported outcomes. This manuscript reports on the protocol for this systematic review. The following databases will be searched for relevant articles: PubMed, Embase, Web of Science, CINAHL and PsycINFO, from their inception to October 2016. We will ascertain ongoing research by querying experts and searching trial registries. To enhance feasibility, we will limit the review to randomized controlled trials (RCTs) including patients with chronic cardiovascular and/or respiratory diseases and/or diabetes. SDM elements incorporated in DAs, DA effects and DA itself will be described. This study will characterize DAs for chronic illness and will provide an overview of their effects on SDM, clinical and patient reported outcomes. We anticipate this review will bring to light knowledge gaps and inform further research into the design and use of DAs for patients with chronic conditions. PROSPERO registration number: CRD42016050320 .

The Ills of Marginality: New Perspectives on Health in South Asia.

PubMed

Ecks, Stefan; Sax, William S

2005-12-01

Social marginality and ill health can form an unholy dyad: firstly, groups who suffer from chronic or infectious diseases often find themselves pushed to the margins. Secondly, people who are already on the edge of society tend to suffer more from illness than those at the centre. In development discourse, marginal people are defined as those who are 'not yet' on the same level as the developed mainstream and are in urgent need of aid from the centre. The papers in this special issue take a different approach by insisting that marginality is a radically relational concept: the centre and its margins constitute each other, and the boundaries between them are constantly shifting. The papers show that there are many types of marginality (based on geography, class, caste, sex/gender, ethnicity, etc.), and that each of them has different effects on the health of a particular group. Yet instead of speaking of a plurality of unrelated 'group identities', marginality preserves a sharp sense of unequal power relations between groups. The specific ethnographic contribution to the study of marginality comes from its attention to the point of view of marginal people. This is of critical importance since marginality puts health most under stress when it is clearly and steadily perceived in everyday life. This, in turn, makes it possible to show that living on the margins is not always and everywhere bad for health. While all of the papers present South Asian case studies, the insights and questions are relevant for the study of the ills of marginality in a global perspective.

First aid kits for recreational dive boats, what should they contain?

PubMed

Pye, Jacqueline; Greenhalgh, Trisha

2010-09-01

Well-equipped first-aid kits are necessary but not always provided on recreational dive boats. We aimed to review the types of illness and injury likely to be encountered on such boats and inform a content list for such kits. We conducted a 3-round Delphi study by email using a volunteer panel of 18 experts drawn from diving, dive medicine and nursing. In round 1, panellists shared examples of illnesses and injuries they had come across personally. These scenarios were circulated along with findings from a literature review, including existing recommendations. In rounds 2 and 3, the list of kit for dive boats in different settings was iteratively refined through online discussion and feedback. Passengers and crew on recreational dive boats may encounter a range of medical problems from minor injuries to serious accidents and non-dive-related illnesses. Recommended kit varied depending on context and setting (e.g. distance from land, qualifications and experience of crew). Consensus was quickly reached on key first-aid items but experts' views on emergency medicines differed. The study highlights the diversity of medical problems encountered on recreational dive boats. We offer preliminary guidance on the content of suitable first-aid kits and suggest areas for further research. Copyright © 2010 Elsevier Ltd. All rights reserved.

International behavioral responses to a health hazard: AIDS.

PubMed

Earickson, R J

1990-01-01

This paper expands on Jonathan Mann's third wave of the AIDS pandemic: the epidemic of economic, social, political, and cultural reaction and response to the HIV infection and to AIDS. This worldwide epidemic is a major economic challenge, especially in Third World countries, which can ill afford additional health care costs. AIDS is also a harbinger of political and cultural conflicts between and among nations, states, institutions, and people everywhere. It may ultimately transform law as radically as it has health care practices. In terms of management, it is possible to approach AIDS much as we do natural and technological hazards. The biology and epidemiology of AIDS require a coordinated attack, involving research on vaccines and drugs, modification of human behavior and education of populations to arrest the disease. All of these require money, of which the United States was the major contributor before the Reagan years. Funding to the United Nations and WHO has since languished, jeopardizing the AIDS efforts of those two organizations.

Multi-symptom illnesses, unexplained illness and Gulf War Syndrome

PubMed Central

Ismail, Khalida; Lewis, Glyn

2006-01-01

Explanatory models for the increased prevalence of ill health in Gulf veterans compared to those not deployed to the Gulf War 1990–1991 remain elusive. This article addresses whether multi-symptom reporting in Gulf veterans are types of medically unexplained symptoms and whether the alleged Gulf War Syndrome is best understood as a medically unexplained syndrome. A review of the epidemiological studies, overwhelmingly cross-sectional, describing ill health was conducted including those that used factor analysis to search for underlying or latent clinical constructs. The overwhelming evidence was that symptoms in Gulf veterans were either in keeping with currently defined psychiatric disorders such as depression and anxiety or were medically unexplained. The application of factor analysis methods had varied widely with a risk of over interpretation in some studies and limiting the validity of their findings. We concluded that ill health in Gulf veterans and the alleged Gulf War Syndrome is best understood within the medically unexplained symptoms and syndromes constructs. The cause of increased reporting in Gulf veterans are still not clear and requires further inquiry into the interaction between sociological factors and symptomatic distress. PMID:16687260

Functional illness in primary care: dysfunction versus disease

PubMed Central

Williams, Nefyn; Wilkinson, Clare; Stott, Nigel; Menkes, David B

2008-01-01

Background The Biopsychosocial Model aims to integrate the biological, psychological and social components of illness, but integration is difficult in practice, particularly when patients consult with medically unexplained physical symptoms or functional illness. Discussion This Biopsychosocial Model was developed from General Systems Theory, which describes nature as a dynamic order of interacting parts and processes, from molecular to societal. Despite such conceptual progress, the biological, psychological, social and spiritual components of illness are seldom managed as an integrated whole in conventional medical practice. This is because the biomedical model can be easier to use, clinicians often have difficulty relinquishing a disease-centred approach to diagnosis, and either dismiss illness when pathology has been excluded, or explain all undifferentiated illness in terms of psychosocial factors. By contrast, traditional and complementary treatment systems describe reversible functional disturbances, and appear better at integrating the different components of illness. Conventional medicine retains the advantage of scientific method and an expanding evidence base, but needs to more effectively integrate psychosocial factors into assessment and management, notably of 'functional' illness. As an aid to integration, pathology characterised by structural change in tissues and organs is contrasted with dysfunction arising from disordered physiology or psychology that may occur independent of pathological change. Summary We propose a classification of illness that includes orthogonal dimensions of pathology and dysfunction to support a broadly based clinical approach to patients; adoption of which may lead to fewer inappropriate investigations and secondary care referrals and greater use of cognitive behavioural techniques, particularly when managing functional illness. PMID:18482442

Persons' experience of HIV/AIDS in Japan: application of Margaret Newman's theory.

PubMed

Awa, M; Yamashita, M

2008-12-01

To describe human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) persons' experience in Japan applying Margaret Newman's theory of health as expanding consciousness. Five men who had sex with other men and who were afflicted with HIV/AIDS were interviewed to describe their experience. Their narratives revealed an evolving pattern of the whole of five stages; self-conscious of own sexual orientation, chaos, stagnation, turning point and regaining a new identity. After viewing their pattern, their expanding consciousness was evident from their becoming compassionate for those who were underserved and underprivileged, and having deeper levels of connectedness with their family and friends. The a priori nature of theory in this praxis research was evident when the researcher embodied the theory of expanding consciousness. The findings of the study demonstrated the relevance and importance of understanding how the condition intersects with race, gender and ethnicity in constructing the unique experience of living with HIV/AIDS. Community health workers, community mental health nurses in particular, should be cognizant of the illness trajectory of those who are afflicted with the condition. Programmes such as outreach should be carried out on an ongoing basis in order to identify and render support to those who might need help from various stages of illness. Community health workers should identify clients' specific needs to refer to appropriate services because there are physical, mental and socio-economic implications throughout illness trajectory in HIV/AIDS.

DALI: Defining Antibiotic Levels in Intensive care unit patients: a multi-centre point of prevalence study to determine whether contemporary antibiotic dosing for critically ill patients is therapeutic.

PubMed

Roberts, Jason A; De Waele, Jan J; Dimopoulos, George; Koulenti, Despoina; Martin, Claude; Montravers, Philippe; Rello, Jordi; Rhodes, Andrew; Starr, Therese; Wallis, Steven C; Lipman, Jeffrey

2012-07-06

The clinical effects of varying pharmacokinetic exposures of antibiotics (antibacterials and antifungals) on outcome in infected critically ill patients are poorly described. A large-scale multi-centre study (DALI Study) is currently underway describing the clinical outcomes of patients achieving pre-defined antibiotic exposures. This report describes the protocol. DALI will recruit over 500 patients administered a wide range of either beta-lactam or glycopeptide antibiotics or triazole or echinocandin antifungals in a pharmacokinetic point-prevalence study. It is anticipated that over 60 European intensive care units (ICUs) will participate. The primary aim will be to determine whether contemporary antibiotic dosing for critically ill patients achieves plasma concentrations associated with maximal activity. Secondary aims will compare antibiotic pharmacokinetic exposures with patient outcome and will describe the population pharmacokinetics of the antibiotics included. Various subgroup analyses will be conducted to determine patient groups that may be at risk of very low or very high concentrations of antibiotics. The DALI study should inform clinicians of the potential clinical advantages of achieving certain antibiotic pharmacokinetic exposures in infected critically ill patients.

"Defining 'peerness' in peer-delivered health and wellness interventions for serious mental illness": Correction to Muralidharan et al. (2017).

PubMed

2017-06-01

Reports an error in "Defining "peerness" in peer-delivered health and wellness interventions for serious mental illness": Response to letter to the editor" by Jody Silver and Patricia B. Nemec ( Psychiatric Rehabilitation Journal , 2017[Mar], Vol 40[1], 116). The article was mislabeled as Editorial and should be a Comment. The Response to Letter to the Editor section should be a Reply and now has its own http://dx.doi.org/10.1037/ h0101580. (The following abstract of the original article appeared in record 2017-13876-001.) Replies to comments by Muralidharan et al (see record 2017-13255-009) on the original article by Silver and Nemec (see record 2016-43088-001). The original authors thank the commentators for raising additional questions regarding "peerness." They were honored that their paper prompted this thought and effort to submit comments. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The illness/non-illness model: hypnotherapy for physically ill patients.

PubMed

Navon, Shaul

2014-07-01

This article proposes a focused, novel sub-set of the cognitive behavioral therapy approach to hypnotherapy for physically ill patients, based upon the illness/non-illness psychotherapeutic model for physically ill patients. The model is based on three logical rules used in differentiating illness from non-illness: duality, contradiction, and complementarity. The article discusses the use of hypnotic interventions to help physically ill and/or disabled patients distinguish between illness and non-illness in their psychotherapeutic themes and attitudes. Two case studies illustrate that patients in this special population group can be taught to learn the language of change and to use this language to overcome difficult situations. The model suggests a new clinical mode of treatment in which individuals who are physically ill and/or disabled are helped in coping with actual motifs and thoughts related to non-illness or non-disability.

Survival Outcomes and Effect of Early vs. Deferred cART Among HIV-Infected Patients Diagnosed at the Time of an AIDS-Defining Event: A Cohort Analysis

PubMed Central

Mussini, Cristina; Johnson, Margaret; d'Arminio Monforte, Antonella; Antinori, Andrea; Gill, M. John; Sighinolfi, Laura; Uberti-Foppa, Caterina; Borghi, Vanni; Sabin, Caroline

2011-01-01

Objectives We analyzed clinical progression among persons diagnosed with HIV at the time of an AIDS-defining event, and assessed the impact on outcome of timing of combined antiretroviral treatment (cART). Methods Retrospective, European and Canadian multicohort study.. Patients were diagnosed with HIV from 1997–2004 and had clinical AIDS from 30 days before to 14 days after diagnosis. Clinical progression (new AIDS event, death) was described using Kaplan-Meier analysis stratifying by type of AIDS event. Factors associated with progression were identified with multivariable Cox regression. Progression rates were compared between those starting early (<30 days after AIDS event) or deferred (30–270 days after AIDS event) cART. Results The median (interquartile range) CD4 count and viral load (VL) at diagnosis of the 584 patients were 42 (16, 119) cells/µL and 5.2 (4.5, 5.7) log10 copies/mL. Clinical progression was observed in 165 (28.3%) patients. Older age, a higher VL at diagnosis, and a diagnosis of non-Hodgkin lymphoma (NHL) (vs. other AIDS events) were independently associated with disease progression. Of 366 patients with an opportunistic infection, 178 (48.6%) received early cART. There was no significant difference in clinical progression between those initiating cART early and those deferring treatment (adjusted hazard ratio 1.32 [95% confidence interval 0.87, 2.00], p = 0.20). Conclusions Older patients and patients with high VL or NHL at diagnosis had a worse outcome. Our data suggest that earlier initiation of cART may be beneficial among HIV-infected patients diagnosed with clinical AIDS in our setting. PMID:22043301

[Guidelines for the facilitation of wholeness in patients with AIDS: the experience of patients with AIDS: I].

PubMed

Torrente, A C; Greeff, M

1996-03-01

AIDS will be remembered as the illness that was discovered in the 1980s of which the effects of this epidemic were only realised in the 1990s. Statistics show that the number of patients with AIDS increase annually because of the number of patients now diagnosed as HIV infected. Statistics indicate that AIDS has a much wider impact on the community than only homosexuals and drug-dependent people. Much attention is paid currently to the prevention of AIDS, but the problem is vested in the third phase of the HIV infection, namely AIDS. Nurses will be more and more exposed to the patient with AIDS and she can make a valuable contribution to facilitating the quest to wholeness of the patient with AIDS. This research was aimed at exploring and describing the experiences of the patient with AIDS and to lay down guidelines for the nurse and the psychiatric nurse specialist as consultant to facilitate the quest for wholeness of the patient with AIDS. A exploratory, descriptive contextual study was done with the aim of achieving insight into the experiences of the patient with AIDS, by way of a specific convenience test sample, five patients who complied with the set criteria were included in the research. The application possibilities of this research are generally set out as regards practice, research and teaching, and also as specific guidelines for the nurse treating the patient with AIDS. By following the guidelines set out in this research, the nurse can facilitate the patient's quest for wholeness.

Shaded-Color Picture Generation of Computer-Defined Arbitrary Shapes

NASA Technical Reports Server (NTRS)

Cozzolongo, J. V.; Hermstad, D. L.; Mccoy, D. S.; Clark, J.

1986-01-01

SHADE computer program generates realistic color-shaded pictures from computer-defined arbitrary shapes. Objects defined for computer representation displayed as smooth, color-shaded surfaces, including varying degrees of transparency. Results also used for presentation of computational results. By performing color mapping, SHADE colors model surface to display analysis results as pressures, stresses, and temperatures. NASA has used SHADE extensively in sign and analysis of high-performance aircraft. Industry should find applications for SHADE in computer-aided design and computer-aided manufacturing. SHADE written in VAX FORTRAN and MACRO Assembler for either interactive or batch execution.

Global prevention, funding, accountability debated in fight against HIV / AIDS.

PubMed

1999-10-18

World leaders, physicians, economists, governmental health organizations, and pharmaceutical manufacturers attended the Third International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-threatening Illnesses in Vienna, Austria. The conference participants discussed the economic, ethical, and human rights issues underlying health care resource allocation. Some highlights of the meeting included: the prevention strategies in fighting AIDS virus; the use of high medical ethical standards; the affordability and accessibility of essential therapies; the economic aspects affecting the medical assistance mechanisms; the need to improve the pharmaceutical industry; the need to improve HIV/AIDS care access in developing countries; promoting the development of HIV/AIDS vaccines; and developing rapid diagnosis of HIV.

Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID).

PubMed

Lipman, Grant S; Kanaan, Nicholas C; Phillips, Caleb; Pomeranz, Dave; Cain, Patrick; Fontes, Kristin; Higbee, Becky; Meyer, Carolyn; Shaheen, Michael; Wentworth, Sean; Walsh, Diane

2015-06-01

Lipman, Grant S., Nicholas C. Kanaan, Caleb Phillips, Dave Pomeranz, Patrick Cain, Kristin Fontes, Becky Higbee, Carolyn Meyer, Michael Shaheen, Sean Wentworth, and Diane Walsh. Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID). High Alt Med Biol 16:154-161, 2015.--Acute mountain sickness (AMS) affects 25%-70% of the tens of millions of high altitude travelers annually, with hypoxia and nocturnal desaturations as major contributing factors. This is the first double blind randomized placebo controlled trial to assess expiratory positive airway pressure (EPAP) for AMS prevention and nocturnal hypoxic events. Healthy adult participants trekking in the Khumbu region of the Himalayas were randomized to a single-use EPAP nasal strip, or a visually identical sham device (placebo) prior to first night sleeping between 4371-4530 m (14,340-14,800 ft). The primary outcome was AMS incidence, measured by Lake Louise Questionnaire (LLQ), with secondary outcomes of AMS severity (by LLQ) and physiologic sleep indices measured by continuous sleep monitor. Intent-to-treat analysis included 219 participants with comparable demographic characteristics, of which 115 received EPAP and 104 placebo. There was no decrease in AMS with EPAP intervention (14% EPAP vs. 17% placebo; p=0.65; risk difference (-)3.15%, 95% CI (-)12.85%-6.56%). While overall AMS severity was not different between groups, EPAP reported decreased incidence of headache (64% vs. 76%; p<0.05, OR 0.51, 95% CI 0.27-0.95) and dizziness (81% vs. 98%; p<0.03, OR 0.29, 95% CI 0.09-0.78). During sleep, EPAP resulted in significant improvements in average peripheral oxygenation (Spo(2)) (80% versus 78%; p<0.01, mean difference=2, 95% CI 0.58-3.63) and a reduced percentage of time below 80% Spo(2) (31% vs. 46%; p<0.03, median difference=16, 95% CI 2.22-28.18). This lightweight and inexpensive EPAP device did not prevent acute mountain sickness, but did reduce the subgroup incidence of

Defining Democracy and the Terms of Engagement with the Postsocialist Polish State: Insights from HIV/AIDS

PubMed Central

2010-01-01

This article explores the history of HIV activism in Poland from the socialist period through the early 1990s transformation as a means of examining the reconfiguration of rights, obligations, and responsibility as Poland redefined itself as a market democracy. Drawing on archival materials, in-depth qualitative interviews with current and former HIV activists, and participant observation at HIV prevention organizations in Warsaw, Poland, I sketch the ways in the socialist system’s failures to protect the health of its subjects led to the terms through which state-citizen engagement were defined in the postsocialist period. Uncertainties and anxieties surrounding who was responsible for protecting the health and well-being of citizens in the newly democratic Poland gave rise to a series of violent protests centered on HIV prevention and care for people living with HIV/AIDS. Resolution of these political and social crises involved defining democracy in postsocialist Poland through claims to moral authority, in alliance with the Catholic Church, and an obligation by multiple stakeholders to disseminate technical/scientific knowledge. By comparing the responses to the epidemic by diverse institutions, including the government, the Catholic Church, and the fledgling gay rights movement, this analysis reveals the ways in which democracy in postsocialist Poland tightly links science, democratic reform, and moral/religious authority, while at the same time excluding sexual minorities from engaging in political activism centered on rights to health and inclusion in the new democracy. PMID:20190876

Clinical Criteria for Physician Aid in Dying.

PubMed

Orentlicher, David; Pope, Thaddeus Mason; Rich, Ben A

2016-03-01

More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID. Their proposal was carefully considered and temperate, but there were little data on the practice of AID at the time. (With AID, a physician writes a prescription for life-ending medication for a terminally ill, mentally capacitated adult.) With the passage of time, a substantial body of data on AID has developed from the states of Oregon and Washington. For more than 17 years, physicians in Oregon have been authorized to provide a prescription for AID. Accordingly, we have updated the clinical criteria of Quill, et al., based on the many years of experience with AID. With more jurisdictions authorizing AID, it is critical that physicians can turn to reliable clinical criteria. As with any medical practice, AID must be provided in a safe and effective manner. Physicians need to know (1) how to respond to a patient's inquiry about AID, (2) how to assess patient decision making capacity, and (3) how to address a range of other issues that may arise. To ensure that physicians have the guidance they need, Compassion & Choices convened the Physician Aid-in-Dying Clinical Criteria Committee, in July 2012, to create clinical criteria for physicians who are willing to provide AID to patients who request it. The committee includes experts in medicine, law, bioethics, hospice, nursing, social work, and pharmacy. Using an iterative consensus process, the Committee drafted the criteria over a one-year period.

Computer-aided design/computer-aided manufacturing skull base drill.

PubMed

Couldwell, William T; MacDonald, Joel D; Thomas, Charles L; Hansen, Bradley C; Lapalikar, Aniruddha; Thakkar, Bharat; Balaji, Alagar K

2017-05-01

The authors have developed a simple device for computer-aided design/computer-aided manufacturing (CAD-CAM) that uses an image-guided system to define a cutting tool path that is shared with a surgical machining system for drilling bone. Information from 2D images (obtained via CT and MRI) is transmitted to a processor that produces a 3D image. The processor generates code defining an optimized cutting tool path, which is sent to a surgical machining system that can drill the desired portion of bone. This tool has applications for bone removal in both cranial and spine neurosurgical approaches. Such applications have the potential to reduce surgical time and associated complications such as infection or blood loss. The device enables rapid removal of bone within 1 mm of vital structures. The validity of such a machining tool is exemplified in the rapid (< 3 minutes machining time) and accurate removal of bone for transtemporal (for example, translabyrinthine) approaches.

Help: first aid issues.

PubMed

Granitoff, N; Whitaker, I Y; Diccini, S; Goncalves, V C; Marin, H F

1995-01-01

First aid is the initial and immediate care given to a victim outside the hospital environment, with the purpose of assuring life and avoiding worsening conditions until he/she receives qualified assistance. Providing immediate aid to someone requires tranquility and, above all, knowledge on what has to be done or not in each situation. In addition to being treated by health professionals, the chances that a victim will receive early treatment by others are large. However, in Brazil, access to information, and the possibility of reviewing it whenever necessary, may contribute greatly to the process of assimilation of this knowledge, in addition to exercises on simulated cases. Informatics has been shown as an extremely useful tool in the development of educational software, considering its multiplicity of resources and providing for the users: motivation for an interactive experience, an individualized teaching that takes into account his/her own rhythm and desired complexity level, besides making possible the user's capacity for solving problems through simulated situations. Considering that, the number of individuals of the population prepared to act as First Aid helpers in situations of life threatening accidents or sudden illness is still very scarce. The ever increasing use of the computer as a mean of spreading information in schools, enterprises, and even households and considering the advantages of an educational software for the users regarding storage and retrieval of information when needed, we proposed the creation of an interactive teaching software. This software is being developed using Storyboard live. The methodology is the following: literature review, selection of images, development of the program, application tests. The initial selected issues are: assessment of the victim, cardiorespiratory arrest and resuscitation, airway obstruction, wounds, and hemorrhages. After utilizing the program, the user should be able to solve hypothetical

Constructivist Learning Environments and Defining the Online Learning Community

ERIC Educational Resources Information Center

Brown, Loren

2014-01-01

The online learning community is frequently referred to, but ill defined. The constructivist philosophy and approach to teaching and learning is both an effective means of constructing an online learning community and it is a tool by which to define key elements of the learning community. In order to build a nurturing, self-sustaining online…

Can AIDS stigma be reduced to poverty stigma? Exploring Zimbabwean children's representations of poverty and AIDS

PubMed Central

Campbell, C; Skovdal, M; Mupambireyi, Z; Madanhire, C; Robertson, L; Nyamukapa, C A; Gregson, S

2012-01-01

Objective We use children's drawings to investigate social stigmatization of AIDS-affected and poverty-affected children by their peers, in the light of suggestions that the stigmatization of AIDS-affected children might derive more from the poverty experienced by these children than from their association with AIDS. Methods A qualitative study, in rural Zimbabwe, used draw-and-write techniques to elicit children's (10–12 years) representations of AIDS-affected children (n= 30) and poverty-affected children (n= 33) in 2009 and 2010 respectively. Results Representations of children affected by AIDS and by poverty differed significantly. The main problems facing AIDS-affected children were said to be the psychosocial humiliations of AIDS stigma and children's distress about sick relatives. Contrastingly, poverty-affected children were depicted as suffering from physical and material neglect and deprivation. Children affected by AIDS were described as caregivers of parents whom illness prevented from working. This translated into admiration and respect for children's active contribution to household survival. Poverty-affected children were often portrayed as more passive victims of their guardians' inability or unwillingness to work or to prioritize their children's needs, with these children having fewer opportunities to exercise agency in response to their plight. Conclusions The nature of children's stigmatization of their AIDS-affected peers may often be quite distinct from poverty stigma, in relation to the nature of suffering (primarily psychosocial and material respectively), the opportunities for agency offered by each affliction, and the opportunities each condition offers for affected children to earn the respect of their peers and community. We conclude that the particular nature of AIDS stigma offers greater opportunities for stigma reduction than poverty stigma. PMID:21985490

Can AIDS stigma be reduced to poverty stigma? Exploring Zimbabwean children's representations of poverty and AIDS.

PubMed

Campbell, C; Skovdal, M; Mupambireyi, Z; Madanhire, C; Robertson, L; Nyamukapa, C A; Gregson, S

2012-09-01

We use children's drawings to investigate social stigmatization of AIDS-affected and poverty-affected children by their peers, in the light of suggestions that the stigmatization of AIDS-affected children might derive more from the poverty experienced by these children than from their association with AIDS. A qualitative study, in rural Zimbabwe, used draw-and-write techniques to elicit children's (10-12 years) representations of AIDS-affected children (n= 30) and poverty-affected children (n= 33) in 2009 and 2010 respectively. Representations of children affected by AIDS and by poverty differed significantly. The main problems facing AIDS-affected children were said to be the psychosocial humiliations of AIDS stigma and children's distress about sick relatives. Contrastingly, poverty-affected children were depicted as suffering from physical and material neglect and deprivation. Children affected by AIDS were described as caregivers of parents whom illness prevented from working. This translated into admiration and respect for children's active contribution to household survival. Poverty-affected children were often portrayed as more passive victims of their guardians' inability or unwillingness to work or to prioritize their children's needs, with these children having fewer opportunities to exercise agency in response to their plight. The nature of children's stigmatization of their AIDS-affected peers may often be quite distinct from poverty stigma, in relation to the nature of suffering (primarily psychosocial and material respectively), the opportunities for agency offered by each affliction, and the opportunities each condition offers for affected children to earn the respect of their peers and community. We conclude that the particular nature of AIDS stigma offers greater opportunities for stigma reduction than poverty stigma. © 2011 Blackwell Publishing Ltd.

Comorbidities and psychotic illness. Part 1: Philosophy and clinical consequences.

PubMed

Agius, Mark; Aquilina, Francesca Falzon

2014-11-01

This article aims at addressing the implications of defining 'comorbidity' within the field of psychiatry. We have looked at the standard definition of comorbidity and then discussed whether this definition can be applied to comorbidities in psychiatry. While comorbidities in physical illness are clearly the coexistence of two independent illnesses, Comorbidities in Mental illness are the result of the polygenic nature of mental illnesses, especially in psychotic illness whether schizophrenia or bipolar disorder. As a consequence, often the comorbidities of psychiatric illness are caused by two conditions which have in common the presence of particular single nucleotide polymorphisms (snps), which regulate the metabolism of neurotransmitters or the presence of neurotrophic factors . Thus inevitably, many such comorbidities are inextricably linked. We discuss the consequences of this form of comorbidity for the description, classification, and risk profile of mental illness.

Ascertainment and verification of end-stage renal disease and end-stage liver disease in the north american AIDS cohort collaboration on research and design.

PubMed

Kitahata, Mari M; Drozd, Daniel R; Crane, Heidi M; Van Rompaey, Stephen E; Althoff, Keri N; Gange, Stephen J; Klein, Marina B; Lucas, Gregory M; Abraham, Alison G; Lo Re, Vincent; McReynolds, Justin; Lober, William B; Mendes, Adell; Modur, Sharada P; Jing, Yuezhou; Morton, Elizabeth J; Griffith, Margaret A; Freeman, Aimee M; Moore, Richard D

2015-01-01

The burden of HIV disease has shifted from traditional AIDS-defining illnesses to serious non-AIDS-defining comorbid conditions. Research aimed at improving HIV-related comorbid disease outcomes requires well-defined, verified clinical endpoints. We developed methods to ascertain and verify end-stage renal disease (ESRD) and end-stage liver disease (ESLD) and validated screening algorithms within the largest HIV cohort collaboration in North America (NA-ACCORD). Individuals who screened positive among all participants in twelve cohorts enrolled between January 1996 and December 2009 underwent medical record review to verify incident ESRD or ESLD using standardized protocols. We randomly sampled 6% of contributing cohorts to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ESLD and ESRD screening algorithms in a validation subcohort. Among 43,433 patients screened for ESRD, 822 screened positive of which 620 met clinical criteria for ESRD. The algorithm had 100% sensitivity, 99% specificity, 82% PPV, and 100% NPV for ESRD. Among 41,463 patients screened for ESLD, 2,024 screened positive of which 645 met diagnostic criteria for ESLD. The algorithm had 100% sensitivity, 95% specificity, 27% PPV, and 100% NPV for ESLD. Our methods proved robust for ascertainment of ESRD and ESLD in persons infected with HIV.

[Tuberculosis and mycobacteriosis important opportunistic disease in AIDS patients].

PubMed

Zalewska-Schönthaler, N; Schönthaler-Humiecka, J; Podlasin, R; Cholewińska, G; Rzeszkowicz, T; Mikuła, T; Horban, A

2001-01-01

The aim of the search was investigation of tuberculosis in AIDS patients. Each year 8-9 mln people fall ill of tuberculosis and one third of them die. To the infection of tuberculosis and fast development into active state are especially exposed people with AIDS. 696 people were examined on tuberculosis most of which were AIDS patients hospitalized and cured in Hospital of Infection Diseases and Prison Hospital. 159 patients were women and 537 were men. The average age was between 25 and 45 (70%). The investigated population was characterized according to age, social and living conditions, using drugs and former contact with tuberculosis. All patients suspected of tuberculosis had chest X-rayed, sputum, BAL and pleural liquor were taken to bacteriological examination when extrapulmonary tuberculosis was suspected. The material was taken adequately to the disease process: CSF, urine, lymph nodes, peritoneal fluids, blood, stool, swabs and other. Bacteriological investigations have been carried out by fast cultivating method since 1998 and rapid genetic method since 1999. Apart from modern, fast diagnostic methods, routine bacteriological procedures were applied in tuberculosis diagnosis. More than 30% of the examined population were from bad social-living conditions, 78% had risk factors, 65% were drug users. The analysis of the tuberculosis illness from 1997 to July 2001 shows growing tendency. Nowadays it is 20% cases proved by bacteriological diagnosis. The structure of falling ill with tuberculosis has changed. Considerable increase of extrapulmonary tuberculosis was observed, 20 patients died due to tuberculosis and 8 patients due to mycobacteriosis. Resistance of M.tub.complex occurred within the range of 10% cases.

AIDS in contemporary Islamic ethical literature.

PubMed

Francesca, Ersilia

2002-01-01

AIDS has been mentioned in Islamic ethical literature since about 1985 as an illness pertaining to European and American homosexuals. Only since about 1990 has the presence of HIV/AIDS in Islamic countries cast light on the fact that the actual sexual behaviour of the population does not always conform to religious norms. The increase in the numbers of people with HIV has compelled religious leaders to take a stand on sexual practices they consider "deviant", from prostitution to homosexuality and extramarital sex. The aim of this paper is to analyse the attitude of Muslim religious authorities towards individual sexual behaviour and AIDS. It is based mainly on contemporary legal responses that largely provide the necessary information on most of Islamic medical ethics. According to Muslim scholars, AIDS is a warning from God not to indulge in illicit conduct. As a remedy against the spread of AIDS, they encourage compliance with traditional family values and the enhancement of faith and devotion and strongly oppose sex education. They oppose promotion of condoms or any form of safe sex outside of marriage, which they perceive as promoting promiscuity and defiance of divine law. All the above-mentioned arguments are not exhaustive of the Islamic attitude towards AIDS. Some religious groups disagree with such a conservative way of conceiving the fight against AIDS as being antithetical to both men's and women's well-being. They support an alternative view of reproductive health and human rights within the Islamic framework and stress the great tolerance of Islam and why it must include people with HIV and AIDS.

Fuzzy health, illness, and disease.

PubMed

Sadegh-Zadeh, K

2000-10-01

The notions of health, illness, and disease are fuzzy-theoretically analyzed. They present themselves as non-Aristotelian concepts violating basic principles of classical logic. A recursive scheme for defining the controversial notion of disease is proposed that also supports a concept of fuzzy disease. A sketch is given of the prototype resemblance theory of disease.

[Women with AIDS: disclosing risk stories].

PubMed

Vermelho, L L; Barbosa, R H; Nogueira, S A

1999-01-01

This study approaches the social and cultural profile concerning risk for HIV infection in women, describing some epidemiological variables and disclosing reports of risk situations, the meaning of living with AIDS, and support received. A semi-structured questionnaire was used to interview 25 women from the University Hospital of the Federal University of Rio de Janeiro, prior to the availability of multi-drug treatment. The majority reported limited schooling, were housewives or engaged in under-skilled occupations, and had family incomes lower than average for users of this public teaching hospital. The view of AIDS as "someone else's disease" was prevalent, and STDs were perceived as male infections, although several women reported episodes of STDs prior to HIV. They had received their diagnosis and initial medical care only after their partners' and/or children's illness or death. The study points to preventive strategies reinforcing these silent women's bargaining power, acting on men as potential active participants in reproductive health programs that incorporate STD/AIDS issues.

NIH Research: Dr. Anthony S. Fauci: "An AIDS-free generation is closer than we might think" | NIH MedlinePlus the ...

MedlinePlus

... infectious diseases, such as HIV/AIDS, influenza, tuberculosis, malaria, and illness from potential agents of bioterrorism. He ... the Global Fund to Fight AIDS, Tuberculosis and Malaria are channeling antiretroviral treatment to millions of people ...

Malignancies in HIV-Infected and AIDS Patients.

PubMed

Ji, Yongjia; Lu, Hongzhou

2017-01-01

Currently, HIV infection and AIDS are still one of the most important epidemic diseases around the world. As early in the initial stage of HIV epidemic, the high incidence of ADCs including Kaposi sarcoma and non-Hodgkin's lymphoma was the substantial amount of disease burden of HIV infection and AIDS. With the increasing accessibility of HAART and improving medical care for HIV infection and AIDS, AIDS-related illness including ADCs has dramatically decreased. Meanwhile, the incidence of NADCs rises in PLWH. Compared with the general population, most of cancers are more likely to attack PLWH, and NADCs in PLWH were characterized as earlier onset and more aggressive. However, the understanding for cancer development in PLWH is still dimness. Herein, we reviewed the current knowledge of epidemiology and pathogenesis for malignancies in PLWH summarized from recent studies. On the basis of that, we discussed the special considerations for cancer treatment in PLWH. As those malignancies could be the major issue for HIV infection or AIDS in the future, we expect enhanced investigations, surveillances, and clinical trial for improving the understanding and management for cancers developed in PLWH.

Concept Analysis of Illness Engulfment in Schizophrenia.

PubMed

Vining, Danny; Robinson, Jennifer C

2016-06-01

Schizophrenia has a significant risk of damaging an individual's self-concept. Through the process of illness engulfment an individual's self-concept becomes reorganized entirely around the experience of having schizophrenia. The purpose of this manuscript is to clarify the structure and function of the concept of illness engulfment in schizophrenia using Walker and Avant's (2011) method of concept analysis. Data came from a review of scholarly literature, as well as contemporary and historical art, literature, music, and other media forms. The analysis discussed two defining attributes of experience of illness and impact on self-concept with a total of seven indicators. The article listed antecedents, consequences, and discussed the Modified Engulfment Scale as empirical referents. Fictional cases were developed to illustrate the concept. Finally, the concept of illness engulfment was discussed within the framework of the Roy Adaptation Model. Copyright © 2016 Elsevier Inc. All rights reserved.

Wound management in patients with advanced illness.

PubMed

Maida, Vincent

2013-03-01

To emphasize that the management of wounds represents a significant component within the overall supportive and palliative care of patients with advanced illness. It is also intended to clarify the linguistics that are commonly used around patients with wounds. New paradigms for wound management, wound outcomes, and goal setting have been defined and graphically depicted. Recent studies show that wounds may be used as prognostic factors for patients with advanced illness. Data from recent studies also demonstrate that marginal levels of wound healing are possible for all wound classes affecting patients with advanced illness. When indicated, time-limited trials of wound healing strategies should be facilitated by the Wound Bed Preparation Paradigm. Wound palliation may be guided through the use of the Toronto Symptom Assessment System for Wounds (TSAS-W). Wound management must continue to evolve as a tenet within the overall supportive and palliative care of patients with advanced illness.

Impact of Parental HIV/AIDS on Children’s Psychological Well-Being: A Systematic Review of Global Literature

PubMed Central

Chi, Peilian; Li, Xiaoming

2012-01-01

This review examines the global literature regarding the impact of parental HIV/AIDS on children’s psychological well-being. Fifty one articles reporting quantitative data from a total of 30 studies were retrieved and reviewed. Findings were mixed but tended to show that AIDS orphans and vulnerable children had poorer psychological well-being in comparison with children from HIV-free families or children orphaned by other causes. Limited longitudinal studies suggested a negative effect of parental HIV on children’s psychological well-being in an early stage of parental HIV-related illness and such effects persisted through the course of parental illness and after parental death. HIV-related stressful life events, stigma, and poverty were risk factors that might aggravate the negative impact of parental HIV/AIDS on children. Individual coping skills, trusting relationship with caregivers and social support were suggested to protect children against the negative effects of parental HIV/AIDS. This review underlines the vulnerability of children affected by HIV/AIDS. Culturally and developmentally appropriate evidence-based interventions are urgently needed to promote the psychological well-being of children affected by HIV/AIDS. PMID:22972606

An exertional heat illness triage tool for a jungle training environment.

PubMed

Smith, Mike; Withnall, R; Boulter, M

2017-09-06

This article introduces a practical triage tool designed to assist commanders, jungle training instructors (JTIs) and medical personnel to identify Defence Personnel (DP) with suspected exertional heat illness (EHI). The challenges of managing suspected EHI in a jungle training environment and the potential advantages to stratifying the urgency of evacuation are discussed. This tool has been designed to be an adjunct to the existing MOD mandated heat illness recognition and first aid training. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Parental HIV/AIDS and Psychosocial Adjustment among Rural Chinese Children

PubMed Central

Fang, Xiaoyi; Stanton, Bonita; Hong, Yan; Zhang, Liying; Zhao, Guoxiang; Zhao, Junfeng; Lin, Xiuyun; Lin, Danhua

2009-01-01

Objective To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. Methods Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. Results AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. Conclusion The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children. PMID:19208701

Parental HIV/AIDS and psychosocial adjustment among rural Chinese children.

PubMed

Fang, Xiaoyi; Li, Xiaoming; Stanton, Bonita; Hong, Yan; Zhang, Liying; Zhao, Guoxiang; Zhao, Junfeng; Lin, Xiuyun; Lin, Danhua

2009-01-01

To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children.

Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review.

PubMed

Mukund Bahadur, Khatry-Chhetry; Murray, Peter J

2010-01-01

The HIV/AIDS pandemic is one of the most serious threats to global health. HIV/AIDS is a chronic illness, requiring patient empowerment to enhance adherence to treatment regimes if it is to be managed effectively. While healthcare costs are rising, people still have expectations of high-quality care. This literature review-based study explored the use of cell phone (mobile phone) short messaging services (SMS) in health care, in particular for HIV/AIDS in South Africa. From an initial corpus of 212 papers, 28 were reviewed. The main findings include that SMS can improve service delivery through appointment reminders and improve communication between healthcare workers. It improves diagnosis, prevention, treatment and rehabilitation by supporting adherence to medication, and monitoring illness and medical interventions. SMS is useful in public health programmes, such as contact tracing and partner notification, therefore playing an important role in control of HIV/AIDS. As South Africa has one of the highest uptakes and demographic distributions of cellular technology in the world, SMS is feasible as a tool to deliver quality health care with low cost.

High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study.

PubMed

Van Scoy, Lauren J; Green, Michael J; Dimmock, Anne Ef; Bascom, Rebecca; Boehmer, John P; Hensel, Jessica K; Hozella, Joshua B; Lehman, Erik B; Schubart, Jane R; Farace, Elana; Stewart, Renee R; Levi, Benjamin H

2016-09-01

Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning. © The Author(s) 2016.

The Untapped Potential of School Directors to Strengthen School-Based Responses to HIV/AIDS. Discussion Paper No. III

ERIC Educational Resources Information Center

Wijngaarden, Jan; Mallik, Arun; Shaeffer, Sheldon

2005-01-01

An evaluation is presented on the impact of HIV/AIDS on the education sector in the Asia Pacific region. The spread of HIV/AIDS not only brings illness and death, it also threatens the efforts already made to achieve the goal of Education for All (EFA). Education can combat the negative consequences wrought by HIV/AIDS. Tactics include (1)…

Report of the Northern California Conference for Guidelines on Aid-in-Dying: definitions, differences, convergences, conclusions.

PubMed Central

Young, E W; Marcus, F S; Drought, T; Mendiola, M; Ciesielski-Carlucci, C; Alpers, A; Eaton, M; Koenig, B A; Loewy, E; Raffin, T A; Ross, C

1997-01-01

In September 1996, the Stanford University Center for Biomedical Ethics convened a conference entitled "Comprehensive Care of the Terminally Ill: The Northern California Consensus Development Conference for Guidelines on Aid-in-Dying." The regionally based, multidisciplinary conference gathered people from a variety of disciplines and diverse perspectives on physician aid-in-dying. This report documents important points of convergence, disagreement, and uncertainty that emerged from the conference and provides commentary on crucial issues: the definition of terminal illness, ensuring adequate palliative care, psychiatric challenges, coping with family pressures, the doctor-patient relationship, the managed care context, the role of ethics committees, and institutional challenges. Should physician aid-in-dying become a legal practice in California, the report will provide guidance to health care organizations, health professionals, and public policy officials engaged in local or state guideline or policy development. PMID:9217449

Strategies for Implementing AIDS/HIV Policy Guidelines in Developmental and Mental Health Services: A Background and Checklist for Advocates. AIDS Technical Report, No. 3.

ERIC Educational Resources Information Center

Harvey, David C.

This technical report is part of a series on AIDS/HIV (Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus) and is intended to help link various legal advocacy organizations providing services to persons with mental illness or developmental disabilities. Through a series of case examples, questions, background information, and…

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS1234

PubMed Central

Young, Sera L; Cohen, Craig R; Kushel, Margot B; Tsai, Alexander C; Tien, Phyllis C; Hatcher, Abigail M; Frongillo, Edward A; Bangsberg, David R

2011-01-01

Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships. PMID:22089434

Spiritual Wellness for Clients with HIV/AIDS: Review of Counseling Issues.

ERIC Educational Resources Information Center

Holt, Jennifer L.; Houg, Bonnie L.; Romano, John L.

1999-01-01

Reviews the salient literature concerning the relationship between HIV/AIDS clients' counseling and spiritual issues. Three broad themes are used: terminal illness issues, religious disenfranchisement, and multicultural spiritual and religious issues. Practical recommendations for counselors and research implications are included. (Author/GCP)

Shelter-based palliative care for the homeless terminally ill.

PubMed

Podymow, Tiina; Turnbull, Jeffrey; Coyle, Doug

2006-03-01

The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.

Welfare status, illness and subjective health definition.

PubMed Central

Prince, E O

1978-01-01

The self-defined health status of welfare recipients hospitalized for illness during the preceding year was compared to that of persons not on welfare but hospitalized for illness during the same period. Data were derived from a systematic probability sample of household residents of the Harlem Hospital inpatient district population surveyed July 1967-June 1970. Welfare recipient respondents were more likely to perceive their health as fair/poor than were persons not on welfare. This difference persisted when the data were analyzed by sex, age, reported levels and type of illness, hospital days and number of stays, and current usual activity; usual activity was a major explanatory variable but only partially accounted for the relationship. It has been hypothesized that in achievement-oriented societies, illness may be used as justification for a culturally-induced sense of personal failure to fulfill socially prescribed role obligations. The data are consistent with this hypothesis. PMID:686211

Pregnancy and HIV disease progression: a systematic review and meta-analysis.

PubMed

Calvert, Clara; Ronsmans, Carine

2015-02-01

To assess whether pregnancy accelerates HIV disease progression. Studies comparing progression to HIV-related illness, low CD4 count, AIDS-defining illness, HIV-related death, or any death in HIV-infected pregnant and non-pregnant women were included. Relative risks (RR) for each outcome were combined using random effects meta-analysis and were stratified by antiretroviral therapy (ART) availability. 15 studies met the inclusion criteria. Pregnancy was not associated with progression to HIV-related illness [summary RR: 1.32, 95% confidence interval (CI): 0.66-2.61], AIDS-defining illness (summary RR: 0.97, 95% CI: 0.74-1.25) or mortality (summary RR: 0.97, 95% CI: 0.62-1.53), but there was an association with low CD4 counts (summary RR: 1.41, 95% CI: 0.99-2.02) and HIV-related death (summary RR: 1.65, 95% CI: 1.06-2.57). In settings where ART was available, there was no evidence that pregnancy accelerated progress to HIV/AIDS-defining illnesses, death and drop in CD4 count. In settings without ART availability, effect estimates were consistent with pregnancy increasing the risk of progression to HIV/AIDS-defining illnesses and HIV-related or all-cause mortality, but there were too few studies to draw meaningful conclusions. In the absence of ART, pregnancy is associated with small but appreciable increases in the risk of several negative HIV outcomes, but the evidence is too weak to draw firm conclusions. When ART is available, the effects of pregnancy on HIV disease progression are attenuated and there is little reason to discourage healthy HIV-infected women who desire to become pregnant from doing so. © 2014 John Wiley & Sons Ltd.

Coliphages and Gastrointestinal Illness in Recreational Waters

PubMed Central

Benjamin-Chung, Jade; Arnold, Benjamin F.; Wade, Timothy J.; Schiff, Kenneth; Griffith, John F.; Dufour, Alfred P.; Weisberg, Stephen B.

2017-01-01

Background: Coliphages have been proposed as indicators of fecal contamination in recreational waters because they better mimic the persistence of pathogenic viruses in the environment and wastewater treatment than fecal indicator bacteria. We estimated the association between coliphages and gastrointestinal illness and compared it with the association with culturable enterococci. Methods: We pooled data from six prospective cohort studies that enrolled coastal beachgoers in California, Alabama, and Rhode Island. Water samples were collected and gastrointestinal illness within 10 days of the beach visit was recorded. Samples were tested for enterococci and male-specific and somatic coliphages. We estimated cumulative incidence ratios (CIR) for the association between swimming in water with detectable coliphage and gastrointestinal illness when human fecal pollution was likely present, not likely present, and under all conditions combined. The reference group was unexposed swimmers. We defined continuous and threshold-based exposures (coliphage present/absent, enterococci >35 vs. ≤35 CFU/100 ml). Results: Under all conditions combined, there was no association between gastrointestinal illness and swimming in water with detectable coliphage or enterococci. When human fecal pollution was likely present, coliphage and enterococci were associated with increased gastrointestinal illness, and there was an association between male-specific coliphage level and illness that was somewhat stronger than the association between enterococci and illness. There were no substantial differences between male-specific and somatic coliphage. Conclusions: Somatic coliphage and enterococci had similar associations with gastrointestinal illness; there was some evidence that male-specific coliphage had a stronger association with illness than enterococci in marine waters with human fecal contamination. PMID:28489717

Causes of Death in HIV Patients and the Evolution of an AIDS Hospice: 1988–2008

PubMed Central

Stewart, Ann; Chan Carusone, Soo; To, Kent; Schaefer-McDaniel, Nicole; Halman, Mark; Grimes, Richard

2012-01-01

This paper reports on the transformation that has occurred in the care of people living with HIV/AIDS in a Toronto Hospice. Casey House opened in the pre-HAART era to care exclusively for people with HIV/AIDS, an incurable disease. At the time, all patients were admitted for palliative care and all deaths were due to AIDS-defining conditions. AIDS-defining malignancies accounted for 22 percent of deaths, mainly, Kaposi sarcoma and lymphoma. In the post-HAART era, AIDS-defining malignancies dropped dramatically and non-AIDS-defining malignancies became a significant cause of death, including liver cancer, lung cancer and gastric cancers. In the post-HAART era, people living with HIV/AIDS served at Casey House have changed considerably, with increasing numbers of patients facing homelessness and mental health issues, including substance use. Casey House offers a picture of the evolving epidemic and provides insight into changes and improvements made in the care of these patients. PMID:22666562

The organized sector mobilizes against AIDS.

PubMed

Mehra-kerpelman, K

1995-01-01

Representatives of English speaking African countries attended the International Labor Organization Tripartite Workshop on the Role of the Organized Sector in Reproductive Health and the Prevention of AIDS held in Uganda. AIDS has robbed these countries of lawyers, physicians, teachers, managers, and other skilled professionals, all of whom are difficult to replace. HIV/AIDS mainly affects persons in their most productive years (20-40 years) and in the higher socioeconomic groups. Professionals with AIDS become ill and die at a faster rate than their replacements can be trained. The young, less experienced work force translates into an increase in breakdowns, accidents, delays, and misjudgments. International and national efforts to control HIV/AIDS have not stopped the spread of HIV in Sub-Saharan Africa (SSA). More than 8 million persons in SSA are HIV infected. 1.5 million in Uganda are HIV infected. As of October 1994, 30,000 persons in Zambia and 33,000 in Zimbabwe had AIDS. These numbers are just the tip of the iceberg due to underreporting. HIV/AIDS increases absenteeism among infected and healthy workers alike. It burdens the already existing scarce health care resources and equipment (e.g., in 1992, AIDS cases occupied 70% of hospital beds in Kigali, Rwanda). Unions, workers, and families must share knowledge about safer sex. The Zimbabwe Confederation of Trade Unions has had an HIV/AIDS education program since 1992. The Zambia Congress of Trade Unions strongly supports government efforts to sensitize the labor force and society to the effects of HIV/AIDS. The Federation of Uganda Employers has reached about 150,000 workers and more than 200 top executives through its AIDS prevention activities. Some company programs provide medical facilities for employees and their families. The Ubombo Ranches, Ltd. in Swaziland, a producer and processor of sugar cane, has a training-of-trainers program on HIV/AIDS and family planning for all village health workers and

Nothing prepared me to manage AIDS.

PubMed

Banas, G E

1992-01-01

Articles and seminars about AIDS in the workplace are not adequate preparation for the genuine problems faced by actual managers in real organizations. There are no easy, win-win solutions to the impossible dilemmas AIDS presents, only various forms of damage control and, at best, more or less humane compromises. Gary Banas knows. Over a period of four years, two of his direct reports developed AIDS, and he watched them suffer through debility, slowly deteriorating performance, and eventual death. He also watched the gradual decline of their subordinates' productivity and morale. He found that, to different degrees, both men refused to acknowledge their illness and their decreasing organizational effectiveness. One of them resisted the author's efforts to give him an easier job at no loss in salary. Both insisted on confidentiality long after the rumor mill had identified their problem. In the course of these two consecutive ordeals, Banas discovered that AIDS patients fall into no single, neat category. AIDS is not an issue but a disease, and the people who get it are human beings first and victims second. He also learned that AIDS affects everyone around the sick individual and that almost every choice a manager makes will injure someone. Finally, he came to understand that while managers have an unequivocal obligation to treat AIDS-afflicted employees with compassion and respect, they have an equally unequivocal obligation to keep their organizations functioning. "Don't let anyone kid you," Banas warns. "When you confront AIDS in the workplace, you will face untenable choices that seem to pit your obligation to humanity against your obligation to your organization.(ABSTRACT TRUNCATED AT 250 WORDS)

[The new methods to define the staffing requirements for doctors,
nurses and nurses aides: an example of their implementation in an Italian hospital].

PubMed

Laquintana, Dario; Pazzaglia, Silvia; Demarchi, Antonia

2017-01-01

. The new methods to define the staffing requirements for doctors, nurses and nurses aides: an example of their implementation in an Italian hospital. The Italian government, after the transposition of European Union legislation on working hours, made a declaration of commitment to increase the number of staff of the National Health Service (NHS). The method for assessing the staffing needs innovates the old one that dated back a few decades. To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. The model was implemented on all the wards, multiplying the minutes of care expected in 2016, dividing the result by 60 to obtain the hours of care, and further dividing by the number of yearly hours of work of a nurse (1418). Same was done for nurses aides. The minutes of care were related to mean weight of the Diagnosis Related Groups of the ward and the results obtained compared to the actual staffing of nurses and nurses aides. The costs of the differences were calculated. The implementation of the model produced an excess of 23 nurses and a scarcity of 95 nurses aides compared to the actual staffing, with an increase of the costs of € 1.828.562,00. The results obtained and the criticisms received so far show the need of major changes. The data from international studies that associate staffing and patients outcomes and the nurse/patient ratio are macro-indicators already available that may orient choices and investments on the health care professions.

Manual of First Aid Practices for School Bus Drivers.

ERIC Educational Resources Information Center

Nesbitt, William R.

This manual is intended to assist local school authorities in California in providing the required course in instruction in first aid practices for school bus drivers. While it deals with basic principles of handling serious medical emergencies, major emphasis is on minor injuries or illnesses that are most likely to occur while students are…

Cancer incidence in people living with HIV/AIDS in Israel, 1981-2010.

PubMed

Zohar, Mor; Micha, Barchana

2015-09-01

Antiretroviral therapy (ART) improved the survival of people living with HIV/AIDS (PLWHA) and decreased HIV-related morbidities. This study assesses the cancer incidence of all adult PLWHA in Israel by transmission routes before and after 1996. This cohort study was based on cross-matching the National HIV/AIDS and Cancer Registries of all HIV/AIDS and cancer cases reported from 1981 to 2010 with the National civil census. PLWHA were followed-up until cancer diagnosis, death, leaving Israel, or 2010, whichever occurred first. Cancer incidence was adjusted for age, and compared with the National incidence. Of all 5,154 PLWHA followed-up for 36,296 person-years, 362 (7.0%) developed cancer (997.4 cases per 100,000 person-years). Higher hazard ratios to develop cancer were demonstrated among older PLWHA, Jewish people, and intravenous drug users. Cancer incidence among PLWHA was higher in the pre-ART period than after 1997 (1,232.0 and 846.7 cases per 100,000 person-years, respectively). The incidence of AIDS-defining cancers was higher than non-AIDS-defining malignancies, and higher in the pre-ART than the post-ART period (777.0 and 467.2 cases per 100,000 person-years, respectively), while the incidence of non-AIDS-defining cancers showed the opposite trend (376.5 and 455.0 cases per 100,000 person-years, respectively). The incidence of AIDS-defining and non-AIDS-defining cancers declined between the pre-ART and the post-ART period by 2.0 to 3.4 times. PLWHA had higher rates of malignancies than the general population. In conclusion, cancer incidence among PLWHA was associated with age, and declined after ART introduction; yet it was higher than that of the general population. PLWHA may benefit from age-related cancer screening, increased adherence to ART, and reduction of environmental oncogenes.

Teaching Third-Year Medical Students how to Care for Terminally Ill Patients.

ERIC Educational Resources Information Center

Martin, Robert W.; Wylie, Norma

1989-01-01

A successful seven-day course offered to third-year medical students is an integrated program for teaching them how to deal with terminal illness. The course uses lectures, audiovisual aids, and group and individual sessions to enhance self-awareness and practical application of the material in a clinical setting. (Author/MSE)

The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study.

PubMed

Cain, Lauren E; Phillips, Andrew; Lodi, Sara; Sabin, Caroline; Bansi, Loveleen; Justice, Amy; Tate, Janet; Logan, Roger; Robins, James M; Sterne, Jonathan A C; van Sighem, Ard; de Wolf, Frank; Bucher, Heiner C; Elzi, Luigia; Touloumi, Giota; Vourli, Georgia; Esteve, Anna; Casabona, Jordi; del Amo, Julia; Moreno, Santiago; Seng, Rémonie; Meyer, Laurence; Pérez-Hoyos, Santiago; Muga, Roberto; Abgrall, Sophie; Costagliola, Dominique; Hernán, Miguel A

2012-08-24

To compare regimens consisting of either efavirenz or nevirapine and two or more nucleoside reverse transcriptase inhibitors (NRTIs) among HIV-infected, antiretroviral-naive, and AIDS-free individuals with respect to clinical, immunologic, and virologic outcomes. Prospective studies of HIV-infected individuals in Europe and the US included in the HIV-CAUSAL Collaboration. Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started an NRTI, efavirenz or nevirapine, classified as following one or both types of regimens at baseline, and censored when they started an ineligible drug or at 6 months if their regimen was not yet complete. We estimated the 'intention-to-treat' effect for nevirapine versus efavirenz regimens on clinical, immunologic, and virologic outcomes. Our models included baseline covariates and adjusted for potential bias introduced by censoring via inverse probability weighting. A total of 15 336 individuals initiated an efavirenz regimen (274 deaths, 774 AIDS-defining illnesses) and 8129 individuals initiated a nevirapine regimen (203 deaths, 441 AIDS-defining illnesses). The intention-to-treat hazard ratios [95% confidence interval (CI)] for nevirapine versus efavirenz regimens were 1.59 (1.27, 1.98) for death and 1.28 (1.09, 1.50) for AIDS-defining illness. Individuals on nevirapine regimens experienced a smaller 12-month increase in CD4 cell count by 11.49 cells/μl and were 52% more likely to have virologic failure at 12 months as those on efavirenz regimens. Our intention-to-treat estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a larger 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with nevirapine. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Does artificial nutrition improve outcome of critical illness? An alternative viewpoint!

PubMed

Heyland, Daren K; Wischmeyer, Paul E

2013-08-27

Recent studies challenge the beneficial role of artificial nutrition provided to critically ill patients and point out the limitations of existing studies in this area. We take a differing view of the existing data and refute many of the arguments put forward by previous authors. We review the mechanistic, observational, and experimental data supporting a role for early enteral nutrition in the critically ill patient. We conclude without question that more, high-quality research is needed to better define the role of artificial nutrition in the critical care setting, but until then early and adequate delivery of enteral nutrition is a legitimate, evidence-based treatment recommendation and we see no evidence-based role for restricting enteral nutrition in critically ill patients. The role of early supplemental parenteral nutrition continues to be defined as new data emerge.

Witchcraft illness in the Evuzok nosological system.

PubMed

Guimera, L M

1978-12-01

The Evuzok nosological system is structured with respect to two frames of reference, one designating illness as an empirical reality (descriptive subsystem), the other designating it according to its religious, magical and social significance (etiological subsystem). The articulation of these two subsystems is brought about in the process of diagnosis. Having examined this system as a whole, the author devotes his attention to a particular set of etiological categories, those which associate illness with witchcraft (nocturnal illnesses). He attempts to define their distinctive traits and, from this, to determine their common elemental structure. This study, based on a number of years of fieldwork, is part of an ongoing research program on African folk-medicine pursued by the Laboratoire d'Ethnologie et de Sociologie Comparative of the Université de Paris X.

Illusions of Immortality: The Confrontation of Adolescence and AIDS.

ERIC Educational Resources Information Center

New York State Dept. of Health, Albany.

Acquired Immune Deficiency Syndrome (AIDS) is a potent and a present danger for teenagers, casting a dark shadow over their lives now and in the future. A small, but significant, number of teenagers will develop Human Immune Virus (HIV)-related illness before they turn 20; a far greater number will become infected with the virus during…

The Truman Administration and Federal Aid to Education.

ERIC Educational Resources Information Center

McCann, Maurice

During the Truman administration, the concept of federal aid to education became clearly defined and gained considerable political support. President Truman supported general aid for education as a policy consistent with the administration's overall objectives in domestic programs, but he avoided leadership because of the controversies surrounding…

Themes of a Long-Term AIDS Support Group for Gay Men.

ERIC Educational Resources Information Center

Stewart, Greig M.; Gregory, Barry C.

1996-01-01

Support groups are established psychosocial treatment modalities where clients address particular problems or diagnoses. Discusses a long-term (five year) AIDS support group and examines the following issues: (1) marginality; (2) making choices; (3) coping with emotions; (4) premature confrontation of life issues; (5) chronic illness versus…

Two tales about illness, ideologies, and intimate identities: sexuality politics and AIDS in South Africa, 1980-95.

PubMed

Tsampiras, Carla

2014-04-01

This article focuses on the micro-narratives of two individuals whose responses to AIDS were mediated by their sexual identity, AIDS activism and the political context of South Africa during a time of transition. Their experiences were also mediated by well-established metanarratives about AIDS and 'homosexuality' created in the USA and the UK which were transplanted and reinforced (with local variations) into South Africa by medico-scientific and political leaders.The nascent process of writing South African AIDS histories provides the opportunity to record responses to AIDS at institutional level, reveal the connections between narratives about AIDS and those responses, and draw on the personal stories of those who were at the nexus of impersonal official responses and the personal politics of AIDS. This article records the experiences of Dennis Sifris, a physician who helped establish one of the first AIDS clinics in South Africa and emptied the dance floors, and Pierre Brouard, a clinical psychologist who was involved in early counselling, support and education initiatives for HIV-positive people, and counselled people about dying, and then about living. Their stories show how, even within government-aligned health care spaces hostile to gay men, they were able to provide support and treatment to people; benefited from international connections with other gay communities; and engaged in socially subversive activities. These oral histories thus provide otherwise hidden insights into the experiences of some gay men at the start of an epidemic that was initially almost exclusively constructed on, and about, gay men's bodies.

Attitudes toward Mental Illness: The Construction of the Libertarian Mental Health Ideology Scale.

ERIC Educational Resources Information Center

Nevid, Jeffrey S.; Morrison, James

1980-01-01

The study was an attempt to construct an attitude scale to measure the radical psychosocial or libertarian position about "mental illness" and mental health practices. The factor analysis defined four scale factors: mental illness mythology, antimedical model, social deviance control, and anti-coercive treatment. (Author)

Contrasting stories of life-threatening illness: a narrative inquiry.

PubMed

Sheilds, L; Molzahn, A; Bruce, A; Schick Makaroff, K; Stajduhar, K; Beuthin, R; Shermak, S

2015-01-01

Advances in science and technology have resulted in longer lives for people with life-threatening illnesses. However, little research compares the stories of people with different life-threatening illnesses. The objectives of this study were to explore and contrast how people story and re-story life-threatening illness specifically cancer, chronic kidney disease (CKD) and HIV. Narrative inquiry within a social constructionist perspective was used. A total of 113 in-depth interviews were conducted with 32 participants over a period of three years. Study participants included 32 people: 10 with cancer, 14 with CKD and 8 with HIV/AIDS. Participants varied in age (37-83 years old, mean=61.2 years), gender (17 men and 14 women), location (urban and rural), time post-diagnosis (median=8 years), intensity or invasiveness of treatment, and prognosis (continuous treatment, remission, cure, palliative). Participants described living with a life-threatening illness as a delicate balance. They focused on living their lives yet were fully and acutely aware of their own mortality. There was an undercurrent of sustained uncertainty that permeated their lives. Stories of life-threatening illness differed across the three illness groups and shifted over time as disease trajectories changed. Each disease brought specific challenges. With cancer, turning points and uncertainty were prominent. With CKD, a stealthy beginning to life-extending treatment through dialysis or transplant was evident, and with HIV, a shift from a perceived death sentence to a focus on hope and living was notable. Findings revealed that trajectories of illness for participants living with cancer, CKD and HIV are complex and differ markedly across the groups. Narratives shifted across all of the illness groups as participants navigated and re-storied the terrains of their life-threatening illness. Findings illuminated the need for health care providers to focus on person specific and contextualized aspects of

Design Aids for Real-Time Systems (DARTS)

NASA Technical Reports Server (NTRS)

Szulewski, P. A.

1982-01-01

Design-Aids for Real-Time Systems (DARTS) is a tool that assists in defining embedded computer systems through tree structured graphics, military standard documentation support, and various analyses including automated Software Science parameter counting and metrics calculation. These analyses provide both static and dynamic design quality feedback which can potentially aid in producing efficient, high quality software systems.

The Stigma of Families with Mental Illness

ERIC Educational Resources Information Center

Larson, Jon E.; Corrigan, Patrick

2008-01-01

Objective: This article describes family stigma, which is defined as the prejudice and discrimination experienced by individuals through associations with their relatives. Methods: The authors describe family stigma and present current research related to mental illness stigma experienced by family members. Research indicates this type of stigma…

Spectrum of cancer risk late after AIDS onset in the United States.

PubMed

Simard, Edgar P; Pfeiffer, Ruth M; Engels, Eric A

2010-08-09

Persons living with AIDS today remain at elevated cancer risk. Highly active antiretroviral therapy (HAART), widely available since 1996, prolongs life, but immune function is not fully restored. We conducted this study to assess long-term cancer risk among persons with AIDS relative to the general population and the impact of HAART on cancer incidence. Records of 263 254 adults and adolescents with AIDS (1980-2004) from 15 US regions were matched to cancer registries to capture incident cancers during years 3 through 5 and 6 through 10 after AIDS onset. Standardized incidence ratios (SIRs) were used to assess risks relative to the general population. Rate ratios (RRs) were used to compare cancer incidence before and after 1996 to assess the impact of availability of HAART. Risk was elevated for the 2 major AIDS-defining cancers: Kaposi sarcoma (SIRs, 5321 and 1347 in years 3-5 and 6-10, respectively) and non-Hodgkin lymphoma (SIRs, 32 and 15). Incidence of both malignancies declined in the HAART era (1996-2006). Risk was elevated for all non-AIDS-defining cancers combined (SIRs, 1.7 and 1.6 in years 3-5 and 6-10, respectively) and for the following specific non-AIDS-defining cancers: Hodgkin lymphoma and cancers of the oral cavity and/or pharynx, tongue, anus, liver, larynx, lung and/or bronchus, and penis. Anal cancer incidence increased between 1990-1995 and 1996-2006 (RR, 2.9; 95% confidence interval [CI], 2.1-4.0), as did that of Hodgkin lymphoma (RR, 2.0; 95% CI, 1.3-2.9). Among people who survived for several years or more after an AIDS diagnosis, we observed high risks of AIDS-defining cancers and increasing incidence of anal cancer and Hodgkin lymphoma.

42 CFR 483.134 - Evaluating whether an individual with mental illness requires specialized services (PASARR/MI).

Code of Federal Regulations, 2012 CFR

2012-10-01

... illness requires specialized services (PASARR/MI). 483.134 Section 483.134 Public Health CENTERS FOR... illness requires specialized services (PASARR/MI). (a) Purpose. The purpose of this section is to identify... this part, needs a specialized services program for mental illness as defined in § 483.120. (b) Data...

42 CFR 483.134 - Evaluating whether an individual with mental illness requires specialized services (PASARR/MI).

Code of Federal Regulations, 2014 CFR

2014-10-01

... illness requires specialized services (PASARR/MI). 483.134 Section 483.134 Public Health CENTERS FOR... illness requires specialized services (PASARR/MI). (a) Purpose. The purpose of this section is to identify... this part, needs a specialized services program for mental illness as defined in § 483.120. (b) Data...

Traditional health practitioners’ management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy

PubMed Central

Zuma, Thembelihle; Wight, Daniel; Rochat, Tamsen; Moshabela, Mosa

2017-01-01

ABSTRACT Background: Traditional health practitioners (THPs) have been identified as a key local resource in the fight against human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in South Africa. However, their approaches to the treatment of people living with HIV (PLHIV) have been met with scepticism by some biomedical practitioners amid increasing access to antiretroviral therapy (ART). Objective: In light of this ambivalence, this study aims to document and identify treatment approaches of THPs to the management of illness among PLHIV in the current era of widespread access to ART. Methods: The study was conducted as part of a larger trial of Treatment as Prevention (TasP) in rural northern Kwa-Zulu Natal, intended to treat PLHIV regardless of CD4 count. Nine THPs were enrolled using purposive and snowballing techniques. Repeat group discussions, triangulated with community walks and photovoice techniques, were conducted. A thematic analysis approach was used to analyse the data. Results: Eight of the nine THPs had received training in biomedical aspects of HIV. THPs showed a multilayered decision-making process in managing illness among PLHIV, influenced by the attributes and choices of the THPs. THPs assessed and managed illness among PLHIV based on THP training in HIV/AIDS, THP type, as well as knowledge and experience in the traditional healing practice. Management of illness depended on the patients’ report of their HIV status or willingness to test for HIV. Conclusions: THPs’ approaches to illness in PLHIV appear to be shifting in light of increasing exposure to HIV/AIDS-related information. Importantly, disclosure of HIV status plays a major role in THPs’ management of illness among PLHIV, as well as linkage to HIV testing and care for their patients. Therefore, THPs can potentially enhance the success of ART for PLHIV when HIV status is known. PMID:28771116

Use of EEG Monitoring and Management of Non-Convulsive Seizures in Critically Ill Patients: A Survey of Neurologists

PubMed Central

Abend, Nicholas S.; Dlugos, Dennis J.; Hahn, Cecil D.; Hirsch, Lawrence J.; Herman, Susan T.

2010-01-01

Background Continuous EEG monitoring (cEEG) of critically ill patients is frequently utilized to detect non-convulsive seizures (NCS) and status epilepticus (NCSE). The indications for cEEG, as well as when and how to treat NCS, remain unclear. We aimed to describe the current practice of cEEG in critically ill patients to define areas of uncertainty that could aid in designing future research. Methods We conducted an international survey of neurologists focused on cEEG utilization and NCS management. Results Three-hundred and thirty physicians completed the survey. 83% use cEEG at least once per month and 86% manage NCS at least five times per year. The use of cEEG in patients with altered mental status was common (69%), with higher use if the patient had a prior convulsion (89%) or abnormal eye movements (85%). Most respondents would continue cEEG for 24 h. If NCS or NCSE is identified, the most common anticonvulsants administered were phenytoin/fosphenytoin, lorazepam, or levetiracetam, with slightly more use of levetiracetam for NCS than NCSE. Conclusions Continuous EEG monitoring (cEEG) is commonly employed in critically ill patients to detect NCS and NCSE. However, there is substantial variability in current practice related to cEEG indications and duration and to management of NCS and NCSE. The fact that such variability exists in the management of this common clinical problem suggests that further prospective study is needed. Multiple points of uncertainty are identified that require investigation. PMID:20198513

Illness causal beliefs in Turkish immigrants

PubMed Central

Minas, Harry; Klimidis, Steven; Tuncer, Can

2007-01-01

Background People hold a wide variety of beliefs concerning the causes of illness. Such beliefs vary across cultures and, among immigrants, may be influenced by many factors, including level of acculturation, gender, level of education, and experience of illness and treatment. This study examines illness causal beliefs in Turkish-immigrants in Australia. Methods Causal beliefs about somatic and mental illness were examined in a sample of 444 members of the Turkish population of Melbourne. The socio-demographic characteristics of the sample were broadly similar to those of the Melbourne Turkish community. Five issues were examined: the structure of causal beliefs; the relative frequency of natural, supernatural and metaphysical beliefs; ascription of somatic, mental, or both somatic and mental conditions to the various causes; the correlations of belief types with socio-demographic, modernizing and acculturation variables; and the relationship between causal beliefs and current illness. Results Principal components analysis revealed two broad factors, accounting for 58 percent of the variation in scores on illness belief scales, distinctly interpretable as natural and supernatural beliefs. Second, beliefs in natural causes were more frequent than beliefs in supernatural causes. Third, some causal beliefs were commonly linked to both somatic and mental conditions while others were regarded as more specific to either somatic or mental disorders. Last, there was a range of correlations between endorsement of belief types and factors defining heterogeneity within the community, including with demographic factors, indicators of modernizing and acculturative processes, and the current presence of illness. Conclusion Results supported the classification of causal beliefs proposed by Murdock, Wilson & Frederick, with a division into natural and supernatural causes. While belief in natural causes is more common, belief in supernatural causes persists despite modernizing and

Illness causal beliefs in Turkish immigrants.

PubMed

Minas, Harry; Klimidis, Steven; Tuncer, Can

2007-07-24

People hold a wide variety of beliefs concerning the causes of illness. Such beliefs vary across cultures and, among immigrants, may be influenced by many factors, including level of acculturation, gender, level of education, and experience of illness and treatment. This study examines illness causal beliefs in Turkish-immigrants in Australia. Causal beliefs about somatic and mental illness were examined in a sample of 444 members of the Turkish population of Melbourne. The socio-demographic characteristics of the sample were broadly similar to those of the Melbourne Turkish community. Five issues were examined: the structure of causal beliefs; the relative frequency of natural, supernatural and metaphysical beliefs; ascription of somatic, mental, or both somatic and mental conditions to the various causes; the correlations of belief types with socio-demographic, modernizing and acculturation variables; and the relationship between causal beliefs and current illness. Principal components analysis revealed two broad factors, accounting for 58 percent of the variation in scores on illness belief scales, distinctly interpretable as natural and supernatural beliefs. Second, beliefs in natural causes were more frequent than beliefs in supernatural causes. Third, some causal beliefs were commonly linked to both somatic and mental conditions while others were regarded as more specific to either somatic or mental disorders. Last, there was a range of correlations between endorsement of belief types and factors defining heterogeneity within the community, including with demographic factors, indicators of modernizing and acculturative processes, and the current presence of illness. Results supported the classification of causal beliefs proposed by Murdock, Wilson & Frederick, with a division into natural and supernatural causes. While belief in natural causes is more common, belief in supernatural causes persists despite modernizing and acculturative influences. Different

Experiences of mental illness stigma, prejudice and discrimination: a review of measures.

PubMed

Brohan, Elaine; Slade, Mike; Clement, Sarah; Thornicroft, Graham

2010-03-25

There has been a substantial increase in research on mental illness related stigma over the past 10 years, with many measures in use. This study aims to review current practice in the survey measurement of mental illness stigma, prejudice and discrimination experienced by people who have personal experience of mental illness. We will identify measures used, their characteristics and psychometric properties. A narrative literature review of survey measures of mental illness stigma was conducted. The databases Medline, PsychInfo and the British Nursing Index were searched for the period 1990-2009. 57 studies were included in the review. 14 survey measures of mental illness stigma were identified. Seven of the located measures addressed aspects of perceived stigma, 10 aspects of experienced stigma and 5 aspects of self-stigma. Of the identified studies, 79% used one of the measures of perceived stigma, 46% one of the measures of experienced stigma and 33% one of the measures of self-stigma. All measures presented some information on psychometric properties. The review was structured by considering perceived, experienced and self stigma as separate but related constructs. It provides a resource to aid researchers in selecting the measure of mental illness stigma which is most appropriate to their purpose.

Febrile Rhinovirus Illness During Pregnancy Is Associated With Low Birth Weight in Nepal

PubMed Central

Philpott, Erin K; Englund, Janet A; Katz, Joanne; Tielsch, James; Khatry, Subarna; LeClerq, Stephen C; Shrestha, Laxman; Kuypers, Jane; Magaret, Amalia S; Steinhoff, Mark C

2017-01-01

Abstract Background Adverse birth outcomes, including low birth weight (LBW), defined as <2500 grams, small-for-gestational-age (SGA), and prematurity, contribute to 60%–80% of infant mortality worldwide and may be related to infections during pregnancy. The aim of this study was to assess whether febrile human rhinovirus (HRV) illness is associated with adverse birth outcomes. Methods Active household-based weekly surveillance was performed for respiratory illness episodes in pregnant women as part of a community-based, prospective, randomized trial of maternal influenza immunization in rural Nepal. Rhinovirus (HRV) febrile illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia with HRV detected on mid-nasal swab. Multivariate regression analysis evaluated the association between febrile HRV respiratory illness and adverse birth outcomes. Results Overall, 96 (3%) of 3693 pregnant women had HRV-positive febrile respiratory illnesses. Infants born to pregnant women with HRV febrile illness had a 1.6-fold increased risk of being LBW compared with those with non-HRV febrile illness (28 of 96 [38%] vs 109 of 458 [24%]; relative risk [RR], 1.6; 95% confidence interval [CI], 1.1–2.3). No difference in risk of LBW was observed between infants born to mothers with non-HRV febrile respiratory illness and those without respiratory illness during pregnancy (109 of 458 [24%] vs 552 of 2220 [25%], respectively; RR, 1.0; 95% CI, 0.8–1.2). Conclusions Febrile illness due to rhinovirus during pregnancy was associated with increased risk of LBW in a rural South Asian population. Interventions to reduce the burden of febrile respiratory illness due to rhinovirus during pregnancy may have a significant impact on LBW and subsequent infant mortality. PMID:28584855

People living with serious illness: stories of spirituality.

PubMed

Molzahn, Anita; Sheilds, Laurene; Bruce, Anne; Stajduhar, Kelli; Makaroff, Kara Schick; Beuthin, Rosanne; Shermak, Sheryl

2012-08-01

To examine stories of spirituality in people living with serious illness. Although knowledge about the experience of people with various chronic illnesses is growing, there is little known about peoples' beliefs and perspectives relating to spirituality where there is a diagnosis of a serious chronic and life-limiting illness. A social constructionist approach to narrative inquiry was used. In-depth narrative interviews were conducted on one occasion with 32 participants. This included 10 people with cancer, 14 people with end stage renal disease (ESRD) and eight people with HIV/AIDS. They ranged in age from 37-83 and included 18 men and 14 women. The themes were reflecting on spiritual religious and personal beliefs, crafting beliefs for their own lives, finding meaning and transcending beyond words. Participants melded various belief systems to fit their own lives. They also looked to find meaning in their illness experience and described what gave life meaning. For some aspects of these belief systems, participants could not or would not express themselves verbally, and it seemed that aspects of their experience were beyond language. The stories revealed considerable depth relating to perspectives on life, illness and existential questions, but many participants were not comfortable with the term 'spirituality'. Nurses must remain open to learning about belief systems of each individual in their care, regardless of that individual's declared religious affiliation or declaration of no religious affiliation, given that personal beliefs and practices do not always fit into specific categories. © 2012 Blackwell Publishing Ltd.

COMPARISON OF ILLNESS ENPOINTS IN SWIMMER'S HEALTH STUDIES

EPA Science Inventory

Prospective epidemiological studies on swimmers¿ health that were conducted by the U.S. Environmental Protection Agency between 1973 and 1980 defined highly credible gastrointestinal illness (HCGI) as the occurrence of one or more of the following set of symptoms: (1) vomiting, (...

Manual of First-Aid Practices for School Bus Drivers. Revised.

ERIC Educational Resources Information Center

Nesbitt, William R.

This manual is intended to provide California school bus drivers with the required course of instruction in first aid practices. It deals with the basic principles of handling serious medical emergencies, but major emphasis is on the variety of minor injuries or illnesses that may occur while students are riding on school buses. Chapter 1 covers…

An Anthropological View of the Change in Attitudes toward Mental Illnesses and Physical Handicaps.

ERIC Educational Resources Information Center

Ross, John Alan

1983-01-01

Anthropologists contend that throughout man's history mental illness has been part of all cultures, and, universally, peoples had taxonomies that classified such maladies. Primitive peoples were better able to treat culturally-defined mental illnesses and could, consequently, accommodate behaviors which in Western cultures would require…

Psychosocial adjustment of children affected by HIV/AIDS in Ghana.

PubMed

Doku, Paul Narh

2010-06-01

The study was conducted to assess the psychosocial adjustment of children affected by HIV/ AIDS in the eastern part of Ghana. Four groups of children (children who lost their parents to AIDS, children who lost their parents through other causes, children living with HIV infected, alive parents and the comparison children who were from the same community but did not have HIV/AIDS-related illness or death in their families) were interviewed on depressive symptoms, prosocial behaviours, hyperactivity, conduct and peer problems using the Strengths and Difficulties Questionnaire (SDQ). Orphans in general and children living with HIV-infected parents consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the wellbeing of these children.

Boosted lopinavir- versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: a prospective study of HIV-infected individuals in high-income countries.

PubMed

Cain, Lauren E; Phillips, Andrew; Olson, Ashley; Sabin, Caroline; Jose, Sophie; Justice, Amy; Tate, Janet; Logan, Roger; Robins, James M; Sterne, Jonathan A C; van Sighem, Ard; Reiss, Peter; Young, James; Fehr, Jan; Touloumi, Giota; Paparizos, Vasilis; Esteve, Anna; Casabona, Jordi; Monge, Susana; Moreno, Santiago; Seng, Rémonie; Meyer, Laurence; Pérez-Hoyos, Santiago; Muga, Roberto; Dabis, François; Vandenhende, Marie-Anne; Abgrall, Sophie; Costagliola, Dominique; Hernán, Miguel A

2015-04-15

Current clinical guidelines consider regimens consisting of either ritonavir-boosted atazanavir or ritonavir-boosted lopinavir and a nucleoside reverse transcriptase inhibitor (NRTI) backbone among their recommended and alternative first-line antiretroviral regimens. However, these guidelines are based on limited evidence from randomized clinical trials and clinical experience. We compared these regimens with respect to clinical, immunologic, and virologic outcomes using data from prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States in the HIV-CAUSAL Collaboration, 2004-2013. Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started a lopinavir or an atazanavir regimen. We estimated the 'intention-to-treat' effect for atazanavir vs lopinavir regimens on each of the outcomes. A total of 6668 individuals started a lopinavir regimen (213 deaths, 457 AIDS-defining illnesses or deaths), and 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths). The adjusted intention-to-treat hazard ratios for atazanavir vs lopinavir regimens were 0.70 (95% confidence interval [CI], .53-.91) for death, 0.67 (95% CI, .55-.82) for AIDS-defining illness or death, and 0.91 (95% CI, .84-.99) for virologic failure at 12 months. The mean 12-month increase in CD4 count was 8.15 (95% CI, -.13 to 16.43) cells/µL higher in the atazanavir group. Estimates differed by NRTI backbone. Our estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a greater 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for atazanavir compared with lopinavir regimens. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

AIDS among blacks in the 1990s.

PubMed

Nickens, H

1990-04-01

In the black community, many health indicators are going in the wrong direction. Black life expectancy is going down. Our middle class is growing but our poor are growing also. It is no longer even jarring to talk about black males as an endangered species. Black women are groaning under family responsibilities. Too many of our young people are better armed than the police and kill each other for "diss'in," ie, he was disrespecting me. It is appropriate that AIDS be responded to as a crisis, but we also have a weighty, preexisting set of long-standing and equally lethal health and social ills. The infrastructure we build in response to AIDS and the lessons we learn from this disease must be developed with this broader view in mind.

COMPARISON OF ILLNESS ENDPOINTS IN SWIMMERS' HEALTH STUDIES

EPA Science Inventory

Prospective epidemiological studies on swimmers¿ health that were conducted by the U.S. Environmental Protection Agency (U.S. EPA) between 1973 and 1980 defined highly credible gastrointestinal illness (HCGI) as the occurrence of one or more of the following set of symptoms: (1) ...

Pressure ulcer prevention in patients with advanced illness.

PubMed

White-Chu, E Foy; Reddy, Madhuri

2013-03-01

Pressure ulcers can be challenging to prevent, particularly in patients with advanced illnesses. This review summarizes the relevant literature since 2011. Through a MEDLINE and CINAHL database search from January 1, 2011 to June 1, 2012, a total of 14 abstracts were found addressing the prevention of pressure ulcers in persons with advanced illness. Search terms included pressure ulcer, prevention, and control. Advanced illness was defined as patients transitioning from curative to supportive and palliative care. Ten original studies and four review articles specifically addressed pressure ulcer prevention. There were four articles that specifically addressed patients with advanced illness. The studies varied in quality. One systematic review, one randomized controlled trial, three prospective trials, two retrospective trials, one cost-effectiveness analysis, one quality improvement project, one comparative descriptive design, and four review articles were found. The interventions for pressure ulcer prevention were risk assessment, repositioning, surface selection, nutritional support and maintenance of skin integrity with or without incontinence. The quality of pressure ulcer prevention studies in persons with advanced illness is poor. Increased number and higher quality studies are needed to further investigate this important topic for these fragile patients.

29 CFR 553.220 - “Tour of duty” defined.

Code of Federal Regulations, 2010 CFR

2010-07-01

... duty” defined. (a) The term “tour of duty” is a unique concept applicable only to employees for whom... take place under the terms of a mutual aid agreement in the jurisdiction in which the employee is...

How medical technologies shape the experience of illness.

PubMed

Hofmann, Bjørn; Svenaeus, Fredrik

2018-02-03

In this article we explore how diagnostic and therapeutic technologies shape the lived experiences of illness for patients. By analysing a wide range of examples, we identify six ways that technology can (trans)form the experience of illness (and health). First, technology may create awareness of disease by revealing asymptomatic signs or markers (imaging techniques, blood tests). Second, the technology can reveal risk factors for developing diseases (e.g., high blood pressure or genetic tests that reveal risks of falling ill in the future). Third, the technology can affect and change an already present illness experience (e.g., the way blood sugar measurement affects the perceived symptoms of diabetes). Fourth, therapeutic technologies may redefine our experiences of a certain condition as diseased rather than unfortunate (e.g. assisted reproductive technologies or symptom based diagnoses in psychiatry). Fifth, technology influences illness experiences through altering social-cultural norms and values regarding various diagnoses. Sixth, technology influences and changes our experiences of being healthy in contrast and relation to being diseased and ill. This typology of how technology forms illness and related conditions calls for reflection regarding the phenomenology of technology and health. How are medical technologies and their outcomes perceived and understood by patients? The phenomenological way of approaching illness as a lived, bodily being-in-the-world is an important approach for better understanding and evaluating the effects that medical technologies may have on our health, not only in defining, diagnosing, or treating diseases, but also in making us feel more vulnerable and less healthy in different regards.

Two Tales about Illness, Ideologies, and Intimate Identities: Sexuality Politics and AIDS in South Africa, 1980–95

PubMed Central

Tsampiras, Carla

2014-01-01

This article focuses on the micro-narratives of two individuals whose responses to AIDS were mediated by their sexual identity, AIDS activism and the political context of South Africa during a time of transition. Their experiences were also mediated by well-established metanarratives about AIDS and ‘homosexuality’ created in the USA and the UK which were transplanted and reinforced (with local variations) into South Africa by medico-scientific and political leaders.The nascent process of writing South African AIDS histories provides the opportunity to record responses to AIDS at institutional level, reveal the connections between narratives about AIDS and those responses, and draw on the personal stories of those who were at the nexus of impersonal official responses and the personal politics of AIDS. This article records the experiences of Dennis Sifris, a physician who helped establish one of the first AIDS clinics in South Africa and emptied the dance floors, and Pierre Brouard, a clinical psychologist who was involved in early counselling, support and education initiatives for HIV-positive people, and counselled people about dying, and then about living. Their stories show how, even within government-aligned health care spaces hostile to gay men, they were able to provide support and treatment to people; benefited from international connections with other gay communities; and engaged in socially subversive activities. These oral histories thus provide otherwise hidden insights into the experiences of some gay men at the start of an epidemic that was initially almost exclusively constructed on, and about, gay men’s bodies. PMID:24775431

Home Care for Children with Chronic Illnesses and Severe Disabilities: A Bibliography and Resource Guide.

ERIC Educational Resources Information Center

Wells, Alice; And Others

The bibliography and resource guide summarizes relevant research and information on home care for children with disabilities and chronic illnesses, including those with such diagnoses as spina bifida, cerebral palsy, severe mental retardation, acquired immune deficiency syndrome (AIDS), hemophilia, sickle cell anemia, autism, or failure-to-thrive…

[Vulnerabilities present in the path experienced by patients with HIV / AIDS in treatment failure].

PubMed

Sousa, Petra Kelly Rabelo de; Torres, Daniele Viana Maia; Miranda, Karla Corrêa Lima; Franco, Amanda Carneiro

2013-01-01

A major breakthrough in AIDS treatment occurred with the advent of antiretroviral therapy. However, several vulnerabilities may be present in the path experienced by patients during treatment. This study aimed to analyze the vulnerabilities of patients with HIV / AIDS in treatment failure. It is a qualitative study, involving seven users with AIDS considered in treatment failure in an Outpatient Service Unit on HIV / AIDS, in Fortaleza-CE. To interpret the data, it was used the technique of content analysis. In the speeches, it was realized that the deponents faced conflicts in the family and, difficult relationships with people and stigma at work. It was observed that patients had experienced various situations that made them more susceptible to HIV infection and illness.

[Assessment criteria in the choice of aids for the lifting of patients].

PubMed

Panciera, D; Menoni, O; Ricci, M G; Occhipinti, E

1999-01-01

A fundamental part of the prevention strategies aimed at reducing risk due to manual handling of patients is the use of appropriate aids. This paper defines the basic types of aids for hospital wards: patient lifting devices, aids for hygiene and minor aids; and also proposes a procedure for choice of the type of aid: the procedure uses a specific protocol and also analyzes work organization and the environmental features of the ward. The proposed criteria for choice concern in the first place the fundamental requirements of the equipment: safety for operator and patient, simplicity of use and comfort for the patient. Secondly the basic determinants for choice of the type of aid are the type of disabled patient usually present in the ward and the analysis of the movements made in handling patients. On this basis, for each type of aid, the specific features are defined which direct the choice of supply for the various wards that will be adequate and effective both in reducing risk due to manual handling of patients and in improving the comfort of the patients.

Illness Identity in Adults with a Chronic Illness.

PubMed

Oris, Leen; Luyckx, Koen; Rassart, Jessica; Goubert, Liesbet; Goossens, Eva; Apers, Silke; Arat, Seher; Vandenberghe, Joris; Westhovens, René; Moons, Philip

2018-02-21

The present study examines the concept of illness identity, the degree to which a chronic illness is integrated into one's identity, in adults with a chronic illness by validating a new self-report questionnaire, the Illness Identity Questionnaire (IIQ). Self-report questionnaires on illness identity, psychological, and physical functioning were assessed in two samples: adults with congenital heart disease (22-78 year old; n = 276) and with multisystem connective tissue disorders (systemic lupus erythematosus or systemic sclerosis; 17-81 year old; n = 241). The IIQ could differentiate four illness identity states (i.e., engulfment, rejection, acceptance, and enrichment) in both samples, based on exploratory and confirmatory factor analysis. All four subscales proved to be reliable. Rejection and engulfment were related to maladaptive psychological and physical functioning, whereas acceptance and enrichment were related to adaptive psychological and physical functioning. The present findings underscore the importance of the concept of illness identity. The IIQ, a self-report questionnaire, is introduced to measure four different illness identity states in adults with a chronic illness.

A Hearing Aid Primer 1

ERIC Educational Resources Information Center

Yetter, Carol J.

2009-01-01

This hearing aid primer is designed to define the differences among the three levels of hearing instrument technology: conventional analog circuit technology (most basic), digitally programmable/analog circuit technology (moderately advanced), and fully digital technology (most advanced). Both moderate and advanced technologies mean that hearing…

Palliative care for patients with HIV/AIDS admitted to intensive care units

PubMed Central

Souza, Paola Nóbrega; de Miranda, Erique José Peixoto; Cruz, Ronaldo; Forte, Daniel Neves

2016-01-01

Objective To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. Methods This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. Results Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit. Conclusion Palliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit. PMID:27737420

HIV Education for Persons with Mental Disabilities. AIDS Technical Report, No. 1.

ERIC Educational Resources Information Center

Harvey, David C.; Trivelli, Lucy U.

This technical report is part of a series on AIDS/HIV (Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus) and is intended to help link various legal advocacy organizations providing services to persons with mental illness or developmental disabilities. Such persons, especially adolescents, are at risk for exposure to HIV because…

Software For Computer-Aided Design Of Control Systems

NASA Technical Reports Server (NTRS)

Wette, Matthew

1994-01-01

Computer Aided Engineering System (CAESY) software developed to provide means to evaluate methods for dealing with users' needs in computer-aided design of control systems. Interpreter program for performing engineering calculations. Incorporates features of both Ada and MATLAB. Designed to be flexible and powerful. Includes internally defined functions, procedures and provides for definition of functions and procedures by user. Written in C language.

Study IDs Genetic Markers that Speed AIDS Progression | Frederick National Laboratory for Cancer Research

Cancer.gov

A study published in the journal Science sheds new light on how a set of human genes can accelerate progression of AIDS-related illness in people living with HIV who are not on treatment. South African scientists led the international research team,

RASCAL: A Rudimentary Adaptive System for Computer-Aided Learning.

ERIC Educational Resources Information Center

Stewart, John Christopher

Both the background of computer-assisted instruction (CAI) systems in general and the requirements of a computer-aided learning system which would be a reasonable assistant to a teacher are discussed. RASCAL (Rudimentary Adaptive System for Computer-Aided Learning) is a first attempt at defining a CAI system which would individualize the learning…

Meaning and purpose in the lives of persons with AIDS.

PubMed

Coward, D D

1994-10-01

Little research has been reported that explores meaning-discovery and meaning-making in persons with AIDS. Self-transcendence experiences, as proposed by Reed (1991), may lead to maintenance or restoration of mental health in persons facing end-of-life issues. Nurses who work with persons with life-threatening illness, such as men and women with AIDS, have opportunities to facilitate choices that lead to experiences from which meaning and emotional well-being may be obtained. This study used a phenomenological approach to describe experiences of 10 men and 10 women with AIDS that led to feelings of increased self-worth, purpose, and meaning in their lives. Participants provided oral or written descriptions of experiences associated with feelings of increased connectedness with others, sense of well-being, and hope for longer life. Data were analyzed using Colaizzi's phenomenological technique (1978). Although men and women with AIDS faced some of the same issues, their responses were different. By incorporating gender and individual differences, nurses may be better able to create therapeutic exchanges in which self-transcendence views and behaviors are fostered in both men and women with AIDS.

Health and illness concepts among lower income Nicaraguan women.

PubMed

Ailinger, Rita L; Gonzalez, Rose; Zamora, Lidya

2007-03-01

Concepts of health and illness are culturally defined; however, few researchers have reported on these concepts among Latina women. A purposive sample of 14 lower income Nicaraguan women living in a squatter settlement is the focus of this qualitative study. The authors used in-depth, tape-recorded interviews in Spanish to gather data on the women's concepts of health and illness for adults and babies and of health maintenance activities. The authors analyzed the verbatim transcripts and analyzed them for themes. The women's concepts of health and illness included four themes: activities, disposition, eating, and appearance. Health maintenance activities included hygiene and sanitation, medical intervention, nutrition, and the appearance of cleanliness. Nurses and other health care providers will find these themes instructive in developing and providing health services for similar Latina women.

End of living: maintaining a lifeworld during terminal illness.

PubMed

Wrubel, Judith; Acree, Michael; Goodman, Steffanie; Folkman, Susan

2009-12-01

The narrative responses of 32 people with AIDS or cancer with survival prognoses of 6 months to a year to monthly interview questions about their daily lives were analysed with a team-based qualitative methodology. Two groups emerged: (a) a Maintained Lifeworld Group characterised by one or more of the following: continued engagement with family, friends, and community; the ability to relinquish untenable goals and substitute new, realistic ones; engagement in spirituality and a spiritual practice; and, (b) a Lifeworld Interrupted Group characterised by one or more of the following: relocation just before or during the study, cognitive impairment, commitment to untenable goals, ongoing substance abuse. Understanding how people with a terminal illness can maintain a lifeworld and experience well-being while also managing the physical challenges of their illness could help inform the support offered by professional and family caregivers to improve care recipients' quality of life.

The clinical impact of continuing to prescribe antiretroviral therapy in patients with advanced AIDS who manifest no virologic or immunologic benefit.

PubMed

Wohl, David A; Kendall, Michelle A; Feinberg, Judith; Alston-Smith, Beverly; Owens, Susan; Chafey, Suzette; Marco, Michael; Maxwell, Sharon; Benson, Constance; Keiser, Philip; van der Horst, Charles; Jacobson, Mark A

2013-01-01

Despite the efficacy and tolerability of modern antiretroviral therapy (ART), many patients with advanced AIDS prescribed these regimens do not achieve viral suppression or immune reconstitution as a result of poor adherence, drug resistance, or both. The clinical outcomes of continued ART prescription for such patients have not been well characterized. We examined the causes and predictors of all-cause mortality, AIDS-defining conditions, and serious non-AIDS-defining events among a cohort of participants in a clinical trial of pre-emptive therapy for CMV disease. We focused on participants who, despite ART had failed to achieve virologic suppression and substantive immune reconstitution. 233 ART-receiving participants entered with a median baseline CD4+ T cell count of 30/mm(3) and plasma HIV RNA of 5 log10 copies/mL. During a median 96 weeks of follow-up, 24.0% died (a mortality rate of 10.7/100 patient-years); 27.5% reported a new AIDS-defining condition, and 22.3% a new serious non-AIDS event. Of the deaths, 42.8% were due to an AIDS-defining condition, 44.6% were due to a non-AIDS-defining condition, and 12.5% were of unknown etiology. Decreased risk of mortality was associated with baseline CD4+ T cell count ≥25/mm(3) and lower baseline HIV RNA. Among patients with advanced AIDS prescribed modern ART who achieve neither virologic suppression nor immune reconstitution, crude mortality percentages appear to be lower than reported in cohorts of patients studied a decade earlier. Also, in contrast to the era before modern ART became available, nearly half of the deaths in our modern-era study were caused by serious non-AIDS-defining events. Even among the most advanced AIDS patients who were not obtaining apparent immunologic and virologic benefit from ART, continued prescription of these medications appears to alter the natural history of AIDS--improving survival and shifting the causes of death from AIDS- to non-AIDS-defining conditions.

Hypoglycemia in Critically Ill Children

PubMed Central

Faustino, E Vincent S; Hirshberg, Eliotte L; Bogue, Clifford W

2012-01-01

Background The practice of glycemic control with intravenous insulin in critically ill patients has brought clinical focus on understanding the effects of hypoglycemia, especially in children. Very little is published on the impact of hypoglycemia in this population. We aimed to review the existing literature on hypoglycemia in critically ill neonates and children. Methods We performed a systematic review of the literature up to August 2011 using PubMed, Ovid MEDLINE and ISI Web of Science using the search terms “hypoglycemia or hypoglyc*” and “critical care or intensive care or critical illness”. Articles were limited to “all child (0–18 years old)” and “English”. Results A total of 513 articles were identified and 132 were included for review. Hypoglycemia is a significant concern among pediatric and neonatal intensivists. Its definition is complicated by the use of a biochemical measure (i.e., blood glucose) for a pathophysiologic problem (i.e., neuroglycopenia). Based on associated outcomes, we suggest defining hypoglycemia as <40–45 mg/dl in neonates and <60–65 mg/dl in children. Below the suggested threshold values, hypoglycemia is associated with worse neurological outcomes, increased intensive care unit stay, and increased mortality. Disruptions in carbohydrate metabolism increase the risk of hypoglycemia incritically ill children. Prevention of hypoglycemia, especially in the setting of intravenous insulin use, will be best accomplished by the combination of accurate measuring techniques, frequent or continuous glucose monitoring, and computerized insulin titration protocols. Conclusion Studies on hypoglycemia in critically ill children have focused on spontaneous hypoglycemia. With the current practice of maintaining blood glucose within a narrow range with intravenous insulin, the risk factors and outcomes associated with insulin-induced hypoglycemia should be rigorously studied to prevent hypoglycemia and potentially improve

Evaluating first-aid knowledge and attitudes of a sample of Turkish primary school teachers.

PubMed

Başer, Mürüvvet; Coban, Sibel; Taşci, Sultan; Sungur, Gönül; Bayat, Meral

2007-10-01

Knowledge of first aid, which constitutes life-saving treatments for injuries or unexpected illnesses, is important for every individual at every age. First aid and basic life support are so important that teaching basic first aid should be compulsory in all schools. The goal of this study was to determine the knowledge and attitudes of a sample of Turkish teachers regarding the administration of first aid. Three hundred twelve teachers took part in this study to evaluate knowledge and attitudes of teachers in primary schools about first aid. Data were obtained using a questionnaire. It included 30 questions that help identify the teachers and determine their knowledge and attitudes about first aid. Data were analyzed by chi-square test. In this study, it was determined that most of the teachers do not have correct knowledge and attitudes about first aid. For example, 65.1% of teachers gave incorrect answers regarding epistaxis, 63.5% for bee stings, and 88.5% for abrasion. It was found out that as the age of the teachers increases, appropriate first-aid practice becomes more and more unlikely. The results of this study showed that teachers did not have enough knowledge about first aid.

A Platform for Crowdsourced Foodborne Illness Surveillance: Description of Users and Reports

PubMed Central

2017-01-01

Background Underreporting of foodborne illness makes foodborne disease burden estimation, timely outbreak detection, and evaluation of policies toward improving food safety challenging. Objective The objective of this study was to present and evaluate Iwaspoisoned.com, an openly accessible Internet-based crowdsourcing platform that was launched in 2009 for the surveillance of foodborne illness. The goal of this system is to collect data that can be used to augment traditional approaches to foodborne disease surveillance. Methods Individuals affected by a foodborne illness can use this system to report their symptoms and the suspected location (eg, restaurant, hotel, hospital) of infection. We present descriptive statistics of users and businesses and highlight three instances where reports of foodborne illness were submitted before the outbreaks were officially confirmed by the local departments of health. Results More than 49,000 reports of suspected foodborne illness have been submitted on Iwaspoisoned.com since its inception by individuals from 89 countries and every state in the United States. Approximately 95.51% (42,139/44,119) of complaints implicated restaurants as the source of illness. Furthermore, an estimated 67.55% (3118/4616) of users who responded to a demographic survey were between the ages of 18 and 34, and 60.14% (2776/4616) of the respondents were female. The platform is also currently used by health departments in 90% (45/50) of states in the US to supplement existing programs on foodborne illness reporting. Conclusions Crowdsourced disease surveillance through systems such as Iwaspoisoned.com uses the influence and familiarity of social media to create an infrastructure for easy reporting and surveillance of suspected foodborne illness events. If combined with traditional surveillance approaches, these systems have the potential to lessen the problem of foodborne illness underreporting and aid in early detection and monitoring of foodborne

Prevention and mental illness: a new era for a healthier tomorrow.

PubMed

Buck, Steven

2010-07-01

The Department of Mental Health and Substance Abuse Services strives to provide the best possible care for Oklahoma communities through preventative programs and approaches such as QPR, Mental Health First Aid and mental health screenings. All of these techniques have been proven in providing adequate knowledge of risk factors in Oklahoma communities for mental health disorders and help to prevent those predisposed to mental illness from experiencing an onset of the disorder.

Youth mental health first aid: a description of the program and an initial evaluation

PubMed Central

2011-01-01

Background Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions. Methods The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries. Results The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action plan. Most results were

Defining clinical deterioration.

PubMed

Jones, Daryl; Mitchell, Imogen; Hillman, Ken; Story, David

2013-08-01

To review literature reporting adverse events and physiological instability in order to develop frameworks that describe and define clinical deterioration in hospitalised patients. Literature review of publications from 1960 to August 2012. Conception and refinement of models to describe clinical deterioration based on prevailing themes that developed chronologically in adverse event literature. We propose four frameworks or models that define clinical deterioration and discuss the utility of each. Early attempts used retrospective chart review and focussed on the end result of deterioration (adverse events) and iatrogenesis. Subsequent models were also retrospective, but used discrete complications (e.g. sepsis, cardiac arrest) to define deterioration, had a more clinical focus, and identified the concept of antecedent physiological instability. Current models for defining clinical deterioration are based on the presence of abnormalities in vital signs and other clinical observations and attempt to prospectively assist clinicians in predicting subsequent risk. However, use of deranged vital signs in isolation does not consider important patient-, disease-, or system-related factors that are known to adversely affect the outcome of hospitalised patients. These include pre-morbid function, frailty, extent and severity of co-morbidity, nature of presenting illness, delays in responding to deterioration and institution of treatment, and patient response to therapy. There is a need to develop multiple-variable models for deteriorating ward patients similar to those used in intensive care units. Such models may assist clinician education, prospective and real-time patient risk stratification, and guide quality improvement initiatives that prevent and improve response to clinical deterioration. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Impact of public health strategies on reducing AIDS mortality in southern Brazil.

PubMed

Raboni, Sonia M; Ribeiro, Clea E; Almeida, Sergio M; Telles, João Paulo M; Azevedo, Marcos; Schaitza, Gustavo A

2017-01-01

In Brazil, all patients who fulfill the criteria for AIDS have had free access to antiretroviral therapy since 1996. We performed this cross-sectional study to evaluate the causes of death among 643 HIV-infected patients over three non-consecutive years (2000, 2006, and 2010), using their epidemiological, clinical, and laboratory data. The causes of death were classified as AIDS-defining or non-AIDS-defining conditions. We observed a progressive increase in the prevalence of HIV infection over the study period, although there was also a decrease in the mortality rate for various groups, and especially among pediatric patients. An AIDS-defining condition was recorded as the cause of death for approximately 30% of the patients. There was also a high frequency (>70%) of infectious and parasitic diseases, including opportunistic infections, and the most common diagnoses were septicemia, pneumonia, tuberculosis, and pneumocystosis. Acute respiratory failure was the underlying cause of death in 30% of these cases. Despite advances in HIV therapy, the mortality rate remains high in Brazil. As few Brazilian studies have investigated HIV/AIDS-related mortality, it is important to evaluate and improve the mortality notification databases, in order to provide information regarding the effects of HIV and to guide the implementation of appropriate healthcare measures.

Metabolic Differentiation of Early Lyme Disease from Southern Tick-Associated Rash Illness (STARI)

PubMed Central

Molins, C. R.; Ashton, L. V.; Wormser, G. P.; Andre, B. G.; Hess, A. M.; Delorey, M. J.; Pilgard, M. A.; Johnson, B. J.; Webb, K.; Islam, M. N.; Pegalajar-Jurado, A; Molla, I.; Jewett, M. W.; Belisle, J. T.

2017-01-01

Lyme disease, the most commonly reported vector-borne disease in the United States, results from infection with Borrelia burgdorferi. Early clinical diagnosis of this disease is largely based on the presence of an erythematous skin lesion for individuals in high-risk regions. This, however, can be confused with other illnesses including southern tick-associated rash illness (STARI), an illness that lacks a defined etiological agent or laboratory diagnostic test, and is co-prevalent with Lyme disease in portions of the Eastern United States. By applying an unbiased metabolomics approach with sera retrospectively obtained from well-characterized patients we defined biochemical and diagnostic differences between early Lyme disease and STARI. Specifically, a metabolic biosignature consisting of 261 molecular features (MFs) revealed that altered N-acyl ethanolamine and primary fatty acid amide metabolism discriminated early Lyme disease from STARI. More importantly, development of classification models with the 261 MF biosignature and testing against validation samples differentiated early Lyme disease from STARI with an accuracy of 85 to 98%. These findings revealed metabolic dissimilarity between early Lyme disease and STARI, and provide a powerful and new approach to objectively distinguish early Lyme disease from an illness with nearly identical symptoms. PMID:28814545

Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports).

PubMed

Mountjoy, M; Junge, A; Alonso, J M; Clarsen, B; Pluim, B M; Shrier, I; van den Hoogenband, C; Marks, S; Gerrard, D; Heyns, P; Kaneoka, K; Dijkstra, H P; Khan, K M

2016-05-01

Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A framework for the study of coping, illness behaviour and outcomes.

PubMed

Shaw, C

1999-05-01

This paper presents a theoretical framework for the study of coping, illness attribution, health behaviour and outcomes. It is based upon models developed within health psychology and aims to provide a theoretical basis for nurse researchers to utilize psychosocial variables. It is an interactionist model which views outcomes as dependent upon both situation and person variables. The situation is viewed as the health threat or illness symptoms as well as the psychosocial context within which the person is operating. This context includes socio-economic factors, social support, social norms, and external factors such as the mass media. The experience of health threat is dependent upon individual appraisal, and the framework incorporates Folkman and Lazarus' transactional model of stress, as well as Leventhal's illness representation model. Behaviour and the perception of threat are also dependent upon outcome expectancies and the appraisal of one's own coping resources, and so the concepts of locus of control and self-efficacy are also incorporated. This framework allows one to identify determinants of behaviour and outcome, and will aid nurses in identifying areas for psycho-social intervention.

Developing interventions for chronically ill patients: is coping a helpful concept?

PubMed

de Ridder, D; Schreurs, K

2001-03-01

In this review, the role of coping in the development of psychosocial interventions for chronically ill patients is discussed. After summarizing the theoretical issues involved in the translation of the coping concept into an intervention, a review is undertaken of 35 studies concerned with the impact of interventions aimed at improving coping on patients' quality of life. These studies concern seven different chronic disease types (AIDS, asthma, cancer, cardiovascular diseases, chronic pain, diabetes, and rheumatoid arthritis) and show explicit consideration of attempts to manage illness in terms of coping to be rare. Many studies nevertheless address the equivalent of coping, namely behaviors and/or cognitions intended to deal with an illness situation appraised as stressful. The results of these studies are encouraging, although largely limited to the improvement of one or two particular coping strategies and problem-focused strategies in particular. It is argued that in order to expand on these initially positive findings, greater and more explicit consideration should be given to the potential of the coping concept for intervention with the chronically ill. The appraisal of stressful situations, the use of coping resources, and the strategic application of particular coping strategies should, for example, be given more careful consideration.

Women and AIDS caregiving: women's work?

PubMed

Songwathana, P

2001-01-01

In this ethnographic study, I examine personal, kinship, and social obligations and the role of women in the traditional Thai family. Under what circumstances do women take on the responsibility to care or not care, and how do they cope with the disease and care when they are also infected? Fifteen women who were afflicted or affected by HIV/AIDS participated in in-depth interviews and participant observations. Analysis employed mainly qualitative methods following Spradley. I show that women who are responsible for caring for both themselves and others, including members of their immediate families or extended family members, face a double jeopardy by virtue of their inferior role and status. When HIV-infected women experience illness, sometimes they feel split; they are incapable of functioning normally, yet they are obligated to do "What they've got to do." Women as carers feel that they have to care because they want to free someone else from suffering despite the fact that they are also suffering. Women roles as family carers seem to be both psychologically and socially constructed. AIDS care is not just a labour of love, but also is done in the spirit of work following Buddhist beliefs of karma and metta. In conclusion, traditional, persistent gender imbalances and inequalities influence women's sexuality, vulnerability, responsibility, and caregiving. When women become infected with HIV and sick with AIDS, their quality of life drops because of the physical, psychological, cultural value, and economic burdens of care they face. AIDS then necessitates rather than prevents women from fulfilling their multiple roles. Consequently, there is a need for greater support especially among Thai women who are afflicted and affected with AIDS.

Perceived social support and psychosocial distress among children affected by AIDS in china.

PubMed

Hong, Yan; Li, Xiaoming; Fang, Xiaoyi; Zhao, Guoxiang; Lin, Xiuyun; Zhang, Jintao; Zhao, Junfeng; Zhang, Liying

2010-02-01

The psychosocial wellbeing of the children affected by Acquired Immune Deficiency Syndrome (AIDS) receives growing international attention. However, limited data in this area are available in China, which hosts an estimate of 100,000 AIDS-orphaned children. The study aims to examine the relationship between perceived social support (PSS) and psychosocial wellbeing among children affected by AIDS. A cross-sectional survey was administered to 1,625 children (aged 6-18 years) in Henan Province, an area with a large number of HIV cases due to unhygienic commercial blood/plasma collection. Our sample included 296 double orphans (i.e., children who lost both parents to AIDS), 459 single orphans (children who lost one parent to AIDS), 466 vulnerable children (children living with HIV-infected parents) and 404 comparison children (children who did not experience HIV-related illness and death in family). Data suggest that vulnerable children reported the lowest level of PSS compared to AIDS orphans and comparison children. Level of PSS was significantly and positively associated with psychosocial wellbeing even after controlling for potential confounders. The study underscores the importance of providing social support and mental health services for children affected by AIDS in China.

Computer Aided Instruction and Problem Solving in the Teaching of Oral Diagnosis.

ERIC Educational Resources Information Center

Spencer, Judson; Gobetti, John P.

A computer-assisted instructional (CAI) program is being used at the University of Michigan School of Dentistry to aid in the teaching of oral diagnosis to dental students. The program is designed to simulate a real life situation--i.e., the diagnosis of patient illness-which would not be otherwise available to the student and to demonstrate to…

Defining Quality of Life in the Children of Parents with Severe Mental Illness: A Preliminary Stakeholder-Led Model

PubMed Central

Bee, Penny; Berzins, Kathryn; Calam, Rachel; Pryjmachuk, Steven; Abel, Kathryn M.

2013-01-01

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13–18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key ‘meta-themes’. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector

Defining quality of life in the children of parents with severe mental illness: a preliminary stakeholder-led model.

PubMed

Bee, Penny; Berzins, Kathryn; Calam, Rachel; Pryjmachuk, Steven; Abel, Kathryn M

2013-01-01

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13-18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key 'meta-themes'. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to

School performance and school behavior of children affected by AIDS in China

PubMed Central

Tu, Xiaoming; Lv, Yunfei; Li, Xiaoming; Fang, Xiaoyi; Zhao, Guoxiang; Lin, Xiuyun; Hong, Yan; Zhang, Liying; Stanton, Bonita

2009-01-01

It is generally recognized that the AIDS epidemic will have a negative effect on the orphans’ school education. However, few studies have been carried out to examine the school performance and school behavior of AIDS orphans and vulnerable children (children living with HIV-infected parents). Using both self-report and teacher evaluation data of 1625 children from rural central China, we examined the impact of parental HIV/AIDS on children's school performances (academic marks, educational expectation, and student leadership) and school behaviors (e.g., aggression, shy/anxious and assertive social skills). Results indicate that AIDS orphans and vulnerable children had disadvantages in school performances in comparison to their peers from the same community who did not experience AIDS-related death and illness in their family (comparison children). AIDS orphans had the lowest academic marks based on the reports of both children and teachers. Educational expectation was significantly lower among AIDS orphans and vulnerable children than comparison children from teacher's perspective. AIDS orphans were significantly more likely to demonstrate aggressive, impulsive and anxious behaviors than non-orphans. Moreover, orphans have more learning difficulties. Vulnerable children were also at a disadvantage on most measures. The data suggest that a greater attention is needed to the school performance and behavior of children affected by AIDS. The findings also indicate that AIDS relief and assistance program for children should go beyond the school attendance and make efforts to improve their school performance and education aspiration. PMID:20107622

Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses.

PubMed

Mullins, Alexandria J; Gamwell, Kaitlyn L; Sharkey, Christina M; Bakula, Dana M; Tackett, Alayna P; Suorsa, Kristina I; Chaney, John M; Mullins, Larry L

2017-07-01

To examine predictors of psychological functioning in college students with chronic illnesses. Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between November 2013 and May 2015. Participants completed online measures of psychosocial functioning, including illness uncertainty, illness intrusiveness, depression, and anxiety. Students with chronic illnesses other than asthma or allergies evidenced the greatest levels of anxious (p <. 05), but not depressive symptomology. Additionally, this group reported greater illness uncertainty and intrusiveness (p <. 05) compared to their peers. Uncertainty and intrusiveness independently predicted depressive and anxious symptoms for students in both illness groups. Compared to peers with asthma or allergies, college students with other chronic illnesses reported higher levels of anxious symptoms. Illness uncertainty and intrusiveness appear to be predictors of psychological distress, regardless of illness.

Parent-adolescent conflict and stress when parents are living with AIDS.

PubMed

Rotheram-Borus, M J; Robin, L; Reid, H M; Draimin, B H

1998-01-01

Parental perceptions of conflict and stress with their adolescent children are described, and their associations with demographic factors, physical health, and lifestyle are examined. Adolescent-parent conflicts, parenting stress, and parents' health, substance use, and sexual lifestyle were assessed among 151 parents living with AIDS. Parents living with AIDS reported a mean of 3.3 (SD = 1.3) areas of conflict with their adolescents and 1.5 (SD = 1.7) stressful parenting events over the previous 3 months. The parents were very ill, with many physical symptoms and diseases. Simultaneously, substance use was common (17% used daily), but not injection drug use (3.3%). Half had a sexual partner (63% protected their partners by using condoms consistently). Regression analysis revealed that parent-adolescent conflict was significantly associated with high parental drug use; stressful parenting events were significantly related to the lifestyle (high drug use and frequent sex acts) of Latino and African American parents, but not of white parents. Results of the analysis indicate that, in contrast to parents with other illnesses, parent-adolescent conflict and stressful parenting events were not influenced by parents' health status, but were significantly influenced by substance use and sexual lifestyles.

Spirituality and Religion in Patients with HIV/AIDS

PubMed Central

Cotton, Sian; Puchalski, Christina M; Sherman, Susan N; Mrus, Joseph M; Peterman, Amy H; Feinberg, Judith; Pargament, Kenneth I; Justice, Amy C; Leonard, Anthony C; Tsevat, Joel

2006-01-01

BACKGROUND Spirituality and religion are often central issues for patients dealing with chronic illness. The purpose of this study is to characterize spirituality/religion in a large and diverse sample of patients with HIV/AIDS by using several measures of spirituality/religion, to examine associations between spirituality/religion and a number of demographic, clinical, and psychosocial variables, and to assess changes in levels of spirituality over 12 to 18 months. METHODS We interviewed 450 patients from 4 clinical sites. Spirituality/religion was assessed by using 8 measures: the Functional Assessment of Chronic Illness Therapy—Spirituality-Expanded scale (meaning/peace, faith, and overall spirituality); the Duke Religion Index (organized and nonorganized religious activities, and intrinsic religiosity); and the Brief RCOPE scale (positive and negative religious coping). Covariates included demographics and clinical characteristics, HIV symptoms, health status, social support, self-esteem, optimism, and depressive symptoms. RESULTS The patients’ mean (SD) age was 43.3 (8.4) years; 387 (86%) were male; 246 (55%) were minorities; and 358 (80%) indicated a specific religious preference. Ninety-five (23%) participants attended religious services weekly, and 143 (32%) engaged in prayer or meditation at least daily. Three hundred thirty-nine (75%) patients said that their illness had strengthened their faith at least a little, and patients used positive religious coping strategies (e.g., sought God’s love and care) more often than negative ones (e.g., wondered whether God has abandoned me; P<.0001). In 8 multivariable models, factors associated with most facets of spirituality/religion included ethnic and racial minority status, greater optimism, less alcohol use, having a religion, greater self-esteem, greater life satisfaction, and lower overall functioning (R2=.16 to .74). Mean levels of spirituality did not change significantly over 12 to 18 months

Antioxidant Vitamins and Trace Elements in Critical Illness.

PubMed

Koekkoek, W A C Kristine; van Zanten, Arthur R H

2016-08-01

This comprehensive narrative review summarizes relevant antioxidant mechanisms, the antioxidant status, and effects of supplementation in critically ill patients for the most studied antioxidant vitamins A, C, and E and the enzyme cofactor trace elements selenium and zinc. Over the past 15 years, oxidative stress-mediated cell damage has been recognized to be fundamental to the pathophysiology of various critical illnesses such as acute respiratory distress syndrome, ischemia-reperfusion injury, and multiorgan dysfunction in sepsis. Related to these conditions, low plasma levels of antioxidant enzymes, vitamins, and trace elements have been frequently reported, and thus supplementation seems logical. However, low antioxidant plasma levels per se may not indicate low total body stores as critical illness may induce redistribution of antioxidants. Furthermore, low antioxidant levels may even be beneficial as pro-oxidants are essential in bacterial killing. The reviewed studies in critically ill patients show conflicting results. This may be due to different patient populations, study designs, timing, dosing regimens, and duration of the intervention and outcome measures evaluated. Therefore, at present, it remains unclear whether supplementation of antioxidant micronutrients has any clinical benefit in critically ill patients as some studies show clear benefits, whereas others demonstrate neutral outcomes and even harm. Combination therapy of antioxidants seems logical as they work in synergy and function as elements of the human antioxidant network. Further research should focus on defining the normal antioxidant status for critically ill patients and to study optimal supplement combinations either by nutrition enrichment or by enteral or parenteral pharmacological interventions. © 2016 American Society for Parenteral and Enteral Nutrition.

An Optimization Model for the Allocation of University Based Merit Aid

ERIC Educational Resources Information Center

Sugrue, Paul K.

2010-01-01

The allocation of merit-based financial aid during the college admissions process presents postsecondary institutions with complex and financially expensive decisions. This article describes the application of linear programming as a decision tool in merit based financial aid decisions at a medium size private university. The objective defined for…

EXPERIENCES OF HIV/AIDS STIGMA OF PERSONS LIVING WITH HIV/AIDS AND NURSES INVOLVED IN THEIR CARE FROM FIVE AFRICAN COUNTRIES

PubMed Central

Greeff, Minrie; Uys, Leana R; Holzemer, William L; Makoae, Lucia N; Dlamini, Priscilla S; Kohi, Thecla W; Chirwa, Maureen L; Naidoo, Joanne R; Phetlhu, Rene D.

2009-01-01

The concept of stigma has received significant attention in recent years in the HIV/AIDS literature. Although there is some change towards the positive, AIDS still remains a significantly stigmatized condition. AIDS stigma and discrimination continue to influence people living with and affected by HIV (PLWA), as well as their health-care providers. Unless stigma is conquered, the illness will not be defeated. Due to the burden that HIV/AIDS places on people living in Africa, a five-year project entitled Perceived AIDS Stigma: A Multinational African Study was undertaken. The focus of the first phase of this project was on exploring and describing the meaning and effect of stigma on PLWA from the experiences of PLWA and the nurses involved in their care in five African countries: Lesotho, Swaziland, Malawi, South Africa and Tanzania. An exploratory descriptive qualitative research design was used to explore and describe the experience of stigma through the critical incident method. Purposive voluntary sampling was utilized. Forty-three focus group discussions were held with respondents to relate incidences which they themselves observed, as well as those that they themselves experienced in the community and in families. The transcribed data was analyzed through the technique of open coding using the NVivo 2.0 analysis package. Three types of stigma (received stigma, internal stigma and associated stigma) and several dimensions for each of these types of stigma emerged from the data. Recommendations were made to pursue these findings further. PMID:20052299

Time spent on health related activities associated with chronic illness: a scoping literature review.

PubMed

Jowsey, Tanisha; Yen, Laurann; W, Paul Mathews

2012-12-03

The management of health care, particularly for people with chronic conditions, combines the activities of health professionals, patients, informal carers and social networks that support them. Understanding the non-professional roles in health management requires information about the health related activities (HRA) that are undertaken by patients and informal carers. This understanding allows management planning that incorporates the capacity of patients and informal carers, as well as identifying the particular skills, knowledge and technical support that are necessary. This review was undertaken to identify how much time people with chronic illness and their informal carers spend on HRA. Literature searches of three electronic databases (CINAHL, Medline, and PubMed) and two journals (Time and Society, Sociology of Health and Illness) were carried out in 2011 using the following search terms (and derivatives): chronic illness AND time AND consumer OR carer. The search was aimed at finding studies of time spent on HRA. A scoping literature review method was utilised. Twenty-two peer reviewed articles published between 1990 and 2010 were included for review. The review identified limited but specific studies about time use by people with a chronic illness and/or their carers. While illness work was seen as demanding, few studies combined inquiry about both defined tasks and defined time use. It also identified methodological issues such as consistency of definition and data collection methods, which remain unresolved. While HRA are seen as demanding by people doing them, few studies have measured actual time taken to carry out a comprehensive range of HRA. The results of this review suggest that both patients with chronic illness and informal carers may be spending 2 hours a day or more on HRA. Illnesses such as diabetes may be associated with higher time use. More empirical research is needed to understand the time demands of self-management, particularly for

Heat Illness

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... dangerous levels and you can develop a heat illness. Most heat illnesses happen when you stay out ... in high heat can also lead to heat illness. Older adults, young children, and those who are ...

Differences in the causes of death of HIV-positive patients in a cohort study by data sources and coding algorithms.

PubMed

Hernando, Victoria; Sobrino-Vegas, Paz; Burriel, M Carmen; Berenguer, Juan; Navarro, Gemma; Santos, Ignacio; Reparaz, Jesús; Martínez, M Angeles; Antela, Antonio; Gutiérrez, Félix; del Amo, Julia

2012-09-10

To compare causes of death (CoDs) from two independent sources: National Basic Death File (NBDF) and deaths reported to the Spanish HIV Research cohort [Cohort de adultos con infección por VIH de la Red de Investigación en SIDA CoRIS)] and compare the two coding algorithms: International Classification of Diseases, 10th revision (ICD-10) and revised version of Coding Causes of Death in HIV (revised CoDe). Between 2004 and 2008, CoDs were obtained from the cohort records (free text, multiple causes) and also from NBDF (ICD-10). CoDs from CoRIS were coded according to ICD-10 and revised CoDe by a panel. Deaths were compared by 13 disease groups: HIV/AIDS, liver diseases, malignancies, infections, cardiovascular, blood disorders, pulmonary, central nervous system, drug use, external, suicide, other causes and ill defined. There were 160 deaths. Concordance for the 13 groups was observed in 111 (69%) cases for the two sources and in 115 (72%) cases for the two coding algorithms. According to revised CoDe, the commonest CoDs were HIV/AIDS (53%), non-AIDS malignancies (11%) and liver related (9%), these percentages were similar, 57, 10 and 8%, respectively, for NBDF (coded as ICD-10). When using ICD-10 to code deaths in CoRIS, wherein HIV infection was known in everyone, the proportion of non-AIDS malignancies was 13%, liver-related accounted for 3%, while HIV/AIDS reached 70% due to liver-related, infections and ill-defined causes being coded as HIV/AIDS. There is substantial variation in CoDs in HIV-infected persons according to sources and algorithms. ICD-10 in patients known to be HIV-positive overestimates HIV/AIDS-related deaths at the expense of underestimating liver-related diseases, infections and ill defined causes. CoDe seems as the best option for cohort studies.

Mental health first aid guidelines: an evaluation of impact following download from the World Wide Web.

PubMed

Hart, Laura M; Jorm, Anthony F; Paxton, Susan J; Cvetkovski, Stefan

2012-11-01

Mental health first aid guidelines provide the public with consensus-based information about how to assist someone who is developing a mental illness or experiencing a mental health crisis. The aim of the current study was to evaluate the usefulness and impact of the guidelines on web users who download them. Web users who downloaded the documents were invited to respond to an initial demographic questionnaire, then a follow up about how the documents had been used, their perceived usefulness, whether first-aid situations had been encountered and if these were influenced by the documents. Over 9.8 months, 706 web users responded to the initial questionnaire and 154 responded to the second. A majority reported downloading the document because their job involved contact with people with mental illness. Sixty-three web users reported providing first aid, 44 of whom reported that the person they were assisting had sought professional care as a result of their suggestion. Twenty-three web users reported seeking care themselves. A majority of those who provided first aid reported feeling that they had been successful in helping the person, that they had been able to assist in a way that was more knowledgeable, skilful and supportive, and that the guidelines had contributed to these outcomes. Information made freely available on the Internet, about how to provide mental health first aid to someone who is developing a mental health problem or experiencing a mental health crisis, is associated with more positive, empathic and successful helping behaviours. © 2012 Wiley Publishing Asia Pty Ltd.

Nature of depression in patients with HIV/AIDS.

PubMed

Judd, Fiona; Komiti, Angela; Chua, Phyllis; Mijch, Anne; Hoy, Jennifer; Grech, Paul; Street, Alan; Lloyd, John; Williams, Ben

2005-09-01

Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS. One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded. Approximately one-third scored > or = 14 on the BDI and 27% met criteria for a current 'mood disorder' on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of 'organic' or secondary depression. These results suggest that at least for 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.

A Computational Framework for Identifiability and Ill-Conditioning Analysis of Lithium-Ion Battery Models

DOE Office of Scientific and Technical Information (OSTI.GOV)

López C, Diana C.; Wozny, Günter; Flores-Tlacuahuac, Antonio

2016-03-23

The lack of informative experimental data and the complexity of first-principles battery models make the recovery of kinetic, transport, and thermodynamic parameters complicated. We present a computational framework that combines sensitivity, singular value, and Monte Carlo analysis to explore how different sources of experimental data affect parameter structural ill conditioning and identifiability. Our study is conducted on a modified version of the Doyle-Fuller-Newman model. We demonstrate that the use of voltage discharge curves only enables the identification of a small parameter subset, regardless of the number of experiments considered. Furthermore, we show that the inclusion of a single electrolyte concentrationmore » measurement significantly aids identifiability and mitigates ill-conditioning.« less

Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis.

PubMed

Farahani, Mansour; Mulinder, Holly; Farahani, Alexander; Marlink, Richard

2017-06-01

The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise. The objective of this study was to provide information about the global prevalence and distribution of non-AIDS causes of death in the last ten years among people living with HIV receiving antiretroviral therapy, by income levels of countries. We used broad search terms in Google Scholar, PubMed, and EMBASE to identify all studies that investigated the cause of death among people living with HIV receiving antiretroviral therapy, published after January 1, 2005. References were also identified from review articles and reference lists. Inclusion criteria were English language, the study's end date was after 2005, all patients were HIV-positive, at least two-thirds of the patients were receiving antiretroviral therapy, at least one patient died of non-AIDS causes of death. Titles, abstracts, and articles were reviewed by at least two independent readers. Of 2951 titles identified in our original search, 151 articles were selected for further screening. We identified 19 studies meeting our full criteria, with patients from 55 different nations. Pooled non-AIDS causes of death prevalence estimates in high-income countries were 53.0% (95% confidence interval, 43.6-62.3), in developing countries 34.0% (95% confidence interval, 20.3-49.1), and in sub-Saharan countries 18.5% (95% confidence interval, 13.8-23.7). Statistically significant variation was noted within and between categories. Our findings show that a significant number of people living with HIV across the world die from cardiovascular disease, non-AIDS malignancies, and liver disease. There is a global need for further scrutiny in all regions to improve preventive measures and early detection according to distinct causes of death patterns.

Mathematical and Numerical Analysis of Model Equations on Interactions of the HIV/AIDS Virus and the Immune System

NASA Astrophysics Data System (ADS)

Parumasur, N.; Willie, R.

2008-09-01

We consider a simple HIV/AIDs finite dimensional mathematical model on interactions of the blood cells, the HIV/AIDs virus and the immune system for consistence of the equations to the real biomedical situation that they model. A better understanding to a cure solution to the illness modeled by the finite dimensional equations is given. This is accomplished through rigorous mathematical analysis and is reinforced by numerical analysis of models developed for real life cases.

Predicting survival in AIDS: refining the model.

PubMed

Hutchinson, S J; Brettle, R P; Gore, S M

1997-11-01

We tested the validity of a previously-published AIDS staging system by examining AIDS-defining diseases (ADDs) and CD4 counts as prognostic factors for survival of the 248 AIDS patients in the Edinburgh City Hospital Cohort, of whom 56% were injecting drug-users (IDUs). Cox regression was used to model the proportionality of risk of death as the CD4 count declined and more ADDs were experienced, and dependence upon post-AIDS treatment. Using the system of Mocroft et al. (Lancet 1995; 346:12-17) to grade severity, our data were well enough modelled, but we suggest: (i) regrading of HIV dementia (RR 3.9, 95% CI 2.5-6.0), mainly attributed to the drug users, to a very severe ADD; (ii) reduction in risk from zidovudine (RR 0.7, 95% CI 0.5-1.0) during AIDS follow-up for patients starting treatment at or after AIDS diagnosis; (iii) improved management of first mild ADDs (from 1987-89 to 1994-95: 40% reduction in IDUs appearing with mild index diseases, and an approximate three-fold reduction in risk associated with a mild ADD). This study supports previous findings on the significance of ADDs and lowest CD4 count in predicting the lifetime of AIDS patients.

Vulnerable to HIV / AIDS. Migration.

PubMed

Fernandez, I

1998-01-01

This special report discusses the impact of globalization, patterns of migration in Southeast Asia, gender issues in migration, the links between migration and HIV/AIDS, and spatial mobility and social networks. Migrants are particularly marginalized in countries that blame migrants for transmission of infectious and communicable diseases and other social ills. Effective control of HIV/AIDS among migrant and native populations requires a multisectoral approach. Programs should critically review the privatization of health care services and challenge economic models that polarize the rich and the poor, men and women, North and South, and migrant and native. Programs should recognize the equality between locals and migrants in receipt of health services. Countermeasures should have input from migrants in order to reduce the conditions that increase vulnerability to HIV/AIDS. Gender-oriented research is needed to understand women's role in migration. Rapid assessment has obscured the human dimension of migrants' vulnerability to HIV. Condom promotion is not enough. Migration is a major consequence of globalization, which holds the promise, real or imagined, of prosperity for all. Mass migration can be fueled by explosive regional developments. In Southeast Asia, migration has been part of the process of economic development. The potential to emigrate increases with greater per capita income. "Tiger" economies have been labor importers. Safe sex is not practiced in many Asian countries because risk is not taken seriously. Migrants tend to be used as economic tools, without consideration of social adjustment and sex behavior among singles.

DALI: defining antibiotic levels in intensive care unit patients: are current β-lactam antibiotic doses sufficient for critically ill patients?

PubMed

Roberts, Jason A; Paul, Sanjoy K; Akova, Murat; Bassetti, Matteo; De Waele, Jan J; Dimopoulos, George; Kaukonen, Kirsi-Maija; Koulenti, Despoina; Martin, Claude; Montravers, Philippe; Rello, Jordi; Rhodes, Andrew; Starr, Therese; Wallis, Steven C; Lipman, Jeffrey

2014-04-01

Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether β-lactam antibiotic dosing in critically ill patients achieves concentrations associated with maximal activity and whether antibiotic concentrations affect patient outcome. This was a prospective, multinational pharmacokinetic point-prevalence study including 8 β-lactam antibiotics. Two blood samples were taken from each patient during a single dosing interval. The primary pharmacokinetic/pharmacodynamic targets were free antibiotic concentrations above the minimum inhibitory concentration (MIC) of the pathogen at both 50% (50% f T>MIC) and 100% (100% f T>MIC) of the dosing interval. We used skewed logistic regression to describe the effect of antibiotic exposure on patient outcome. We included 384 patients (361 evaluable patients) across 68 hospitals. The median age was 61 (interquartile range [IQR], 48-73) years, the median Acute Physiology and Chronic Health Evaluation II score was 18 (IQR, 14-24), and 65% of patients were male. Of the 248 patients treated for infection, 16% did not achieve 50% f T>MIC and these patients were 32% less likely to have a positive clinical outcome (odds ratio [OR], 0.68; P = .009). Positive clinical outcome was associated with increasing 50% f T>MIC and 100% f T>MIC ratios (OR, 1.02 and 1.56, respectively; P < .03), with significant interaction with sickness severity status. Infected critically ill patients may have adverse outcomes as a result of inadeqaute antibiotic exposure; a paradigm change to more personalized antibiotic dosing may be necessary to improve outcomes for these most seriously ill patients.

Social/sexual norms and AIDS in the South. Ethics and the politics of aids: lessons for small cities and rural areas throughout the U.S.

PubMed

Bell, N K

1991-01-01

No one denies that the face of AIDS (the "AIDS profile") is changing, and it is clear that we are entering a new phase in our understanding of this disease. As the AIDS profile changes, however, we are seeing a change in attitudes about prevention. In this stage of the epidemic there seems to be a move toward adopting more coercive strategies for breaking the chain of transmission. One concern, obviously, is that newly HIV-infected persons will find that they have little capacity to demand recognition of their rights to consent, to be treated, to confidentiality, to move about freely in society, to work, and so on. Unfortunately, this bodes ill for newly infected persons in previously low-incidence areas. Two very recent studies suggest that rates of high-risk sexual behavior among homosexual/bisexual men in smaller cities and rural areas in the South are much higher than rates now reported for gay men in large city epicenters. This paper attempts to examine the implications of differences in social and sexual behavior norms in the South for the spread of AIDS/HIV and to suggest morally appropriate primary prevention strategies for working within them.

Children's attitudes toward people with AIDS in Puerto Rico: exploring stigma through drawings and stories.

PubMed

González-Rivera, Milagritos; Bauermeister, José A

2007-02-01

AIDS stigma refers to prejudice and discrimination directed at people or groups perceived to have HIV/AIDS (Herek, 1999). Although AIDS stigma has been found in adolescent and adult populations, few researchers have explored it among children. Misconceptions about people with AIDS (PWA) might lead to negative attitudes toward PWA and obstruct HIV prevention efforts. The authors assessed 110 Puerto Rican children's attitudes toward PWA using drawings (n=65) and stories (n=45). Although participants held stigmatizing attitudes toward PWA across both methods, the approaches captured different beliefs and attitudes. Drawings depicted PWA as physically deteriorated and performing socially condemned behaviors, whereas stories describing PWA highlighted children's fear of contagion and death. Stigma toward PWA was more pronounced than toward other illnesses (e.g., cancer). The study highlights the importance of assessing children's attitudes through creative data collection procedures.

Injury and illness among athletes during a multi-day elite cycling road race.

PubMed

Yanturali, Sedat; Canacik, Omer; Karsli, Emre; Suner, Selim

2015-11-01

Although road bicycle races have been held for more than a century, injury and illness patterns during multi-day bicycle events have not been widely studied. The aim of this study was to determine the incidence of injury and illness among riders and describe the medical care interventions provided to participants of cycling road races. A prospective observational study was conducted on the Presidential Cycling Tour of Turkey, which was held between April 26 and May 3, 2015. The race lasted 8 days and covered 1258 km of road. There were 166 elite cycling athletes representing 21 teams from various countries. Data collected pertaining to incidents involving injury or illness included the following: type of injury; anatomical location of injury; details of the medical encounter; location of the intervention; treatment provided; medication administered and disposition of the rider. An injury was defined as a physical complaint or observable damage to the body produced by the transfer of energy of the rider. An illness was defined as a physical complaint or presentation not related to injury. The overall incidence (injury and illness) was 5.83 per 1000 cycling hours. (Injury incidence was 2.82 vs illness incidence of 3.01 per 1000 hours cycling). A total of 31 incidents occurred. Of these, 15 were injuries, while 16 were complaints of a non-traumatic nature. A total of 43 interventions were made in the 15 cases of injury. The most commonly injured body regions were limbs; the majority of injuries involved the skin and soft tissue. The most common medical intervention was wound care (64% of all interventions). Two riders had to withdraw from the race, and one was hospitalized due to a traumatic pneumothorax. None of the non-traumatic cases resulted in withdrawal from the race. A broad spectrum of illness and injury occurs during elite multi-day road races, ranging from simple skin injuries to serious injuries requiring hospital admission. Most injuries and illnesses are

Religion and HIV/AIDS stigma: Implications for health professionals in Puerto Rico

PubMed Central

Varas-Díaz, N.; Neilands, T.B.; Malavé Rivera, S.; Betancourt, E.

2009-01-01

HIV/AIDS stigma continues to be a barrier for prevention efforts. Its detrimental effects have been documented among people living with HIV/AIDS and encompass loss of social support and depression. When it is manifested by health professionals, it can lead to suboptimal services. Although strides have been made to document the effects of HIV/AIDS stigma, much needs to be done in order to understand the structural factors that can foster it. Such is the case of religion’s role on HIV/AIDS stigma in Puerto Rico. The Caribbean Island has a Judeo-Christian based culture due to years of Spanish colonisation. This religious influence continued under Protestantism as part of the Island’s integration as a non-incorporated territory of the USA. The main objective of this study was to explore the role of religion in HIV/AIDS stigma manifested by Puerto Rican health professionals in practice and in training. Through a mixed method approach, 501 health professionals completed qualitative interviews (n=80) and self-administered questionnaires (n=421). Results show that religion plays some role in conceptualisations of health and illness among participants in the study. Furthermore, the importance placed on religion and participation in such activities was related to higher levels of HIV/AIDS stigma. PMID:20087809

Supporting families of parents with mental illness in general practice.

PubMed

Baulderstone, Michaela J; Morgan, Bradley S; Fudge, Elizabeth A

2013-08-05

The general-practice setting provides a unique opportunity to positively influence the impact of mental illness on individuals and families. Intervention can begin from the moment an individual seeks professional help. Using a family-focused approach, and supporting parents to develop practical strategies to promote resilience in their children, can aid parents' recovery and promote the optimal emotional wellbeing of their children. We suggest a family-orientated therapeutic approach relevant to the general-practice setting, with particular consideration of the value of communicating with children according to the child's stage of emotional development.

A Platform for Crowdsourced Foodborne Illness Surveillance: Description of Users and Reports.

PubMed

Quade, Patrick; Nsoesie, Elaine Okanyene

2017-07-05

Underreporting of foodborne illness makes foodborne disease burden estimation, timely outbreak detection, and evaluation of policies toward improving food safety challenging. The objective of this study was to present and evaluate Iwaspoisoned.com, an openly accessible Internet-based crowdsourcing platform that was launched in 2009 for the surveillance of foodborne illness. The goal of this system is to collect data that can be used to augment traditional approaches to foodborne disease surveillance. Individuals affected by a foodborne illness can use this system to report their symptoms and the suspected location (eg, restaurant, hotel, hospital) of infection. We present descriptive statistics of users and businesses and highlight three instances where reports of foodborne illness were submitted before the outbreaks were officially confirmed by the local departments of health. More than 49,000 reports of suspected foodborne illness have been submitted on Iwaspoisoned.com since its inception by individuals from 89 countries and every state in the United States. Approximately 95.51% (42,139/44,119) of complaints implicated restaurants as the source of illness. Furthermore, an estimated 67.55% (3118/4616) of users who responded to a demographic survey were between the ages of 18 and 34, and 60.14% (2776/4616) of the respondents were female. The platform is also currently used by health departments in 90% (45/50) of states in the US to supplement existing programs on foodborne illness reporting. Crowdsourced disease surveillance through systems such as Iwaspoisoned.com uses the influence and familiarity of social media to create an infrastructure for easy reporting and surveillance of suspected foodborne illness events. If combined with traditional surveillance approaches, these systems have the potential to lessen the problem of foodborne illness underreporting and aid in early detection and monitoring of foodborne disease outbreaks. ©Patrick Quade, Elaine Okanyene

Sources of AIDS awareness among women in India.

PubMed

Pallikadavath, S; Sreedharan, C; Stones, R W

2006-01-01

Sources of AIDS awareness among rural and urban Indian women were analysed using data from the National Family and Health Survey (1998-2000). Two measures were developed to study the impact each source had on knowledge. 'Effectiveness' was defined as the proportion of women who had heard of AIDS from only one source, from among women who had heard of AIDS from that particular source and other sources. 'Independent effect' was the proportion who had heard of AIDS from only one source in relation to all women who had heard of AIDS. Television was the most effective medium, and also had the highest independent effect. Radio and print had very low effectiveness and independent effect. Although television and print audiences are growing in India, it is likely a sub-group of women will continue to lack media access. There is an urgent need to disseminate AIDS awareness to this 'media underclass'. Since the media will not reach this group, other sources including health workers, community level activities such as adult education programmes, and networks of friends and relatives need to be explored.

Understanding and influencing the stigma of mental illness.

PubMed

Corrigan, Patrick W; Wassel, Abigail

2008-01-01

Life goals and the opportunities that define them are impaired by the stigma of mental illness. Three kinds of stigma may act as barriers to personal aspirations: public stigma, self-stigma, and label avoidance. Challenging mental illness stigm is essential in helping individuals accomplish recovery-related goals. Public stigma may be changed through protest, education, and contact. Self-stigma can be addressed by fostering group identity, changing the perceived legitimacy of stigma through cognitive rehabilitation, and making strategic decisions about disclosing one's mental health history. Stigma change for label avoidance is not as well understood but may include the education and contact approaches used for public stigma. Evidence-based approaches to stigma change need to be substantiated by rigorous investigations.

The AIDS pandemic in historic perspective.

PubMed

Kazanjian, Powel

2014-07-01

Potent antiretroviral drugs (ART) have changed the nature of AIDS, a once deadly disease, into a manageable illness and offer the promise of reducing the spread of HIV. But the pandemic continues to expand and cause significant morbidity and devastation to families and nations as ART cannot be distributed worldwide to all who need the drugs to treat their infections, prevent HIV transmission, or serve as prophylaxis. Furthermore, conventional behavioral prevention efforts based on theories that individuals can be taught to modify risky behaviors if they have the knowledge to do so have been ineffective. Noting behavioral strategies targeting individuals fail to address broader social and political structures that create environments vulnerable to HIV spread, social scientists and public health officials insist that HIV policies must be comprehensive and also target a variety of structures at the population and environmental level. Nineteenth-century public health programs that targeted environmental susceptibility are the historical analogues to today's comprehensive biomedical and structural strategies to handle AIDS. Current AIDS policies underscore that those fighting HIV using scientific advances in virology and molecular biology cannot isolate HIV from its broader environment and social context any more than their nineteenth-century predecessors who were driven by the filth theory of disease. © The Author 2012. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

AIDS: The Impact on the Criminal Justice System Management of Aids in Corrections.

DTIC Science & Technology

1991-01-01

interferon and some antibiotics, cause weakness and depression, which only adds to the patient’s feeling of dysphoria . In addition, some treatments ...science and ourselves will sharply redefine the future of AIDS treatment in correctional institutions. Sources of Data The data utilized in this...an effort to help define and evaluate current treatment rationale used in the correctional setting in comparison to that of "normal" society

Game-Based Learning as a Vehicle to Teach First Aid Content: A Randomized Experiment

ERIC Educational Resources Information Center

Charlier, Nathalie; De Fraine, Bieke

2013-01-01

Background: Knowledge of first aid (FA), which constitutes lifesaving treatments for injuries or illnesses, is important for every individual. In this study, we have set up a group-randomized controlled trial to assess the effectiveness of a board game for learning FA. Methods: Four class groups (120 students) were randomly assigned to 2…

Perception of HIV/AIDS Education at the Community Level in Jordan

PubMed Central

ABU MOGHLI, Fathieh; AL HABEESH, Suhair; ABU SHIKHA, Lubna

2017-01-01

Background: The control of spread of HIV takes concerted efforts at both national and international levels. Education is an important component of preventing the spread of HIV. This study aimed to assess the attitudes of parents, teachers and students towards informing children about HIV/AIDS, attitudes concerning ‘proper’ age to learn about HIV/AIDS, possible differences in attitudes relating to gender of child and what they should learn and ideas about the most ‘adequate’ person/institution to be responsible for provision of HIV/AIDS education. Methods: This study was conducted in Amman, Jordan in April 2015. Descriptive correlational design was used; a sample of school students, university students, school teachers and parents, a stratified random sample was used. Data was collected by using a questionnaire. Results: All groups asserted the importance of HIV/AIDS education and awareness rising for all. 62.0% of respondents thought that school was the main source of information. About 82% of respondents believed that HIV/AIDS education should be integrated into different disciplines of school curricula, 84% of respondents believed that HIV/AIDS education should be part of university curricula. Nobody believed that HIV/AIDS education should be restricted to boys only. Conclusion: As HIV/AIDS is a scary matter to all, stigmatization and shame may be behind potentially bigger numbers of infected or ill people who do not come forward for treatment or care. Attitudes of their kin care providers need to be addressed as well as those of the official health care providers. PMID:28435815

Raising the bar for the care of seriously ill patients: results of a national survey to define essential palliative care competencies for medical students and residents.

PubMed

Schaefer, Kristen G; Chittenden, Eva H; Sullivan, Amy M; Periyakoil, Vyjeyanth S; Morrison, Laura J; Carey, Elise C; Sanchez-Reilly, Sandra; Block, Susan D

2014-07-01

Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.

Raising the Bar for the Care of Seriously Ill Patients: Results of a National Survey to Define Essential Palliative Care Competencies for Medical Students and Residents

PubMed Central

Schaefer, Kristen G.; Chittenden, Eva H.; Sullivan, Amy M.; Periyakoil, Vyjeyanth S.; Morrison, Laura J.; Carey, Elise C.; Sanchez-Reilly, Sandra; Block, Susan D.

2014-01-01

Purpose Given the shortage of palliative care specialists in the U.S., to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. Method Proposed competencies were derived from existing Hospice and Palliative Medicine fellowship competencies, and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. Results The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate=72%, 71/98). Using predefined cut-off criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. Conclusions This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community. PMID:24979171

Cultural conceptions of HIV/AIDS among teenagers in Bolivia, Chile and Mexico.

PubMed

Torres López, Teresa Margarita; Reynaldos Quinteros, Carolina; Lozano González, Aldo Favio; Munguía Cortés, Jazmín Aranzazú

2010-10-01

To understand the cultural dimensions of HIV/AIDS among adolescent students. A cognitive anthropological study was undertaken in Cochabamba (Bolivia), Talca (Chile) and Guadalajara (Mexico), during 2007 and 2008. A total of 184 teenagers (from 14 to 19 years old) were selected by purposeful sampling at secondary schools in each country. Free association lists and pile sorts were utilized. Terms associated with the concept of HIV/AIDS and groups of conceptual dimensions were investigated. Subsequently, consensus analysis was performed using factorial principal components and dimensional analysis through hierarchical clusters and multidimensional scales. The differences between the country contexts were in the degree of consensus in relation to the term HIV/AIDS, which was greater in Cochabamba. In Talca and Guadalajara the youths mentioned metaphors of fighting against HIV/AIDS, while in Cochabamba participants talked about help, support and love that infected people should receive. The similarities among conceptions by youth from the three countries were: the risk factors (unprotected sexual practice and contact with specific population groups), the consequences (physical and social death, being the latter understood as social rejection of people living with HIV/AIDS) and the prevention of illness (based on information and condom use). For adolescent students, HIV/AIDS is a disease caused by sexual practices and drug use and involves harm, pain and death. HIV/AIDS prevention programs for adolescents should promote science based information on the topic and not concentrate only on the emotional and social consequences of HIV/AIDS.

HIV/AIDS among women in Havana, Cuba: 1986-2011.

PubMed

Oliva, Dinorah C; Viñas, Arturo L; Saavedra, Clarivel; Oliva, Maritza; González, Ciro; de la Torre, Caridad

2013-10-01

Women are being diagnosed with HIV infection in increasing numbers, and now account for 50% of cases worldwide. In Cuba, HIV is more frequent in men, but in recent years, a growing number of women have been diagnosed. Describe patterns of HIV among women in Havana, Cuba, 1986-2011. Descriptive study of women with HIV aged >14 years, residents of Havana, Cuba, who were diagnosed with HIV from 1 January 1986 through 31 December 2011. Information was obtained from the limited-access HIV/AIDS database of Cuba's Ministry of Public Health. Data were studied from all reported cases, a total of 1274 women. Variables selected were age at diagnosis, education, municipality of residence, screening group, year of HIV diagnosis, late presentation, AIDS-defining condition, year of diagnosis as AIDS case, vital status at the end of 2011, and year of death (if applicable). Incidence of HIV and AIDS, cumulative incidence by municipality of residence, and case fatality rates were calculated. Those aged 20-29 years were most affected by HIV. Almost half (46.7%) the women had completed middle school, and a further 35.4% had completed high school or middle-level technical studies. HIV incidence began to increase more steeply starting in 1998, as did AIDS incidence by year of diagnosis, though to a lesser extent. Central Havana and Old Havana municipalities had the highest cumulative incidence. Late presentation was seen in 7.4% of cases; mean age of those diagnosed late was 38.9 years. Wasting syndrome and Pneumocystis jirovecii pneumonia were the most frequent AIDS-defining conditions. Case fatality rates started to decline in 1998. HIV infection in women is occurring in a predominantly young, relatively well-educated population. Increasing rates of HIV and AIDS in the past decade are a warning sign of the possible expansion of HIV infection in women, even though mortality is declining.

Self-care and mothering in African American women with HIV/AIDS.

PubMed

Shambley-Ebron, Donna Z; Boyle, Joyceen S

2006-02-01

African American women are the most rapidly growing group of people in the United States diagnosed with HIV/AIDS. The purpose of this study was to explore experiences of self-care and mothering among African American women with HIV/AIDS. It is important to recognize how culture affects illness management, childrearing, and daily living to design culturally appropriate nursing interventions for African American women. Critical ethnography was used to study 10 African American mothers from the rural Southeast who were HIV positive and mothered children who were HIV positive. Domains derived from the research were disabling relationships, strong mothering, and redefining self-care. The cultural theme was creating a life of meaning. African American mothers with HIV/AIDS in the rural Southeast used culturally specific self-care and mothering strategies reflective of cultural traditions. This study acknowledges strengths of African American women and generates theory that will enhance nursing care to this population.

Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review.

PubMed

Hamilton, Clayon B; Wong, Ming-Kin; Gignac, Monique A M; Davis, Aileen M; Chesworth, Bert M

2017-01-01

To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis. © 2016 World Institute of Pain.

Houston man with AIDS loses job after co-workers vote to expel him.

PubMed

1995-03-10

An employee sued a [name removed] machine shop that held a companywide vote culminating in the firing of the employee because he had AIDS. The lawsuit contended that the employee was able to perform his duties at the shop and that the shop had violated the Texas Health and Safety Code by disclosing his AIDS illness to his co-workers without his consent. The Equal Employment Opportunity Commission (EEOC) found that all the evidence indicated that the sole reason for the employee's firing was due to his disability. It was also judged that the company had violated the employee's right to privacy by publicizing his HIV status.

Defining Support Requirements During Conceptual Design of Reusable Launch Vehicles

NASA Technical Reports Server (NTRS)

Morris, W. D.; White, N. H.; Davis, W. T.; Ebeling, C. E.

1995-01-01

Current methods for defining the operational support requirements of new systems are data intensive and require significant design information. Methods are being developed to aid in the analysis process of defining support requirements for new launch vehicles during their conceptual design phase that work with the level of information available during this phase. These methods will provide support assessments based on the vehicle design and the operating scenarios. The results can be used both to define expected support requirements for new launch vehicle designs and to help evaluate the benefits of using new technologies. This paper describes the models, their current status, and provides examples of their use.

Mental illness research in the Gulf Cooperation Council: a scoping review.

PubMed

Hickey, Jason E; Pryjmachuk, Steven; Waterman, Heather

2016-08-04

Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users' experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services.This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users' experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting.From this review, it is clear that the sociocultural context in the region is linked to service users' experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice

A literature review on self-care of chronic illness: definition, assessment and related outcomes.

PubMed

Ausili, Davide; Masotto, Matteo; Dall'Ora, Chiara; Salvini, Lorena; Di Mauro, Stefania

2014-01-01

Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients. A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies. Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed.

At risk, infected, and invisible: older gay men and HIV/AIDS.

PubMed

Grossman, A H

1995-01-01

Older gay men over the age of 50 have been and continue to be an invisible part of the HIV/AIDS epidemic. The reasons for this phenomenon are many, but among them are societal beliefs, myths, and stereotypes emanating from ageism and homophobia. In addition, HIV/AIDS is sometimes misdiagnosed in older adults because many of its symptoms mimic other illness that affect older people. Among the HIV risk factors of older gay men are internalized homophobia, denial of risk, alcohol and other substance use, and anonymous sexual encounters. The challenge for nurses and other providers is to reach, educate, and assist older gay men effectively in changing and maintaining safe behaviors when they are engaging in sexual and drug-using behaviors that can transmit HIV.

Risk factors for unplanned pregnancy in women with mental illness living in a developing country.

PubMed

du Toit, Elsa; Jordaan, Esme; Niehaus, Dana; Koen, Liezl; Leppanen, Jukka

2018-06-01

Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. In this quantitative, descriptive study, we investigated both socio-demographic factors and variables relating to mental illness itself that may place women at an increased risk of experiencing unplanned pregnancy. Data was gathered at two maternal mental health clinics in Cape Town by means of semi-structured interviews. Univariate analyses of the data revealed five independent key risk factors for unplanned pregnancy: lower levels of education, unmarried status, belonging to the Colored ethnic population, substance use, and having a history of two or more suicide attempts. Some of these factors overlap with findings of similar studies, but others are unique to the specific population (women with mental illness within a developing country). Screening of women based on these risk predictors may pave the way for early interventions and reduce the incidence of unplanned pregnancy and the negative consequences thereof in the South African population.

How does uncertainty shape patient experience in advanced illness? A secondary analysis of qualitative data.

PubMed

Etkind, Simon Noah; Bristowe, Katherine; Bailey, Katharine; Selman, Lucy Ellen; Murtagh, Fliss Em

2017-02-01

Uncertainty is common in advanced illness but is infrequently studied in this context. If poorly addressed, uncertainty can lead to adverse patient outcomes. We aimed to understand patient experiences of uncertainty in advanced illness and develop a typology of patients' responses and preferences to inform practice. Secondary analysis of qualitative interview transcripts. Studies were assessed for inclusion and interviews were sampled using maximum-variation sampling. Analysis used a thematic approach with 10% of coding cross-checked to enhance reliability. Qualitative interviews from six studies including patients with heart failure, chronic obstructive pulmonary disease, renal disease, cancer and liver failure. A total of 30 transcripts were analysed. Median age was 75 (range, 43-95), 12 patients were women. The impact of uncertainty was frequently discussed: the main related themes were engagement with illness, information needs, patient priorities and the period of time that patients mainly focused their attention on (temporal focus). A typology of patient responses to uncertainty was developed from these themes. Uncertainty influences patient experience in advanced illness through affecting patients' information needs, preferences and future priorities for care. Our typology aids understanding of how patients with advanced illness respond to uncertainty. Assessment of these three factors may be a useful starting point to guide clinical assessment and shared decision making.

Illness as Teacher: Learning from Illness

ERIC Educational Resources Information Center

Yoo, Joanne

2017-01-01

This article is a conceptual exploration into the value of illness, bodies and embodied practice in teacher education. It draws on my reflections and practitioner accounts of poor health to investigate the potential to learn from illness. I position myself in this discussion as a non-tenured academic who experiences the challenges of her uncertain…

Home Health Care for Chronically Ill Children: Hearing before the Committee on Labor and Human Resources, United States Senate, Ninety-Ninth Congress, First Session on Examining the Needs for Pediatric Home Care for Children with Long-Term Illnesses and Disabilities.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

The proceedings of the 1985 hearing address issues in pediatric home care for children with long-term illnesses and disabilities. Statements of parents center on extreme expenses of home care and the difficulties of finding financial aid. Additional testimony is offered by representatives of home health care agencies, physicians involved in care…

HIV Liability & Disability Services Providers: An Introduction to Tort Principles. AIDS Technical Report, No. 2.

ERIC Educational Resources Information Center

Harvey, David C.; Decker, Curtis L.

This technical report is part of a series on AIDS/HIV (Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus) and is intended to help link various legal advocacy organizations providing services to persons with mental illness or developmental disabilities. This report focuses on liability issues from worker and client exposure to HIV.…

Evaluating the Effectiveness of Mental Health First Aid Program for Chinese People in Hong Kong

ERIC Educational Resources Information Center

Wong, Daniel F. K.; Lau, Ying; Kwok, Sylvia; Wong, Prudence; Tori, Christopher

2017-01-01

Purpose: Chinese people generally lack knowledge of mental illness. Such phenomenon may lead to a delay in seeking psychiatric treatments. This study evaluated the effectiveness of Mental Health First Aid (MHFA) program in improving mental health knowledge of the general public in Hong Kong. Methods: A quasi-experimental design was adopted whereby…

Physical Illness, Psychiatric Illness, and the Acceptability of Suicide.

ERIC Educational Resources Information Center

Deluty, Robert H.

1989-01-01

Assessed whether attitudes toward suicide vary as function of type of illness that precipitates suicide. College students (N=455) responded to scenarios of suicide victim. Evaluations of suicide were most favorable when it occurred in response to terminal physical illness; less favorable in response to chronic, non-terminal physical illness; and…

Positive parenting for positive parents: HIV/AIDS, poverty, caregiver depression, child behavior, and parenting in South Africa.

PubMed

Lachman, Jamie M; Cluver, Lucie D; Boyes, Mark E; Kuo, Caroline; Casale, Marisa

2014-01-01

Families affected by HIV/AIDS in the developing world experience higher risks of psychosocial problems than nonaffected families. Positive parenting behavior may buffer against the negative impact of child AIDS-orphanhood and caregiver AIDS-sickness on child well-being. Although there is substantial literature regarding the predictors of parenting behavior in Western populations, there is insufficient evidence on HIV/AIDS as a risk factor for poor parenting in low- and middle-income countries. This paper examines the relationship between HIV/AIDS and positive parenting by comparing HIV/AIDS-affected and nonaffected caregiver-child dyads (n=2477) from a cross-sectional survey in KwaZulu-Natal, South Africa (27.7% AIDS-ill caregivers; 7.4% child AIDS-orphanhood). Multiple mediation analyses tested an ecological model with poverty, caregiver depression, perceived social support, and child behavior problems as potential mediators of the association of HIV/AIDS with positive parenting. Results indicate that familial HIV/AIDS's association to reduced positive parenting was consistent with mediation by poverty, caregiver depression, and child behavior problems. Parenting interventions that situate positive parenting within a wider ecological framework by improving child behavior problems and caregiver depression may buffer against risks for poor child mental and physical health outcomes in families affected by HIV/AIDS and poverty.

Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes

PubMed Central

Cain, Lauren E.; Caniglia, Ellen C.; Phillips, Andrew; Olson, Ashley; Muga, Roberto; Pérez-Hoyos, Santiago; Abgrall, Sophie; Costagliola, Dominique; Rubio, Rafael; Jarrín, Inma; Bucher, Heiner; Fehr, Jan; van Sighem, Ard; Reiss, Peter; Dabis, François; Vandenhende, Marie-Anne; Logan, Roger; Robins, James; Sterne, Jonathan A. C.; Justice, Amy; Tate, Janet; Touloumi, Giota; Paparizos, Vasilis; Esteve, Anna; Casabona, Jordi; Seng, Rémonie; Meyer, Laurence; Jose, Sophie; Sabin, Caroline; Hernán, Miguel A.

2016-01-01

Abstract Objective: To compare regimens consisting of either ritonavir-boosted atazanavir or efavirenz and a nucleoside reverse transcriptase inhibitor (NRTI) backbone with respect to clinical, immunologic, and virologic outcomes. Design: Prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States included in the HIV-CAUSAL Collaboration. Methods: HIV-positive, antiretroviral therapy-naive, and acquired immune deficiency syndrome (AIDS)-free individuals were followed from the time they started an atazanavir or efavirenz regimen. We estimated an analog of the “intention-to-treat” effect for efavirenz versus atazanavir regimens on clinical, immunologic, and virologic outcomes with adjustment via inverse probability weighting for time-varying covariates. Results: A total of 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths) and 18,786 individuals started an efavirenz regimen (389 deaths, 825 AIDS-defining illnesses or deaths). During a median follow-up of 31 months, the hazard ratios (95% confidence intervals) were 0.98 (0.77, 1.24) for death and 1.09 (0.91, 1.30) for AIDS-defining illness or death comparing efavirenz with atazanavir regimens. The 5-year survival difference was 0.1% (95% confidence interval: −0.7%, 0.8%) and the AIDS-free survival difference was −0.3% (−1.2%, 0.6%). After 12 months, the mean change in CD4 cell count was 20.8 (95% confidence interval: 13.9, 27.8) cells/mm3 lower and the risk of virologic failure was 20% (14%, 26%) lower in the efavirenz regimens. Conclusion: Our estimates are consistent with a smaller 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with atazanavir regimens. No overall differences could be detected with respect to 5-year survival or AIDS-free survival. PMID:27741139

Children's Attitudes toward People with AIDS in Puerto Rico: Exploring stigma through drawings and stories

PubMed Central

González-Rivera, Milagritos; Bauermeister, Josè A.

2014-01-01

AIDS stigma refers to prejudice and discrimination directed at people or groups perceived to have HIV/AIDS (Herek, 1999). Although AIDS stigma has been found in adolescent and adult populations, few researchers have explored it among children. Misconceptions about people with AIDS (PWA) might lead to negative attitudes toward PWA and obstruct HIV prevention efforts. The authors assessed 110 Puerto Rican children’s attitudes toward PWA using drawings (n = 65) and stories (n = 45). Although participants held stigmatizing attitudes toward PWA across both methods, the approaches captured different beliefs and attitudes. Drawings depicted PWA as physically deteriorated and performing socially condemned behaviors, whereas stories describing PWA highlighted children’s fear of contagion and death. Stigma toward PWA was more pronounced than toward other illnesses (e.g., cancer). The study highlights the importance of assessing children’s attitudes through creative data collection procedures. PMID:17220395

Metabolic differentiation of early Lyme disease from southern tick-associated rash illness (STARI).

PubMed

Molins, Claudia R; Ashton, Laura V; Wormser, Gary P; Andre, Barbara G; Hess, Ann M; Delorey, Mark J; Pilgard, Mark A; Johnson, Barbara J; Webb, Kristofor; Islam, M Nurul; Pegalajar-Jurado, Adoracion; Molla, Irida; Jewett, Mollie W; Belisle, John T

2017-08-16

Lyme disease, the most commonly reported vector-borne disease in the United States, results from infection with Borrelia burgdorferi. Early clinical diagnosis of this disease is largely based on the presence of an erythematous skin lesion for individuals in high-risk regions. This, however, can be confused with other illnesses including southern tick-associated rash illness (STARI), an illness that lacks a defined etiological agent or laboratory diagnostic test, and is coprevalent with Lyme disease in portions of the eastern United States. By applying an unbiased metabolomics approach with sera retrospectively obtained from well-characterized patients, we defined biochemical and diagnostic differences between early Lyme disease and STARI. Specifically, a metabolic biosignature consisting of 261 molecular features (MFs) revealed that altered N -acyl ethanolamine and primary fatty acid amide metabolism discriminated early Lyme disease from STARI. Development of classification models with the 261-MF biosignature and testing against validation samples differentiated early Lyme disease from STARI with an accuracy of 85 to 98%. These findings revealed metabolic dissimilarity between early Lyme disease and STARI, and provide a powerful and new approach to inform patient management by objectively distinguishing early Lyme disease from an illness with nearly identical symptoms. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

Using people to cope with the hunger: social networks and food transfers amongst HIV/AIDS afflicted households in KwaZulu-Natal, South Africa.

PubMed

Kaschula, Sarah

2011-10-01

Household afflicted by HIV/AIDS are particularly prone to food insecurity. This article explores the role of community networks in meeting household food deficits. One hundred households exhibiting a range (0-5) of HIV/AIDS proxies related to orphan fostering, prime adult chronic illness and mortality were visited at quarterly intervals for a year. At each assessment, donated food types consumed in the past 48 h were recorded, and household food security was monitored through an experiential measure. Factors determining access to donated foods were explored qualitatively by means of participant observation and semi-structured interviews. Poor households with prime adult chronic illness were prone to food insecurity, and used the most donated foods. However, not all households perceived to be afflicted with HIV/AIDS were able to access donated foods due to stigma and social exclusion. Concerted action must be taken by government, non-government and community agents if social food transfer networks are to be transformed into coordinated community action.

Why we must keep up the war on AIDS.

PubMed

Chalker

1993-01-01

A rebuttal is made to Neville Hodgkinson's article questioning the existence of the AIDS epidemic in view of the pressure on funds for overseas aid in order to explain why support is provided to international AIDS control programs. Some AIDS workers have questioned the reliability of AIDS statistics and challenged the conventional wisdom that the human immunodeficiency virus (HIV) causes illness and death. The British Medical Research Council and the Ugandan government have studied about 10,000 people in 15 villages in rural Masaka, southern Uganda. Adolescents and young adults infected with HIV-1 were 60 times more likely to die in the next year than those who were not infected. More than 50% of all adult deaths, and more than 80% of deaths in young adults, are associated with HIV-1. HIV-1 targets CD4 lymphocytes and kills them making people vulnerable to infections such as diarrhea and tuberculosis. In Africa, many of those infected with HIV die as a result of infections from which they would normally recover. In some parts of southern Uganda and northern Tanzania, the prevalence of adults infected with HIV has changed little over the past few years, hovering at 10-15%. In other areas, prevalence is nearer 30-40%. Condoms reduce infection risk and education and condom marketing is changing sexual behavior in Zaire, Zimbabwe, and Tanzania. British aid is designed to help countries tackle health issues in addition to HIV-AIDS faced by their people and to make the best use of cash. Predictions of drastic population decline across Africa, resulting from the relentless spread of HIV also undermined the efforts of African governments to restore both public and external confidence. Hundreds of medical and nursing staff working to improve the world's health draw attention to unnecessary expenditure and condemning waste. Yet none argue that the HIV epidemic is a myth.

Families, children, migration and AIDS.

PubMed

Haour-Knipe, Mary

2009-01-01

Migration is very often a family affair, and often involves children, directly or indirectly. It may give rise to better quality of life for an entire family, or to bitter disappointment, and may also increase vulnerability to HIV and AIDS. This review, carried out for the Joint Learning Initiative on Children and AIDS, links the literature on "migration", on "HIV and AIDS" and on "families". Three themes are sketched: (1) As both HIV prevalence and circular migration increase, former migrant workers affected by AIDS may return to their families for care and support, especially at the end of life, often under crisis conditions. Families thus lose promising members, as well as sources of support. However, very little is known about the children of such migrants. (2) Following patterns of migration established for far different reasons, children may have to relocate to different places, sometimes over long distances, if their AIDS-affected parents can no longer care for them. They face the same adaptation challenges as other children who move, but complicated by loss of parent(s), AIDS stigma, and often poverty. (3) The issue of migrant families living with HIV has been studied to some extent, but mainly in developed countries with a long history of migration, and with little attention paid to the children in such families. Difficulties include involuntary separation from family members, isolation and lack of support, disclosure and planning for children's care should the parent(s) die and differences in treatment access within the same family. Numerous research and policy gaps are defined regarding the three themes, and a call is made for thinking about migration, families and AIDS to go beyond description to include resilience theory, and to go beyond prevention to include care.

Families living with chronic illness: beliefs about illness, family, and health care.

PubMed

Årestedt, Liselott; Benzein, Eva; Persson, Carina

2015-05-01

Beliefs can be described as the lenses through which we view the world. With emerging illness, beliefs about the illness experience become important for nurses to understand to enhance well-being and healing. The aim of this study was to illuminate illness beliefs of families living with chronic illness. A qualitative design was chosen, including repeated narrative research interviews with seven Swedish families living with chronic illness. Hermeneutic analysis was used to interpret the transcribed family interviews. The result described beliefs in families, both within and across families. Both core beliefs and secondary beliefs about illness, family, and health care were revealed. Illness beliefs have importance for how families respond to and manage situations that arise from their encounters with illness. Nurses have to make space for and listen to families' stories of illness to become aware of what beliefs may support and encourage family well-being and healing. The Illness Beliefs Model provides a touchstone whereby nurses can distinguish both individual and shared beliefs within families living with chronic illness and provide ideas for family intervention if needed. © The Author(s) 2015.

Frailty in the critically ill: a novel concept

PubMed Central

2011-01-01

The concept of frailty has been defined as a multidimensional syndrome characterized by the loss of physical and cognitive reserve that predisposes to the accumulation of deficits and increased vulnerability to adverse events. Frailty is strongly correlated with age, and overlaps with and extends aspects of a patient's disability status (that is, functional limitation) and/or burden of comorbid disease. The frail phenotype has more specifically been characterized by adverse changes to a patient's mobility, muscle mass, nutritional status, strength and endurance. We contend that, in selected circumstances, the critically ill patient may be analogous to the frail geriatric patient. The prevalence of frailty amongst critically ill patients is currently unknown; however, it is probably increasing, based on data showing that the utilization of intensive care unit (ICU) resources by older people is rising. Owing to the theoretical similarities in frailty between geriatric and critically ill patients, this concept may have clinical relevance and may be predictive of outcomes, along with showing important interaction with several factors including illness severity, comorbid disease, and the social and structural environment. We believe studies of frailty in critically ill patients are needed to evaluate how it correlates with outcomes such as survival and quality of life, and how it relates to resource utilization, such as length of mechanical ventilation, ICU stay and duration of hospitalization. We hypothesize that the objective measurement of frailty may provide additional support and reinforcement to clinicians confronted with end-of-life decisions on the appropriateness of ICU support and/or withholding of life-sustaining therapies. PMID:21345259

Consecutive interactions with HSP90 and eEF1A underlie a functional maturation and storage pathway of AID in the cytoplasm

PubMed Central

Methot, Stephen P.; Litzler, Ludivine C.; Trajtenberg, Felipe; Zahn, Astrid; Robert, Francis; Pelletier, Jerry; Buschiazzo, Alejandro; Magor, Brad G.

2015-01-01

Activation-induced deaminase (AID) initiates mutagenic pathways to diversify the antibody genes during immune responses. The access of AID to the nucleus is limited by CRM1-mediated nuclear export and by an uncharacterized mechanism of cytoplasmic retention. Here, we define a conformational motif in AID that dictates its cytoplasmic retention and demonstrate that the translation elongation factor eukaryotic elongation factor 1 α (eEF1A) is necessary for AID cytoplasmic sequestering. The mechanism is independent of protein synthesis but dependent on a tRNA-free form of eEF1A. Inhibiting eEF1A prevents the interaction with AID, which accumulates in the nucleus and increases class switch recombination as well as chromosomal translocation byproducts. Most AID is associated to unspecified cytoplasmic complexes. We find that the interactions of AID with eEF1A and heat-shock protein 90 kD (HSP90) are inversely correlated. Despite both interactions stabilizing AID, the nature of the AID fractions associated with HSP90 or eEF1A are different, defining two complexes that sequentially produce and store functional AID in the cytoplasm. In addition, nuclear export and cytoplasmic retention cooperate to exclude AID from the nucleus but might not be functionally equivalent. Our results elucidate the molecular basis of AID cytoplasmic retention, define its functional relevance and distinguish it from other mechanisms regulating AID. PMID:25824822

Development and validation of the functional assessment of chronic illness therapy treatment satisfaction (FACIT TS) measures.

PubMed

Peipert, John D; Beaumont, Jennifer L; Bode, Rita; Cella, Dave; Garcia, Sofia F; Hahn, Elizabeth A

2014-04-01

To develop and validate a new functional assessment of chronic illness therapy (FACIT) measure of satisfaction with treatment for chronic illnesses such as cancer and HIV/AIDS. To define domains and generate items, a literature review informed creation of semi-structured interview guides for patients and an international expert panel of clinicians and researchers. Patients and experts also rated 15 areas of satisfaction for relevance. The final list of items underwent further refinement by the original expert panel and a new group of clinical experts. Items were tested in four studies (primarily lung cancer) and data were pooled for analysis. Exploratory and confirmatory factor analyses (CFA), and item response theory modeling were conducted to evaluate dimensionality. Internal consistency reliability and test-retest reliability were both evaluated. Validity was evaluated by correlating the FACIT subscale scores and measures of comparable concepts and by testing the scales' ability to distinguish people according to their overall treatment satisfaction. Two instruments were created: the FACIT TS-general (G), an overall evaluation of current treatment, and the FACIT TS-patient satisfaction (PS), a measure of patient satisfaction. CFA results were not optimal for a five-factor solution for PS. Internal consistency reliability met psychometric standards (≥0.70) for all PS subscales. Construct validity was established for the PS subscales: Physician Communication, Treatment Staff Communication, Technical Competence, Confidence and Trust, and Nurse Communication. The two instruments generated here offer a new way to assess several key dimensions of patient satisfaction with treatment, especially for people with lung cancer.

Mental health first aid training by e-learning: a randomized controlled trial.

PubMed

Jorm, Anthony F; Kitchener, Betty A; Fischer, Julie-Anne; Cvetkovski, Stefan

2010-12-01

Mental Health First Aid training is a course for the public that teaches how to give initial help to a person developing a mental health problem or in a mental health crisis. The present study evaluated the effects of Mental Health First Aid training delivered by e-learning on knowledge about mental disorders, stigmatizing attitudes and helping behaviour. A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health. Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to waiting list. E-learning also improved first aid actions taken more than waiting list, and was superior to the printed manual in reducing stigma and disability due to mental ill health. Mental Health First Aid information received by either e-learning or printed manual had positive effects, but e-learning was better at reducing stigma.

Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases.

PubMed

Suárez-García, Inés; Jarrín, Inmaculada; Iribarren, José Antonio; López-Cortés, Luis Fernando; Lacruz-Rodrigo, José; Masiá, Mar; Gómez-Sirvent, Juan Luis; Hernández-Quero, José; Vidal, Francesc; Alejos-Ferreras, Belén; Moreno, Santiago; Del Amo, Julia

2013-05-01

The aim of this study was to investigate the incidence and risk factors for the development of AIDS-defining cancers (ADCs); and to investigate the effect of making different assumptions on the definition of incident cases. A multicentre cohort study was designed. Poisson regression was used to assess incidence and risk factors. To account for misclassification, incident cases were defined using lag-times of 0, 14 and 30 days after enrolment. A total of 6393 HIV-positive subjects were included in the study. The incidences of ADCs changed as the lag periods were varied from 0 to 30 days. Different risk factors emerged as the definition of incident cases was changed. For a lag time of 0, the risk of Kaposi sarcoma [KS] and non-Hodgkin lymphoma [NHL] increased at CD4 counts <200/ml. HAART was associated with lower risk of NHL and KS. Men who had sex with men had a higher risk of KS. KS and NHL were not associated with viral load, gender, or hepatitis B or C. The results were similar for a lag-time of 14 and 30 days; however, hepatitis C was significantly associated with NHL. This analysis shows the importance of the definition of incident cases in cohort studies. Alternative definitions gave different incidence estimates, and may have implications for the analysis of risk factors. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Computer-Aided Design in Further Education.

ERIC Educational Resources Information Center

Ingham, Peter, Ed.

This publication updates the 1982 occasional paper that was intended to foster staff awareness and assist colleges in Great Britain considering the use of computer-aided design (CAD) material in engineering courses. The paper begins by defining CAD and its place in the Integrated Business System with a brief discussion of the effect of CAD on the…

The concept of stigma in mental illness as applied to Haitian Americans.

PubMed

Dieujuste, Colette

2016-06-01

To report on the analysis of the concept of the stigma of mental illness within the Haitian American community. Mental illness is a highly stigmatized condition within certain communities making it challenging for individuals to seek effective treatment. The consequences of such stigma can have lifelong corollaries for the individuals, the families and the communities. The concept of stigma is not fully developed in nursing; clarity of the concept of stigma of mental illness is still needed in the nursing literature. In order to assist patients in accessing mental health services, the concept of stigma must first be clarified. The method used for this concept analysis was that of Walker and Avant. Five attributes were identified, creating the following definition: labelling, stereotype, negative attitude, emotional response, and discrimination. The antecedents for stigma of mental illness are lack of knowledge about mental illness, emotional state and cultural beliefs and values. The origins of stigmatization of mental illness among Haitian Americans need to be understood. Mental health illnesses are stigmatized within the Haitian culture, which presents as a barrier to accessing help for many Haitian American women suffering from mental illness. The defining attributes can be used to develop tools to help clinicians identify patients being stigmatized. Once stigma is recognized, nurses can develop strategies and policies that can mitigate the effects of stigmatization of mental illness among this patient population. Further research is essential to examine the ways in which this concept impacts the Haitian American community, as well as effective strategies to help minimize its effects. © 2016 International Council of Nurses.

Epidemiology, determinants, and management of AIDS cholangiopathy: A review

PubMed Central

Naseer, Maliha; Dailey, Francis E; Juboori, Alhareth Al; Samiullah, Sami; Tahan, Veysel

2018-01-01

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management. PMID:29467548

Epidemiology, determinants, and management of AIDS cholangiopathy: A review.

PubMed

Naseer, Maliha; Dailey, Francis E; Juboori, Alhareth Al; Samiullah, Sami; Tahan, Veysel

2018-02-21

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.

When Is Depression a Terminal Illness? Deliberative Suicide in Chronic Mental Illness.

PubMed

George, Constance E

2016-06-01

This commentary explores the utility of hope as a therapeutic tool for intervention in the case of a patient with a mental illness that is refractory to treatment over time, who expresses her intention to commit suicide. It begins with a short discussion differentiating a deliberative consideration of suicide from an impulsive act. Then the commentary defines hope, how it might be used as a therapeutic tool, and which limitations a clinician might confront in such a case. This commentary also considers the role of a physician in orientation not only to the patient but also to her own thoughts, feelings, and emotions regarding a patient's expressed desire to end her life. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

Evaluation of heterosexual partners, children, and household contacts of adults with AIDS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fischl, M.A.; Dickinson, G.M.; Scott, G.B.

Forty-five adults with the acquired immunodeficiency syndrome (AIDS) and their 45 spouses, 109 children, and 29 household contacts were studied for evidence of heterosexual, perinatal, and household spread of human T-cell lymphotropic virus type III (HTLV-III) infection. Of the 45 spouses enrolled, 26 (58%) had antibody to HTLV-III, including 12 (71%) of 17 male spouses and 14 (50%) of 28 female spouses. Of the 12 seropositive male spouses, nine were seropositive at enrollment and three had seroconversion. Of the 14 seropositive female spouses, four were seropositive at enrollment and ten seroconverted. Lack of barrier contraceptive use and oral sex weremore » associated with seroconversion. Of the 109 children enrolled, 15 had AIDS or an AIDS-related illness, two had evidence of passive transfer of maternal antibodies, and two had HTLV-III infection acquired outside the household. None of the 90 seronegative children seroconverted. Of 29 household contacts studied, nondeveloped antibody to HTLV-III.« less

Illness behavior.

PubMed

Sirri, Laura; Grandi, Silvana

2012-01-01

The term illness behavior was introduced by Mechanic and Volkart to describe the individuals' different ways to respond to their own health status. Pilowsky's concept of abnormal illness behavior encompasses several clinical conditions characterized by a maladaptive mode of experiencing, perceiving, evaluating and responding to one's own health status. The concept of somatization was criticized because it implies the presence of psychological distress or an underlying psychiatric disturbance when an organic cause for somatic symptoms is not found. Thus, more atheoretical terms , such as functional somatic symptoms and medically unexplained symptoms, were introduced. Both Kellner's Symptom Questionnaire and Derogatis' Symptom Checklist-90 include a scale for somatic symptoms, and other questionnaires were specifically designed to measure their frequency and severity. Kellner's Illness Attitude Scales appear to be the gold standard for the measurement of the hypochondriacal spectrum, which includes several clinical conditions, such as nosophobia, thanatophobia and health anxiety. The assessment of illness denial should consider that a certain degree of denial may sometimes prevent patients from overwhelming psychological distress resulting from life-threatening or stigmatized diseases. Denial may concern both physical and psychiatric symptoms. Specific instruments are available for both types of denial. The cognitive and emotional representations developed by subjects when they have to cope with an illness or a perceived health threat are subsumed under the concept of illness perception and may be assessed by the Brief Illness Perception Questionnaire. Copyright © 2012 S. Karger AG, Basel.

Ethical Guidelines for Counselors when Working with Clients with Terminal Illness Requesting Physician Aid in Dying

ERIC Educational Resources Information Center

Kurt, Layla J.; Piazza, Nick J.

2012-01-01

In 2005, the American Counseling Association (ACA) introduced a new ethical standard for counselors working with clients with terminal illness who are considering hastened death options. The authors' purpose is to inform counselors of the Death With Dignity Act and explore relevant ethical guidelines in the "ACA Code of Ethics" (ACA, 2005).

Building Coalitions To Provide HIV Legal Advocacy Services: Utilizing Existing Disability Models. AIDS Technical Report, No. 5.

ERIC Educational Resources Information Center

Harvey, David C.; Ardinger, Robert S.

This technical report is part of a series on AIDS/HIV (Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus) and is intended to help link various legal advocacy organizations providing services to persons with mental illness or developmental disabilities. This report discusses strategies to utilize existing disability models for…

[Mutual aid societies for industrial accidents and occupational diseases in the social security service within the framework of the Prevention of Occupational Risk Act].

PubMed

Albalá-Ortiz, M

The passing of the Prevention of Industrial Risks Act, in force from 9 February 1996 has altered previous ideas on the subject, which is currently considered to be of utmost importance for national and community legislation. In this article we describe the preventive functions of the Mutual Aid Societies for Industrial Accidents and professional diseases of the National Health Service. We have analysed the current legislation so as to clarify the activities of the Mutual Aid Societies in the field of the prevention of industrial accidents, and have defined the actions which may be taken in this field according to the present laws. Two different types of preventive activities are considered: (1) Those which depend on contributions, included in the professional risks cover, and which are obliged to prepare an annual plan of the measures taken to prevent industrial accidents and professional illness, following the guidelines established by the Ministry of Labor and Social Services and according to certain priorities. (2) The functions corresponding to the services for third-party prevention exclusively for their associated companies when the Mutual Aid Society is approved as a service for third party cover. This requires a voluntary or professional contract and the financial cost is borne by the company which requests it. The objective of the current legislation is, amongst other things, to introduce the new preventive approach established by the Prevention of Industrial Risks Act in the workplace and through the Mutual Aid Societies as well as to foment a new culture of prevention.

Molecular epidemiology of HIV: tracking AIDS pandemic.

PubMed

TakebE, Yutaka; Kusagawa, Shigeru; Motomura, Kazushi

2004-04-01

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) epidemic is a global threat to maternal and child health, especially in developing countries. It is estimated that 800 000 children are infected and 580 000 children die of AIDS-related illnesses every year. Molecular epidemiology has been a useful tool in analyzing the origin of HIV and tracking the course of global HIV spread. This article provides an overview of recent advances in the field of molecular epidemiology of HIV across the world, and discuss the biological implications. Based on the near full-length or partial nucleotide sequence information, the phylogeny and recombinant structure of HIV strains are analyzed. Using genotype classification of HIV as a molecular marker, the origin and the genesis of HIV epidemic are investigated. The HIV-1 group M, a major HIV group responsible for current AIDS pandemic, began its expansion in human population approximately 70 years ago and diversified rapidly over time, now comprising a number of different subtypes and circulating recombinant forms (CRF). Of note, recent studies revealed that new recombinant strains are arising continually, becoming a powerful force in the spread of HIV-1 across the globe. Global dissemination of HIV is a dramatic and deadly example of recent genome emergence and expansion. Molecular epidemiological investigation is expected to provide information critical for prevention and future vaccine strategies.

Promoting vision and hearing aids use in an intensive care unit.

PubMed

Zhou, Qiaoling; Faure Walker, Nicholas

2015-01-01

Vision and hearing impairments have long been recognised as modifiable risk factors for delirium.[1,2,3] Delirium in critically ill patients is a frequent complication (reported as high as 60% to 80% of intensive care patients), and is associated with a three-fold increase in mortality and prolonged hospital stay.[1] Guidelines by the UK Clinical Pharmacy Association recommend minimising risk factors to prevent delirium, rather than to treat it with pharmacological agents which may themselves cause delirium.[4] To address risk factors is a measure of multi-system management, such as sleep-wake cycle correction, orientation and use of vision and hearing aids, etc.[5] We designed an audit to survey the prevalence and availability of vision and hearing aids use in the intensive care unit (ICU) of one university hospital. The baseline data demonstrated a high level of prevalence and low level of availability of vision /hearing aid use. We implemented changes to the ICU Innovian assessment system, which serves to remind nursing staff performing daily checks on delirium reduction measures. This has improved practice in promoting vision and hearing aids use in ICU as shown by re-audit at six month. Further amendments to the Innovian risk assessments have increased the rate of assessment to 100% and vision aid use to near 100%.

Impact of smoking cessation aids and mass media among recent quitters.

PubMed

Biener, Lois; Reimer, Rebecca L; Wakefield, Melanie; Szczypka, Glen; Rigotti, Nancy A; Connolly, Gregory

2006-03-01

Although studies have addressed the effectiveness of conventional smoking aids such as quit-smoking programs and pharmaceutical therapy, few studies have assessed their likely impact on cessation at the population level relative to the impact of mass media anti-tobacco advertisements. A random digit dial telephone survey of 6739 Massachusetts residents conducted in 2001-2002 yielded a subsample of 787 individuals who had quit-smoking within the past 2 years. Measures included the types of cessation aids used and perceptions of their helpfulness. Rates of population impact were estimated. Multinomial logistic regression determined the predictors of being helped by conventional aids, by TV advertisements only, or having no help. Analyses conducted in 2004-2005 showed that advertisements were the most frequently mentioned source of help among recent quitters. Older more dependent smokers were most likely to find conventional aids helpful. Younger respondents and those who had remained abstinent for more than 6 months were most likely to report being helped by TV ads. The most helpful ads were those that depicted illness due to smoking or provided inspirational quit tips. Anti-tobacco media campaigns are a vital component of the National Action Plan for Tobacco Cessation. It is essential that such a campaign be implemented, both to support the National Quit Line and to provide assistance to those smokers who find no other form of aid helpful.

Comparative Impact of Two Training Packages on Awareness and Practices of First Aid for Injuries and Common Illnesses among High School Students in India

ERIC Educational Resources Information Center

Goel, Sonu; Singh, Amarjeet

2008-01-01

Knowledge about various illnesses and their management is not satisfactory among high school students especially in rural areas in India. Various incorrect practices and myths associated with illnesses and injuries still exit. Training and education about correct management of injuries and illnesses for students is a sound and logical investment.…

Effects of contact-based mental illness stigma reduction programs: age, gender, and Asian, Latino, and White American differences.

PubMed

Wong, Eunice C; Collins, Rebecca L; Cerully, Jennifer L; Yu, Jennifer W; Seelam, Rachana

2018-03-01

Mental illness stigma disproportionately affects help seeking among youth, men, and ethnic minorities. As part of a comprehensive statewide initiative to reduce mental illness stigma and discrimination in California, a broad set of contact-based educational programs were widely disseminated. This study examined whether the effects of contact-based educational programs varied depending on the age, gender, and race-ethnicity of participants. Participants (N = 4122) attended a contact-based educational program that was delivered as part of the statewide initiative to reduce mental illness stigma and discrimination. Self-administered surveys assessing beliefs, attitudes, and intentions toward mental illnesses and treatment were conducted immediately before and after participation in contact-based educational programs. Participant age, gender, and race-ethnicity significantly moderated pre-post changes in mental illness stigma. Although all groups exhibited significant pre-post changes across most of the stigma domains assessed, young adults, females, and Asian and Latino American participants reported larger improvements compared to older adults, males, and Whites, respectively. Findings suggest that contact-based educational programs can achieve immediate reductions in mental illness stigma across a variety of sociodemographic groups and may particularly benefit young adults and racial-ethnic minorities. Further research is needed to assess whether contact-based educational programs can sustain longer-term changes and aid in the reduction of disparities in mental illness stigma and treatment.

Health technology assessment-based development of a Spanish breast cancer patient decision aid.

PubMed

Izquierdo, Fátima; Gracia, Javier; Guerra, Mercedes; Blasco, Juan Antonio; Andradas, Elena

2011-10-01

The aim of this study was to develop a breast cancer Patient Decision Aid (PDA), using a Health Technology Assessment (HTA) process, to assist patients in their choice of therapeutic options, and to promote shared decision making among patients, healthcare professionals, and other interested parties. A systematic review (SR) was conducted of existing breast cancer patient Decision Aids encountered in the main scientific journal databases and on institutional Web sites that create PDAs, together with a Qualitative Research (QR) study, using semi-structured interviews and focus group with stakeholders (patients, family members, and health professionals), with the aim of developing a PDA for breast cancer. The SR shows that PDAs in breast cancer not only increase patient knowledge of the illness, leading to more realistic expectations of treatment outcomes, but also reduce passivity in the decision-making process and facilitate the appropriate choice of treatment options in accordance with patient medical and personal preferences. The analysis of QR shows that both breast cancer patients and healthcare professionals agree that surgery, adjuvant treatments, and breast reconstruction represent the most important decisions to be made. Worry, anxiety, optimism, and trust in healthcare professionals were determined as factors that most affected patients subjective experiences of the illness. This HTA was used as the basis for developing a PDA software program. The SR and QR used in the development of this PDA for breast cancer allowed patients to access information, gain additional knowledge of their illness, make shared treatment decisions, and gave healthcare professionals a deeper insight into patient experiences of the disease.

[First-aid in France. Current situation and future perspectives].

PubMed

Larcan, Alain; Julien, Henri

2010-06-01

First-aid--treatment aimed at enabling a victim to survive pending the arrival of qualified medical support--is less well developed in France than in many other industrialized countries, especially among the general public. The current status of first-aid in France is paradoxical: schooling is free and obligatory, the ambulance service and emergency services are of the highest quality, but the general public are too often passive and unknowledgeable when faced with an emergency situation. This situation is due to several factors, including the complexity of first-aid training and regulations, the involvement of too many public bodies, the legal liability of the first-aider, and a lack of ongoing training. The French National Academy of Medicine recommends 8 measures to improve this situation: Provide a legal definition of first-aid: "a set of recognized measures aimed, in an emergency setting, at preserving the physical and psychological integrity of the victim of an accident or illness, notably pending the arrival of professional medical assistance". Waive, as in many other countries, civil and legal responsibility for the non professional first-aider, except in case of clear negligence. Reinforce the organization of first-aid in France in order to monitor the number and quality of first-aiders, and to ensure theoretical and pedagogic research; create a communications department capable of supporting and promoting first-aid. Improve access to first-aid training by increasing the number of situations in which it is obligatory (driving tuition, school and university examinations, group responsibility, at-risk practices), by providing financial assistance for certain groups, and by ensuring routine training at school, in the armed forces, and in the workplace. Create a progressive and integrated citizen first-aid training course with individual modules, ensuring that first-aiders update and perfect their knowledge throughout life. Soften pedagogic rules and shorten

Effectiveness of first-aid training on school students in Singur Block of Hooghly District, West Bengal.

PubMed

Bandyopadhyay, Lina; Manjula, M; Paul, Bobby; Dasgupta, Aparajita

2017-01-01

First aid is the helping behavior and initial care provided for an acute illness or injury. Students have the potential for changing the health scenario of the society if properly groomed and educated. The objective of the study is to evaluate the effectiveness of educational intervention on the first aid among middle school students of a rural school in West Bengal. A total of 230, 6 th and 7 th standard students were given a self-administered questionnaire for assessing their baseline knowledge about management of common injuries followed by educational intervention with a systematically devised teaching module during February to March 2016. Post intervention evaluation of their knowledge acquisition was done after 2 weeks with same questionnaire. The baseline knowledge on the management of selected injuries was found to be insufficient among the study subjects. Paired t -test was performed to compare the pre- and post-test scores of knowledge and attitude of the students about first aid, and there was a significant change in knowledge from pretest score (mean = 1.50, standard deviation [SD] =0.47) to posttest score (mean = 6.53, SD = 1.30). To quantify the effectiveness of health education, effect size (Cohen's d) was derived. For knowledge score, Cohen's d was 5.14 with large effect size indicating highly effective impact of the training program. Significant change was also noticed regarding attitude regarding first aid as evident from increase in pretest score (mean = 1.19, SD = 0.96) to posttest score (mean = 3.17, SD = 1.03); Cohen's d was 1.88 with medium effect size. Inculcating first-aid training in the school curriculum can be a fruitful investment in ensuring proper and timely management of illnesses and injuries not only for the school children but also for the community at large.

Extracurricular interest as a resilience building block for children affected by parental HIV/AIDS.

PubMed

Zhao, Junfeng; Chi, Peilian; Li, Xiaoming; Tam, Cheuk Chi; Zhao, Guoxiang

2014-01-01

Parental illness and death due to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) impose challenges to children's psychological adjustment. Positive psychology emphasizes individual's resilience in the face of adversity, trauma, and tragedy. Limited data are available regarding the factors that can cultivate resilience of children affected by HIV/AIDS. This study aims to examine the role of extracurricular interest in strengthening resilience among children affected by HIV/AIDS. Participants included 755 children orphaned by parental HIV/AIDS, 466 vulnerable children living with HIV-positive parent(s), and 404 comparison children from HIV-free families in the same community in rural China. The measures include extracurricular interest (i.e., reading, sports, music, painting, science, and playing chess) and indicators of psychological adjustment (i.e., depression, loneliness, and self-esteem). Having extracurricular interest was positively associated with self-esteem and negatively associated with depression and loneliness. Having extracurricular interest attenuated the negative effect of parental HIV/AIDS on children's self-esteem and loneliness, after controlling for children's age, gender, and family socioeconomic status. The findings underscore the importance of nurturing extracurricular interest and make available of such activities to promote resilience for children affected by HIV/AIDS in resource-limited settings.

The Hidden Strand of Mathematical Proficiency: Defining and Assessing for Productive Disposition in Elementary School Teachers' Mathematical Content Knowledge

ERIC Educational Resources Information Center

Siegfried, John Zig Michael

2012-01-01

Teachers' mathematical content knowledge is one of the most important constructs considered by researchers studying elementary mathematics education (Fennema & Franke, 1992). One component of mathematical content knowledge that is complicated, ill-defined, and oft-ignored is "productive disposition," defined as the…

HIV and AIDS in suburban Asian and Pacific Islander communities: factors influencing self-efficacy in HIV risk reduction.

PubMed

Takahashi, Lois M; Magalong, Michelle G; Debell, Paula; Fasudhani, Angela

2006-12-01

Though AIDS case rates among Asian Pacific Islander Americans (APIs) in the United States remain relatively low, the number has been steadily increasing. Scholars, policy makers, and service providers still know little about how confident APIs are in carrying out different HIV risk reduction strategies. This article addresses this gap by presenting an analysis of a survey of API women and youth in Orange County, California (N = 313), a suburban county in southern California with large concentrations of Asian residents. Multivariate logistic regression models using subsamples of API women and API youth respondents were used. Variations in reported self-efficacy for female respondents were explained by acculturation, comfort in asking medical practitioners about HIV/AIDS, and to a lesser degree, education, household size, whether respondents were currently dating, HIV knowledge, and whether respondents believed that HIV could be identified by physical appearance. For respondents younger than 25 years, variations in self-efficacy were related to gender, age, acculturation, HIV knowledge, taking-over-the-counter medicines for illness, whether respondents were dating, and to a lesser degree, employment, recent serious illness, whether they believe that one could identify HIV by how one looks, and believing that illness was caused by germs. Implications for HIV prevention programs and future research are provided.

A new prognostic score for AIDS-related lymphomas in the rituximab-era

PubMed Central

Barta, Stefan K.; Xue, Xiaonan; Wang, Dan; Lee, Jeannette Y.; Kaplan, Lawrence D.; Ribera, Josep-Maria; Oriol, Albert; Spina, Michele; Tirelli, Umberto; Boue, Francois; Wilson, Wyndham H.; Wyen, Christoph; Dunleavy, Kieron; Noy, Ariela; Sparano, Joseph A.

2014-01-01

While the International Prognostic Index is commonly used to predict outcomes in immunocompetent patients with aggressive B-cell non-Hodgkin lymphomas, HIV-infection is an important competing risk for death in patients with AIDS-related lymphomas. We investigated whether a newly created prognostic score (AIDS-related lymphoma International Prognostic Index) could better assess risk of death in patients with AIDS-related lymphomas. We randomly divided a dataset of 487 patients newly diagnosed with AIDS-related lymphomas and treated with rituximab-containing chemoimmunotherapy into a training (n=244) and validation (n=243) set. We examined the association of HIV-related and other known risk factors with overall survival in both sets independently. We defined a new score (AIDS-related lymphoma International Prognostic Index) by assigning weights to each significant predictor [age-adjusted International Prognostic Index, extranodal sites, HIV-score (composed of CD4 count, viral load, and prior history of AIDS)] with three risk categories similar to the age-adjusted International Prognostic Index (low, intermediate and high risk). We compared the prognostic value for overall survival between AIDS-related lymphoma International Prognostic Index and age-adjusted International Prognostic Index in the validation set and found that the AIDS-related lymphoma International Prognostic Index performed significantly better in predicting risk of death than the age-adjusted International Prognostic Index (P=0.004) and better discriminated risk of death between each risk category (P=0.015 vs. P=0.13). Twenty-eight percent of patients were defined as low risk by the ARL-IPI and had an estimated 5-year overall survival (OS) of 78% (52% intermediate risk, 5-year OS 60%; 20% high risk, 5-year OS 50%). PMID:25150257

Presentation and outcome amongst older Singaporeans living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS): does age alone drive excess mortality?

PubMed

Huggan, Paul J; Foo, Rui Min; Olszyna, Dariusz; Chew, Nicholas S; Smitasen, Nares; Mukhopadhyay, Amartya; Archuleta, Sophia

2012-12-01

There is little detailed information on human immunodeficiency virus (HIV) amongst older adults in Singapore. A retrospective study of 121 consecutive referrals of patients presenting for HIV care was conducted. Demographic, clinical and laboratory variables were collected. A prognostic model derived from the North American Veterans' Affairs Cohort Study (VACS) was used to estimate prognosis. The median age at presentation was 43 (range, 18 to 76). Thirty-eight patients (31%) were aged 50 or older and 106 patients (88%) were male. Older patients were more likely to be of Chinese ethnicity (P = 0.035), married (P = 0.0001), unemployed or retired (P = 0.0001), and to have acquired their infection heterosexually (P = 0.0002). The majority of patients in both groups were symptomatic at presentation. Eighty-one (67%) had CD4 counts less than 200 at baseline with no observable differences in HIV ribonucleic acid (RNA) or clinical stage based on age. Non-Acquired Immunodeficiency Syndrome (AIDS) morbidity was observed more frequently amongst older patients. The estimated prognosis of patients differed significantly based on age. Using the VACS Index and comparing younger patients with those aged 50 and above, mean 5 year mortality estimates were 25% and 50% respectively (P <0.001). A trend towards earlier antiretroviral therapy was noted amongst older patients (P = 0.067) driven mainly by fewer financial difficulties reported as barriers to treatment. Older patients form a high proportion of newly diagnosed HIV/AIDS cases and present with more non-AIDS morbidity. This confers a poor prognosis despite comparable findings with younger patients in terms of clinical stage, AIDS-defining illness, CD4 count and HIV viral load.

47 CFR 68.112 - Hearing aid-compatibility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... located on public property or in a semi-public location (e.g., drugstore, gas station, private club). (b... disabilities. (4) All credit card operated telephones, whether located on public property or in a semipublic location (e.g., drugstore, gas station, private club), unless a hearing aid compatible (as defined in § 68...

47 CFR 68.112 - Hearing aid-compatibility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... located on public property or in a semi-public location (e.g., drugstore, gas station, private club). (b... disabilities. (4) All credit card operated telephones, whether located on public property or in a semipublic location (e.g., drugstore, gas station, private club), unless a hearing aid compatible (as defined in § 68...

47 CFR 68.112 - Hearing aid-compatibility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... located on public property or in a semi-public location (e.g., drugstore, gas station, private club). (b... disabilities. (4) All credit card operated telephones, whether located on public property or in a semipublic location (e.g., drugstore, gas station, private club), unless a hearing aid compatible (as defined in § 68...

Parental Explicit Heuristics in Decision-making for Children With Life-threatening Illnesses

PubMed Central

Renjilian, Chris B.; Womer, James W.; Carroll, Karen W.; Kang, Tammy I.

2013-01-01

OBJECTIVE: To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. METHODS: Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children’s Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. RESULTS: All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. CONCLUSIONS: Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process. PMID:23319524

Parental explicit heuristics in decision-making for children with life-threatening illnesses.

PubMed

Renjilian, Chris B; Womer, James W; Carroll, Karen W; Kang, Tammy I; Feudtner, Chris

2013-02-01

To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.

Women's rights and women's health during HIV/AIDS epidemics: the experience of women in sub-Saharan Africa.

PubMed

Dugassa, Begna F

2009-08-01

Twenty-five years have passed since HIV/AIDS was recognized as a major public health problem. Although billions of dollars are spent in research and development, we still have no medical cure or vaccination. In the early days of the epidemic, public health slogans suggested that HIV/AIDS does not discriminate. Now it is becoming clear that HIV/AIDS spreads most rapidly among poor, marginalized, women, colonized, and disempowered groups of people more than others. The HIV/AIDS epidemic is exacerbated by the social, economic, political, and cultural conditions of societies such as gender, racial, class, and other forms of inequalities. Sub-Saharan African countries are severely hit by HIV/AIDS. For these countries the pandemic of HIV/AIDS demands the need to travel extra miles. My objective in this article is to promote the need to go beyond the biomedical model of "technical fixes" and the traditional public health education tools, and come up with innovative ideas and strategic thinking to contain the epidemic. In this article, I argue that containing the HIV/AIDS epidemic and improving family and community health requires giving appropriate attention to the social illnesses that are responsible for exacerbating biological disorders.

Stigma in mental illness: attitudes of medical students towards mental illness.

PubMed

Mas, A; Hatim, A

2002-12-01

Negative attitudes towards people with mental illness can be attributed to stigma. The objective of this study was to determine the attitudes of medical students towards mental illness by comparing those who have had contact with mental patients and those who have not. This study also assesses to what extent knowledge about mental illness can affect the students' attitude. A vignette and two dependent measures (social distance scale and dangerousness scale) were used to assess the attitudes of medical students towards mental illness. They comprised of 108 first year and 85 final year medical students in University of Malaya, Kuala Lumpur. The first year students didn't have any prior psychiatric training. The final year students who had knowledge and contact (undergone 8 weeks of clinical psychiatric training) were less stigmatizing toward mentally ill patients. There were no significant differences in the attitudes towards mentally ill patient among the first year students (no knowledge) regardless they had previous contact or not. Knowledge seems to have the effect in inculcating greater tolerance of mental illness. Contact by itself is not sufficient for attitude changes.

Risk factors for heat illness among British soldiers in the hot Collective Training Environment

PubMed Central

Moore, Alice C; Stacey, M J; Bailey, K G H; Bunn, R J; Woods, D R; Haworth, K J; Brett, S J; Folkes, S E F

2016-01-01

Background Heat illness is a preventable disorder in military populations. Measures that protect vulnerable individuals and contribute to effective Immediate Treatment may reduce the impact of heat illness, but depend upon adequate understanding and awareness among Commanders and their troops. Objective To assess risk factors for heat illness in British soldiers deployed to the hot Collective Training Environment (CTE) and to explore awareness of Immediate Treatment responses. Methods An anonymous questionnaire was distributed to British soldiers deployed in the hot CTEs of Kenya and Canada. Responses were analysed to determine the prevalence of individual (Intrinsic) and Command-practice (Extrinsic) risk factors for heat illness and the self-reported awareness of key Immediate Treatment priorities (recognition, first aid and casualty evacuation). Results The prevalence of Intrinsic risk factors was relatively low in comparison with Extrinsic risk factors. The majority of respondents were aware of key Immediate Treatment responses. The most frequently reported factors in each domain were increased risk by body composition scoring, inadequate time for heat acclimatisation and insufficient briefing about casualty evacuation. Conclusions Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of ‘marginal gains’ is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE. PMID:26036822

The innate immune response in HIV/AIDS septic shock patients: a comparative study.

PubMed

Amancio, Rodrigo T; Japiassu, Andre M; Gomes, Rachel N; Mesquita, Emersom C; Assis, Edson F; Medeiros, Denise M; Grinsztejn, Beatriz; Bozza, Patrícia T; Castro-Faria Neto, Hugo C; Bozza, Fernando A

2013-01-01

In recent years, the incidence of sepsis has increased in critically ill HIV/AIDS patients, and the presence of severe sepsis emerged as a major determinant of outcomes in this population. The inflammatory response and deregulated cytokine production play key roles in the pathophysiology of sepsis; however, these mechanisms have not been fully characterized in HIV/AIDS septic patients. We conducted a prospective cohort study that included HIV/AIDS and non-HIV patients with septic shock. We measured clinical parameters and biomarkers (C-reactive protein and cytokine levels) on the first day of septic shock and compared these parameters between HIV/AIDS and non-HIV patients. We included 30 HIV/AIDS septic shock patients and 30 non-HIV septic shock patients. The HIV/AIDS patients presented low CD4 cell counts (72 [7-268] cells/mm(3)), and 17 (57%) patients were on HAART before hospital admission. Both groups were similar according to the acute severity scores and hospital mortality. The IL-6, IL-10 and G-CSF levels were associated with hospital mortality in the HIV/AIDS septic group; however, the CRP levels and the surrogates of innate immune activation (cytokines) were similar among HIV/AIDS and non-HIV septic patients. Age (odds ratio 1.05, CI 95% 1.02-1.09, p=0.002) and the IL-6 levels (odds ratio 1.00, CI 95% 1.00-1.01, p=0.05) were independent risk factors for hospital mortality. IL-6, IL-10 and G-CSF are biomarkers that can be used to predict prognosis and outcomes in HIV/AIDS septic patients. Although HIV/AIDS patients are immunocompromised, an innate immune response can be activated in these patients, which is similar to that in the non-HIV septic population. In addition, age and the IL-6 levels are independent risk factors for hospital mortality irrespective of HIV/AIDS disease.

Cost of illness and illness perceptions in patients with fibromyalgia.

PubMed

Vervoort, Vera M; Vriezekolk, Johanna E; Olde Hartman, Tim C; Cats, Hans A; van Helmond, Toon; van der Laan, Willemijn H; Geenen, Rinie; van den Ende, Cornelia H

2016-01-01

The disease impact and economic burden of fibromyalgia (FM) are high for patients and society at large. Knowing potential determinants of economic costs may help in reducing this burden. Cognitive appraisals (perceptions) of the illness could affect costs. The present study estimated costs of illness in FM and examined the association between these costs and illness perceptions. Questionnaire data of FM severity (FIQ), illness perceptions (IPQ-R-FM), productivity losses (SF-HLQ) and health care use were collected in a cohort of patients with FM. Costs were calculated and dichotomised (median split). Univariate and hierarchic logistic regression models examined the unique association of each illness perception with 1) health care costs and 2) costs of productivity losses. Covariates were FM severity, comorbidity and other illness perceptions. 280 patients participated: 95% female, mean age 42 (SD=12) years. Annualised costs of FM per patient were €2944 for health care, and €5731 for productivity losses. In multivariate analyses, a higher disease impact (FIQ) and two of seven illness perceptions (IPQ-R-FM) were associated with high health care costs: 1) high scores on 'cyclical timeline' reflecting a fluctuating, unpredictable course and 2) low scores on 'emotional representations', thus not perceiving a connection between fibromyalgia and emotions. None of the variables was associated with productivity losses. Our study indicates that perceiving a fluctuating course and low emotional representation, which perhaps reflects somatic fixation, are associated with health care costs in FM. Future studies should examine whether targeting these illness perceptions results in reduction of costs.

An Aid for Planning Programs in Career Education.

ERIC Educational Resources Information Center

Illinois State Board of Vocational Education and Rehabilitation, Springfield. Div. of Vocational and Technical Education.

Offered as an aid for developing sequential occupational education programs, the publication presents a concept in career education planning beginning with kindergarten and continuing through adult years. Career education goals are defined, and steps in planning sequential programs are outlined as follows: (1) organization of the occupational…

Transfusion-related immunomodulation: review of the literature and implications for pediatric critical illness.

PubMed

Muszynski, Jennifer A; Spinella, Philip C; Cholette, Jill M; Acker, Jason P; Hall, Mark W; Juffermans, Nicole P; Kelly, Daniel P; Blumberg, Neil; Nicol, Kathleen; Liedel, Jennifer; Doctor, Allan; Remy, Kenneth E; Tucci, Marisa; Lacroix, Jacques; Norris, Philip J

2017-01-01

Transfusion-related immunomodulation (TRIM) in the intensive care unit (ICU) is difficult to define and likely represents a complicated set of physiologic responses to transfusion, including both proinflammatory and immunosuppressive effects. Similarly, the immunologic response to critical illness in both adults and children is highly complex and is characterized by both acute inflammation and acquired immune suppression. How transfusion may contribute to or perpetuate these phenotypes in the ICU is poorly understood, despite the fact that transfusion is common in critically ill patients. Both hyperinflammation and severe immune suppression are associated with poor outcomes from critical illness, underscoring the need to understand potential immunologic consequences of blood product transfusion. In this review we outline the dynamic immunologic response to critical illness, provide clinical evidence in support of immunomodulatory effects of blood product transfusion, review preclinical and translational studies to date of TRIM, and provide insight into future research directions. © 2016 AABB.

Ill Posed Problems: Numerical and Statistical Methods for Mildly, Moderately and Severely Ill Posed Problems with Noisy Data.

DTIC Science & Technology

1980-02-01

to estimate f -..ell, -noderately ,-ell, or- poorly. 1 ’The sansitivity *of a rec-ilarized estimate of f to the noise is made explicit. After giving the...AD-A 7 .SA92 925 WISCONSIN UN! V-MADISON DEFT OF STATISTICS F /S 11,’ 1 ILL POSED PRORLEMS: NUMERICAL ANn STATISTICAL METHODS FOR MILOL-ETC(U FEB 80 a...estimate f given z. We first define the 1 intrinsic rank of the problem where jK(tit) f (t)dt is known exactly. This 0 definition is used to provide insight

What is AIDS in Guadeloupe? A descriptive and comparative study.

PubMed

Elenga, Narcisse; Georger-Sow, Marie-Thérèse; Messiaen, Thierry; Lamaury, Isabelle; Favre, Isabelle; Nacher, Mathieu; Beaucaire, Gilles

2014-03-01

Since the pathogen ecology differs between Caribbean regions, specific differences in the most frequent clinical presentations of acquired immunodeficiency syndrome (AIDS) may be expected. We therefore conducted the present retrospective cohort study in order to describe the main AIDS-defining events in Guadeloupe and to compare them with those observed in Metropolitan France and in French Guiana. We discuss the local pathogen ecology, the diagnostic limitations of hospitals in overseas territories and the drivers of the epidemic.

Trado-Cultural Practices, Situation, Analysis and Epidemiological Factors in the Spread of HIV/AIDS in Nigeria

ERIC Educational Resources Information Center

Adesina, Modupe Olutayo

2015-01-01

This paper attempted to look at the Trado-cultural practices in the spread of HIV/AIDS in Nigeria. Human Immunodeficiency Virus (HIV) is virus that gradually attack and weaken the body immune system, whose task is to fight off infections and illness. Eventually, the body loses its ability to fight off and defend itself and thereby become…

Improving Communication About Serious Illness in Primary Care: A Review.

PubMed

Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

2016-09-01

The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will

Case study: beverage temperature at aid stations in ironman triathlon.

PubMed

Burdon, Catriona A; Johnson, Nathan A; Chapman, Phillip G; Munir Che Muhamed, Ahmad; O'Connor, Helen T

2013-08-01

The aim of this study was to measure the effect of environmental conditions and aid-station beverage- cooling practices on the temperature of competitor beverages. Environmental and beverage temperatures were measured at three cycling and two run course aid stations at the 2010 Langkawi, Malaysia (MA), and Port Macquarie, Australia (AU), Ironman triathlon events. To measure the specific effect of radiant temperature, additional fluid-filled (600 ml) drink bottles (n = 12) were cooled overnight (C) and then placed in direct sun (n = 6) or shade (n = 6) near to a cycle aid station at AU. During both events, beverage temperature increased over time (p < .05) as environmental conditions, particularly radiant temperature increased (p < .05). Mean beverage temperature ranged between 14-26°C and during both events was above the palatable range (15-22°C) for extended periods. At AU, bottles placed in direct sunlight heated faster (6.9 ± 2.3 °C·h-1) than those in the shade (4.8 ±1.1°C·h-1, p = .05). Simple changes to Ironman aid-station practices, including shade and chilling beverages with ice, result in the provision of cooler beverages. Future studies should investigate whether provision of cool beverages at prolonged endurance events influences heat-illness incidence, beverage-consumption patterns, and competitor performance.

AIDS and the status of women. Challenges and perspectives for the 1990s.

PubMed

1990-10-01

WHO and the Swedish Government hosted the expert group meeting on women and HIV/AIDS in Vienna, August in 1990. Attendees concentrated their discussions on government recognized entities (national machinery) responsible for women's advancement and how they can assist in forming national policies to better women's status and limit the effect of HIV/AIDS. A very important issue came out of this meeting that had not yet been addressed in AIDS prevention strategies--the fundamental problem of women's subordination as a component of the HIV/AIDS epidemic. In addition, even though national groups for women's advancement have worked hard to rectify subordination, they have not yet addressed AIDS as a barrier to equality. Subordination of women varies from country to country, nevertheless they are all vulnerable to HIV/AIDS worldwide. They do not have equal access to education, information, and health services. They cannot demand that sexual partners practice safe sex. Despite being ill, they are expected to continue caring for their families. The national machinery must be able to assemble needed resources and assure implementation of these policies. It should encourage government policies to improve maternal and child health and family planning services, to control sexually transmitted diseases, and to provide adequate counseling and research. National AIDS committees and national machinery should communicate and form linkages to advance the status of women. Preventing the spread of HIV/AIDS cannot occur, however, if men and women do not cooperate. WHO estimated that at least 500,000 women and children acquired AIDS in the 1980s. It expects an additional 3 million in the 1990s. In the early 1990s, 8-10 million people are infected with HIV.

Developing clinical strength-of-evidence approach to define HIV-associated malignancies for cancer registration in Kenya.

PubMed

Korir, Anne; Mauti, Nathan; Moats, Pamela; Gurka, Matthew J; Mutuma, Geoffrey; Metheny, Christine; Mwamba, Peter M; Oyiro, Peter O; Fisher, Melanie; Ayers, Leona W; Rochford, Rosemary; Mwanda, Walter O; Remick, Scot C

2014-01-01

Sub-Saharan Africa cancer registries are beset by an increasing cancer burden further exacerbated by the AIDS epidemic where there are limited capabilities for cancer-AIDS match co-registration. We undertook a pilot study based on a "strength-of-evidence" approach using clinical data that is abstracted at the time of cancer registration for purposes of linking cancer diagnosis to AIDS diagnosis. The standard Nairobi Cancer Registry form was modified for registrars to abstract the following clinical data from medical records regarding HIV infection/AIDS in a hierarchal approach at time of cancer registration from highest-to-lowest strength-of-evidence: 1) documentation of positive HIV serology; 2) antiretroviral drug prescription; 3) CD4+ lymphocyte count; and 4) WHO HIV clinical stage or immune suppression syndrome (ISS), which is Kenyan terminology for AIDS. Between August 1 and October 31, 2011 a total of 1,200 cancer cases were registered. Of these, 171 cases (14.3%) met clinical strength-of-evidence criteria for association with HIV infection/AIDS; 69% (118 cases were tumor types with known HIV association - Kaposi's sarcoma, cervical cancer, non-Hodgkin's and Hodgkin's lymphoma, and conjunctiva carcinoma) and 31% (53) were consistent with non-AIDS defining cancers. Verifiable positive HIV serology was identified in 47 (27%) cases for an absolute seroprevalence rate of 4% among the cancer registered cases with an upper boundary of 14% among those meeting at least one of strength-of-evidence criteria. This pilot demonstration of a hierarchal, clinical strength-of-evidence approach for cancer-AIDS registration in Kenya establishes feasibility, is readily adaptable, pragmatic, and does not require additional resources for critically under staffed cancer registries. Cancer is an emerging public health challenge, and African nations need to develop well designed population-based studies in order to better define the impact and spectrum of malignant disease in the

Cancer Treatment in Patients With HIV Infection and Non-AIDS-Defining Cancers: A Survey of US Oncologists.

PubMed

Suneja, Gita; Boyer, Matthew; Yehia, Baligh R; Shiels, Meredith S; Engels, Eric A; Bekelman, Justin E; Long, Judith A

2015-05-01

HIV-infected individuals with non-AIDS-defining cancers are less likely to receive cancer treatment compared with uninfected individuals. We sought to identify provider-level factors influencing the delivery of oncology care to HIV-infected patients. A survey was mailed to 500 randomly selected US medical and radiation oncologists. The primary outcome was delivery of standard treatment, assessed by responses to three specialty-specific management questions. We used the χ(2) test to evaluate associations between delivery of standard treatment, provider demographics, and perceptions of HIV-infected individuals. Multivariable logistic regression identified associations using factor analysis to combine several correlated survey questions. Our response rate was 60%; 69% of respondents felt that available cancer management guidelines were insufficient for the care of HIV-infected patients with cancer; 45% never or rarely discussed their cancer management plan with an HIV specialist; 20% and 15% of providers were not comfortable discussing cancer treatment adverse effects and prognosis with their HIV-infected patients with cancer, respectively; 79% indicated that they would provide standard cancer treatment to HIV-infected patients. In multivariable analysis, physicians comfortable discussing adverse effects and prognosis were more likely to provide standard cancer treatment (adjusted odds ratio, 1.52; 95% CI, 1.12 to 2.07). Physicians with concerns about toxicity and efficacy of treatment were significantly less likely to provide standard cancer treatment (adjusted odds ratio, 0.67; 95% CI, 0.53 to 0.85). Provider-level factors are associated with delivery of nonstandard cancer treatment to HIV-infected patients. Policy change, provider education, and multidisciplinary collaboration are needed to improve access to cancer treatment. Copyright © 2015 by American Society of Clinical Oncology.

Incidence of opportunistic illness before and after initiation of highly active antiretroviral therapy in children.

PubMed

Nesheim, Steven R; Hardnett, Felicia; Wheeling, John T; Siberry, George K; Paul, Mary E; Emmanuel, Patricia; Bohannon, Beverly; Dominguez, Kenneth

2013-10-01

Little is known about immune reconstitution inflammatory syndrome in children in the United States. LEGACY is a longitudinal cohort study of HIV-infected participants 0-24 years at enrollment during 2005 to 2007 from 22 US clinics. For this analysis, we included participants with complete medical record abstraction from birth or time of HIV diagnosis through 2006. Opportunistic illness (OI) included AIDS-defining conditions and selected HIV-related diagnoses. We calculated the incidence (#/100 patient-years) of OI diagnosed in the months pre- and postinitiation of the first highly active antiretroviral therapy (HAART) regimen which was followed by ≥1 log reduction in HIV viral load. We defined OI as immune reconstitution inflammatory syndrome if an OI incidence increased after HAART initiation. "Responders" were defined as experiencing ≥1 log decline in viral load within 6 months after HAART initiation. Among 575 patients with complete chart abstraction, 524 received HAART. Of these 524 patients, 343 were responders, 181 were nonresponders and 86 experienced OI. Responders accounted for 98 of 124 (79%) of OI. Pre-HAART and post-HAART OI incidences were 43.7 and 24.4 (P = 0.003), respectively, among responders and 15.9 and 9.1 (P = 0.2), respectively, among nonresponders. Overall, OI incidences among responders and nonresponders were 33.8 and 12.3, respectively (P = 0.002). Responders were more likely than nonresponders to experience herpes simplex and herpes zoster before HAART initiation (all, P < 0.002). The lack of immune reconstitution inflammatory syndrome in participants initiating HAART may be due to low overall OI rates. The unexpectedly higher OI prevalence comprised mainly of herpes simplex and zoster, before HAART initiation among responders, may have motivated them to better adhere to HAART.

Toward Beijing: linking HIV / AIDS to other women's issues is imperative.

PubMed

Forrest, K

1995-01-01

The senior advisor to the AIDSCAP Women's Initiative, Dr. E. Maxine Ankrah, is actively lobbying to secure the inclusion of HIV/AIDS language in the draft platform of the UN Fourth World Conference on Women: Action for Equality, Development and Peace scheduled for September 1995 in Beijing. She organized the only workshop on HIV/AIDS at the preparatory meeting in New York in March 1995. It examined the effects of poverty on the expanding epidemic among females. Workshop presentations included international perspectives on: the effect of structural adjustment programs on women's vulnerability; the relationship between poverty, female prostitution, and AIDS; credit schemes and education to empower rural women; reproductive rights; ethnic issues; and the need for women to help women. Obstacles that obscured the relationships between HIV/AIDS and other women's issues have been: that AIDS was initially defined as a medical problem; that risk groups were narrowly defined; and the emphasis on behavior that blames persons infected with HIV. Despite earlier obstacles, the draft platform has several sections with HIV/AIDS language. Strategic Objective C.3: Undertake Multi-Sectoral Initiatives Sensitive to Women's Life Situations addresses the HIV pandemic and other sexual and reproductive health issues. Some of the actions called for in this objective are involvement of women in decision making, expansion of peer education and outreach, and supporting research of woman-controlled prevention methods. AIDSCAP Women's Initiative and other nongovernmental organizations will work together focus attention on HIV/AIDS in Beijing. AIDSCAP plans to have resource publications available in Beijing as well as to host networking sessions. Unless it is waived, the policy prohibiting HIV-infected persons from entering China will preclude HIV-infected women from taking part in the Conference.

Is HIV/AIDS Epidemic Outcome of Poverty in Sub-Saharan Africa?

PubMed Central

Dzimnenani Mbirimtengerenji, Noel

2007-01-01

Undisputable fact is that 14 000 people in Sub-Saharan Africa are being infected daily with HIV and 11 000 are dying every day due to HIV/AIDS related illnesses. In this region more than 60% of the people live below UN poverty line of US$ 1 per day. Some studies have shown that poverty and HIV infection are in correlation, but none has shown whether HIV/AIDS in Sub-Saharan Africa is an outcome of poverty. This article, therefore, shows that HIV is an important outcome of poverty, with sexual trade, migration, polygamy, and teenage marriages as its predictors in the Sub Saharan region. I used the examples of 20 countries with the highest poverty level in the region to demonstrate the gravity of the HIV scourge, using the data from different international databases. PMID:17948947

Nurse aide decision making in nursing homes: factors affecting empowerment.

PubMed

Chaudhuri, Tanni; Yeatts, Dale E; Cready, Cynthia M

2013-09-01

To evaluate factors affecting structural empowerment among nurse aides in nursing homes. Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment. © 2013 Blackwell Publishing Ltd.

Why companies should intervene: a case study of the costs of HIV / AIDS to employers. Economic impact: Southern Africa.

PubMed

Greener, R

1998-04-01

5 member companies of the Botswana Business Coalition on AIDS (BBCA) in the manufacturing, transport, distribution, and finance sectors participated in a pilot study of the impact of HIV/AIDS upon companies in Botswana. The study was conducted on behalf of the Botswana National Task Force on AIDS in the Workplace, and involved both management and employee teams from the participating companies. While HIV is usually not spread in the course of work, company characteristics such as having a mobile, well-paid work force, poor housing, or a high community HIV prevalence may increase employees' susceptibility to contracting and transmitting HIV. Companies' susceptibility to the impact of the HIV/AIDS epidemic was assessed through interviews with management and employees. The transport sector was at highest risk, while the finance sector was at lowest risk. Assessing the HIV/AIDS impact, lost labor time due to sick leave, the costs of other benefits, future HIV/AIDS cases and health costs, and regional comparisons of the HIV/AIDS impact are considered. The most significant HIV/AIDS-related cost to the businesses in this study is the cost of lost work time due to employee illness.

Therapeutic drug monitoring of anti-infective agents in critically ill patients.

PubMed

Jager, Nynke G L; van Hest, Reinier M; Lipman, Jeffrey; Taccone, Fabio S; Roberts, Jason A

2016-07-01

Initial adequate anti-infective therapy is associated with significantly improved clinical outcomes for patients with severe infections. However, in critically ill patients, several pathophysiological and/or iatrogenic factors may affect the pharmacokinetics of anti-infective agents leading to suboptimal drug exposure, in particular during the early phase of therapy. Therapeutic drug monitoring (TDM) may assist to overcome this problem. We discuss the available evidence on the use of TDM in critically ill patient populations for a number of anti-infective agents, including aminoglycosides, β-lactams, glycopeptides, antifungals and antivirals. Also, we present the available evidence on the practices of anti-infective TDM and describe the potential utility of TDM to improve treatment outcome in critically ill patients with severe infections. For aminoglycosides, glycopeptides and voriconazole, beneficial effects of TDM have been established on both drug effectiveness and potential side effects. However, for other drugs, therapeutic ranges need to be further defined to optimize treatment prescription in this setting.

[THE SYSTEMIC IMMUNITY CELLULAR LINK REACTION IN PATIENTS WITH TRAUMATIC ILLNESS].

PubMed

Plehutsa, I M; Sydorchuk, R I; Plehutsa, O M

2015-01-01

The effect of trauma on parameters of cellular immunity changes is studied. The study includes 52 patients with various forms of traumatic illness, aged 18-69 years (37.91-4.28). The control group consisted of 16 patients who underwent routine surgery not related to the pathology of musculoskeletal system. All patients of the main group were divided into 3 groups according to severity of the condition. Analysis of parameters of cellular link of immune system was performed by defining subpopulations of T-lymphocytes in indirect immunofluorescence method using a panel of monoclonal antibodies for CD3, CD4, CD8, CD22 lymphocytes' receptors and calculation of integrated indicators. The highest expression (immune disorders of II-III grades) of changes of cellular immunity observed in patients with severe traumatic: illness (expand clinical picture). Surgical intervention, even without traumatic injury significantly impact cellular immunity, but in patients with traumatic illness immunity violation were significantly higher than in comparison groups patients except immunoregulatory index.

Computational approaches to define a human milk metaglycome

PubMed Central

Agravat, Sanjay B.; Song, Xuezheng; Rojsajjakul, Teerapat; Cummings, Richard D.; Smith, David F.

2016-01-01

Motivation: The goal of deciphering the human glycome has been hindered by the lack of high-throughput sequencing methods for glycans. Although mass spectrometry (MS) is a key technology in glycan sequencing, MS alone provides limited information about the identification of monosaccharide constituents, their anomericity and their linkages. These features of individual, purified glycans can be partly identified using well-defined glycan-binding proteins, such as lectins and antibodies that recognize specific determinants within glycan structures. Results: We present a novel computational approach to automate the sequencing of glycans using metadata-assisted glycan sequencing, which combines MS analyses with glycan structural information from glycan microarray technology. Success in this approach was aided by the generation of a ‘virtual glycome’ to represent all potential glycan structures that might exist within a metaglycomes based on a set of biosynthetic assumptions using known structural information. We exploited this approach to deduce the structures of soluble glycans within the human milk glycome by matching predicted structures based on experimental data against the virtual glycome. This represents the first meta-glycome to be defined using this method and we provide a publically available web-based application to aid in sequencing milk glycans. Availability and implementation: http://glycomeseq.emory.edu Contact: sagravat@bidmc.harvard.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:26803164

Aid for Aides.

ERIC Educational Resources Information Center

Townley, Arthur J.

1980-01-01

Recognizing the diversity in experience and training among teacher aides, the Yucaipa School District established a formal inservice program for this employee group. This article describes how the district developed a seminar program to help instructional aides in improving their skills. Reactions to the program were favorable. (Author/SJL)

Transitions Study of predictors of illness progression in young people with mental ill health: study methodology.

PubMed

Purcell, R; Jorm, A F; Hickie, I B; Yung, A R; Pantelis, C; Amminger, G P; Glozier, N; Killackey, E; Phillips, L; Wood, S J; Mackinnon, A; Scott, E; Kenyon, A; Mundy, L; Nichles, A; Scaffidi, A; Spiliotacopoulos, D; Taylor, L; Tong, J P Y; Wiltink, S; Zmicerevska, N; Hermens, Daniel; Guastella, Adam; McGorry, P D

2015-02-01

An estimated 75% of mental disorders begin before the age of 24 and approximately 25% of 13-24-year-olds are affected by mental disorders at any one time. To better understand and ideally prevent the onset of post-pubertal mental disorders, a clinical staging model has been proposed that provides a longitudinal perspective of illness development. This heuristic model takes account of the differential effects of both genetic and environmental risk factors, as well as markers relevant to the stage of illness, course or prognosis. The aim of the Transitions Study is to test empirically the assumptions that underpin the clinical staging model. Additionally, it will permit investigation of a range of psychological, social and genetic markers in terms of their capacity to define current clinical stage or predict transition from less severe or enduring to more severe and persistent stages of mental disorder. This paper describes the study methodology, which involves a longitudinal cohort design implemented within four headspace youth mental health services in Australia. Participants are young people aged 12-25 years who have sought help at headspace and consented to complete a comprehensive assessment of clinical state and psychosocial risk factors. A total of 802 young people (66% female) completed baseline assessments. Annual follow-up assessments have commenced. The results of this study may have implications for the way mental disorders are diagnosed and treated, and progress our understanding of the pathophysiologies of complex mental disorders by identifying genetic or psychosocial markers of illness stage or progression. © 2013 Wiley Publishing Asia Pty Ltd.

Place of family in recovery models for those with a mental illness.

PubMed

Reupert, Andrea; Maybery, Darryl; Cox, Merrilee; Scott Stokes, Eileen

2015-12-01

Within the context of mental illness, there is an acknowledgement that the social environment is critical to recovery. Nonetheless, how family roles and interactions are presented in recovery frameworks is unclear. This systematic review sought to: (i) identify how family is defined in recovery models, and (ii) synthesize how family relationships and roles are incorporated into recovery models for those with a mental illness. A systematic search of electronic databases was conducted for peer reviewed, English language papers published between 1980 to April 2013, from Ovid MEDLINE, PsycINFO, Proquest, CINAHL plus and Web of Knowledge. Studies were included if they presented a recovery framework and include primary data from people with a mental illness where family was incorporated. A narrative thematic analysis was conducted on the eligible 31 studies, using inductive, open coding techniques. Eight studies did not define what was meant by 'family' while 10 studies focused exclusively on an individual's relationships with parents; six papers collected parenting demographics. Family roles included being a (adult) child, parent, spouse and being part of a 'family'. Family interactions involved being passive recipients of family support, caring for elderly parents and children and reciprocal, give and take relationships. Family interactions and roles offer the opportunity to both facilitate and impede recovery. © 2015 Australian College of Mental Health Nurses Inc.

Are Victims of AIDS 'Handicapped' under Federal Law?

ERIC Educational Resources Information Center

Flygare, Thomas J.

1986-01-01

Discusses whether the disease AIDS (Acquired Immune Deficiency Syndrome) could be considered a "handicap." Describes a recent court decision, "Arline vs. School Board of Nassau County," in which the court found that a teacher with tuberculosis could be defined as handicapped and that her dismissal was in violation of Section…

A randomized controlled trial testing the efficacy of an HIV/AIDS symptom management manual.

PubMed

Wantland, Dean J; Holzemer, William L; Moezzi, Shahnaz; Willard, Suzanne S; Arudo, John; Kirksey, Kenn M; Portillo, Carmen J; Corless, Inge B; Rosa, María E; Robinson, Linda L; Nicholas, Patrice K; Hamilton, Mary Jane; Sefcik, Elizabeth F; Human, Sarie; Rivero, Marta M; Maryland, Mary; Huang, Emily

2008-09-01

This study investigates whether using an HIV/AIDS symptom management manual with self-care strategies for 21 common symptoms, compared to a basic nutrition manual, had an effect on reducing symptom frequency and intensity. A 775-person, repeated measures, randomized controlled trial was conducted over three months in 12 sites from the United States, Puerto Rico, and Africa to assess the relationship between symptom intensity with predictors for differences in initial symptom status and change over time. A mixed model growth analysis showed a significantly greater decline in symptom frequency and intensity for the group using the symptom management manual (intervention) compared to those using the nutrition manual (control) (t=2.36, P=0.018). The models identified three significant predictors for increased initial symptom intensities and in intensity change over time: (1) protease inhibitor-based therapy (increased mean intensity by 28%); (2) having comorbid illness (nearly twice the mean intensity); and (3) being Hispanic receiving care in the United States (increased the mean intensity by 2.5 times). In addition, the symptom manual showed a significantly higher helpfulness rating and was used more often compared to the nutrition manual. The reduction in symptom intensity scores provides evidence of the need for palliation of symptoms in individuals with HIV/AIDS, as well as symptoms and treatment side effects associated with other illnesses. The information from this study may help health care providers become more aware of self-management strategies that are useful to persons with HIV/AIDS and help them to assist patients in making informed choices.

Safety of intravenous lacosamide in critically ill children.

PubMed

Welsh, Sarah S; Lin, Nan; Topjian, Alexis A; Abend, Nicholas S

2017-11-01

Acute seizures are common in critically ill children. These patients would benefit from intravenous anti-seizure medications with few adverse effects. We reviewed the usage and effects of intravenous lacosamide in critically ill children with seizures or status epilepticus. This retrospective series included consecutive patients who received at least one dose of intravenous lacosamide from April 2011 to February 2016 in the pediatric intensive care unit of a quaternary care children's hospital, including patients with new lacosamide initiation and continuation of outpatient oral lacosamide. Dosing and prescribing practices were reviewed. Adverse effects were defined by predefined criteria, and most were evaluated during the full admission. We identified 51 intensive care unit admissions (47 unique patients) with intravenous lacosamide administration. Lacosamide was utilized as a third or fourth-line anti-seizure medication for acute seizures or status epilepticus in the lacosamide-naïve cohort. One patient experienced bradycardia and one patient experienced a rash that were considered potentially related to lacosamide. No other adverse effects were identified, including no evidence of PR interval prolongation. Lacosamide was well tolerated in critically ill children. Further study is warranted to evaluate the effectiveness of earlier lacosamide use for pediatric status epilepticus and acute seizures. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Primary pulmonary lymphoma in a patient with advanced AIDS

PubMed Central

Shahani, Lokesh; McKenna, Megan

2014-01-01

Non-Hodgkin's lymphoma (NHL) is an AIDS defining lesion and risk of NHL most likely correlates with the degree of immunosuppression from HIV. Risk of NHL is highest among patients with CD4 count <50 cells/mL. Primary pulmonary lymphoma (PPL) is an infrequent cause of AIDS-related lymphoma. The authors report a patient with advanced AIDS presenting with recurrent fever and pulmonary nodule seen on the CT scan. The patient remained febrile despite being on broad spectrum antibiotics with no clear source of infection. The patient underwent a bronchoscopy with biopsy of the pulmonary lesion which was most consistent with diffuse large B-cell lymphoma. The patient was started on dose-adjusted etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone (EPOCH) and was noted to be afebrile and a repeat CT scan few weeks later showed resolution of her pulmonary nodule. This case highlights the importance of considering NHL in patients with advanced AIDS presenting with pulmonary nodule and fever. PMID:25527680

Patients understanding of depression associated with chronic physical illness: a qualitative study

PubMed Central

2014-01-01

Background Detection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. We explored patient beliefs about the nature of depression associated with physical illness. Methods A qualitative interview study of patients registered with general practices in Leeds, UK. We invited patients with coronary heart disease or diabetes from primary care to participate in semi-structured interviews exploring their beliefs and experiences. We analysed transcripts using a thematic approach, extended to consider narratives as important contextual elements. Results We interviewed 26 patients, including 17 with personal experience of depression. We developed six themes: recognising a problem, complex causality, the role of the primary care, responsibility, resilience, and the role of their life story. Participants did not consistently talk about depression as an illness-like disorder. They described a change in their sense of self against the background of their life stories. Participants were unsure about seeking help from general practitioners (GPs) and felt a personal responsibility to overcome depression themselves. Chronic illness, as opposed to other life pressures, was seen as a justifiable cause of depression. Conclusions People with chronic illness do not necessarily regard depression as an easily defined illness, especially outside of the context of their life stories. Efforts to engage patients with chronic illness in the detection and management of depression may need further tailoring to accommodate beliefs about how people view themselves, responsibility and negative views of treatment. PMID:24555886

Evaluation of mental health first aid training in a diverse community setting.

PubMed

Morawska, Alina; Fletcher, Renee; Pope, Susan; Heathwood, Ellen; Anderson, Emily; McAuliffe, Christine

2013-02-01

Mental health first aid (MHFA) training has been disseminated in the community and has yielded positive outcomes in terms of increasing help-seeking behaviour and mental health literacy. However, there has been limited research investigating the effectiveness of this programme in multicultural communities. Given the increasing levels of multiculturalism in many countries, as well as the large number of barriers presented to these groups when trying to seek help for mental illnesses, the present study aimed to investigate the effectiveness of MHFA in these settings. A total of 458 participants, who were recruited from multicultural organizations, participated in a series of MHFA training courses. Participants completed questionnaires pre and post the training course, and 6-month follow-up interviews were conducted with a subsample of participants. Findings suggested that MHFA training increased participant recognition of mental illnesses, concordance with primary care physicians about treatments, confidence in providing first aid, actual help provided to others, and a reduction in stigmatizing attitudes. A 6-month follow up also yielded positive long-term effects of MHFA. The results have implications for further dissemination and the use of MHFA in diverse communities. In addition, the results highlight the need for mental health training in health-care service providers. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

[AIDS in the world: revolution, paradigm and solidarity].

PubMed

Mann, J

1991-01-01

AIDS in a single decade has affected life and assumptions on the societal and individual level more than any other illness or epidemic in history. The most important aspect of the HIV pandemic is that it is still in an early stage of development. The pandemic will continue to be volatile and dynamic; its greatest impact has not yet been felt. There is still great potential to influence its future course. HIV infection is spreading rapidly in some already affected populations in Africa, Latin America, and the Caribbean, and is penetrating deeply into new areas such as Eastern Europe, the Middle East, and Southeast Asia. Thailand and India are symbols of its rapid spread. The more than 100 million new cases of sexually transmitted diseases diagnosed in the world each year demonstrate the potential for sexual transmission of HIV. On the global level, the foundations have been laid for preventing the spread of HIV infection. But in many countries information is still inadequate or incorrect, needed social and health services are nonexistent, and punitive and discriminatory attitudes persist toward the infected. The gap between rich and poor within and between countries is widening. 2/3 of AIDS cases and 3/4 of seropositive individuals are in developing countries. The cost of drugs and treatment implies that "early intervention" is a meaningless concept for developing countries. The developed world contributes $200 million or less to combat AIDS in developing countries. Some of the revolutionary ideas prompted by the advent of AIDS included the immediate attention given to behavior as a preventive measure, the eradication of complacency about the condition of health and social services, the insistence of AIDS patients and the HIV infected on being included in the total process of prevention, treatment, and research, and the unexpected flowering of a dialogue on dignity, human rights, and social justice. AIDS is now leading to a new vision of health promotion in which

Homicide and mental illness in New Zealand, 1970-2000.

PubMed

Simpson, Alexander I F; McKenna, Brian; Moskowitz, Andrew; Skipworth, Jeremy; Barry-Walsh, Justin

2004-11-01

Homicides by mentally ill persons have led to political concerns about deinstitutionalisation. To provide accurate information about the contribution of mental illness to homicide rates. Retrospective study of homicide in New Zealand from 1970 to 2000, using data from government sources. 'Mentally abnormal homicide'perpetrators were defined as those found unfitto stand trial, not guilty by reason of insanity, convicted and sentenced to psychiatric committal, or convicted of infanticide. Group and time trends were analysed. Mentally abnormal homicides constituted 8.7% of the 1498 homicides. The annual rate of such homicides was 1.3 per million population, static over the period. Total homicides increased by over 6% per year from 1970 to 1990, then declined from 1990 to 2000. The percentage of all homicides committed by the mentally abnormal group fell from 19.5% in 1970 to 5.0% in 2000. Ten percent of perpetrators had been admitted to hospital during the month before the offence; 28.6% had had no prior contact with mental health services. Victims were most commonly known to the perpetrator (74%). Deinstitutionalisation appears not to be associated with an increased risk of homicide by people who are mentally ill.

Mental health first aid for the elderly: A pilot study of a training program adapted for helping elderly people.

PubMed

Svensson, Bengt; Hansson, Lars

2017-06-01

Epidemiological studies have shown a high prevalence of mental illness among the elderly. Clinical data however indicate both insufficient detection and treatment of illnesses. Suggested barriers to treatment include conceptions that mental health symptoms belong to normal aging and lack of competence among staff in elderly care in detecting mental illness. A Mental Health First Aid (MHFA) training program for the elderly was developed and provided to staff in elderly care. The aim of this study was to investigate changes in knowledge in mental illness, confidence in helping a person, readiness to give help and attitudes towards persons with mental illness. Single group pre-test-post-test design. The study group included staff in elderly care from different places in Sweden (n = 139). Significant improvements in knowledge, confidence in helping an elderly person with mental illness and attitudes towards persons with mental illness are shown. Skills acquired during the course have been practiced during the follow-up. The adaption of MHFA training for staff working in elderly care gives promising results. Improvements in self-reported confidence in giving help, attitudes towards persons with mental illness and actual help given to persons with mental illness are shown. However, the study design allows no firm conclusions and a randomized controlled trail is needed to investigate the effectiveness of the program. Outcomes should include if the detection and treatment of mental illness among the elderly actually improved.

Quick screening tool for patients with severe negative emotional reactions to chronic illness: psychometric study of the negative emotions due to chronic illness screening test (NECIS).

PubMed

Huang, Yun-Hsin; Wu, Chih-Hsun; Chen, Hsiu-Jung; Cheng, Yih-Ru; Hung, Fu-Chien; Leung, Kai-Kuan; Lue, Bee-Horng; Chen, Ching-Yu; Chiu, Tai-Yuan; Wu, Yin-Chang

2018-01-16

Severe negative emotional reactions to chronic illness are maladaptive to patients and they need to be addressed in a primary care setting. The psychometric properties of a quick screening tool-the Negative Emotions due to Chronic Illness Screening Test (NECIS)-for general emotional problems among patients with chronic illness being treated in a primary care setting was investigated. Three studies including 375 of patients with chronic illness were used to assess and analyze internal consistency, test-retest reliability, criterion-related validity, a cut-off point for distinguishing maladaptive emotions and clinical application validity of NECIS. Self-report questionnaires were used. Internal consistency (Cronbach's α) ranged from 0.78 to 0.82, and the test-retest reliability was 0.71 (P < 0.001). Criterion-related validity was 0.51 (P < 0.001). Based on the 'severe maladaptation' and 'moderate maladaptation' groups defined by using the 'Worsening due to Chronic Illness' index as the analysis reference, the receiver-operating characteristic curve analysis revealed an area under the curve of 0.81 and 0.82 (ps < 0.001), and a cut-off point of 19/20 was the most satisfactory for distinguishing those with overly negative emotions, with a sensitivity and specificity of 83.3 and 69.0%, and 68.5 and 83.0%, respectively. The clinical application validity analysis revealed that low NECIS group showed significantly better adaptation to chronic illness on the scales of subjective health, general satisfaction with life, self-efficacy of self-care for disease, illness perception and stressors in everyday life. The NECIS has satisfactory psychometric properties for use in the primary care setting. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The impact of HIV / AIDS on child survival and development in Kenya.

PubMed

Wekesa, E

2000-01-01

This paper focuses on the impact of HIV/AIDS on child survival and development in Kenya. The rapid spread of HIV, mainly through heterosexual contact and mother-to child transmission, contributes to the increasing rates of infant and under-five mortality in Kenyan provinces. Moreover, the impact of AIDS on the well-being of children is likely to worsen, as preliminary findings of the 1999 sentinel surveillance data indicate that HIV prevalence among the adult population is still rising. Poverty increases the vulnerability of children to HIV/AIDS. In addition, it may increase the likelihood that women become commercial sex workers as an alternative source of income. Poverty also increases the risk of illness and death through poor access to basic services. Poor environmental sanitation and lack of access to safe water sources increase the vulnerability of children to the impact of the infection. As a consequence, more and more children will be infected and affected by HIV/AIDS, and the ability of HIV-positive parents to care for their children will be impaired, while the number of orphans will continue to increase dramatically as parents die within a short period. Recommended strategies in combating the epidemic and improving the well-being of children are outlined.

Coliphages and Gastrointestinal Illness in Recreational Waters: Pooled Analysis of Six Coastal Beach Cohorts.

PubMed

Benjamin-Chung, Jade; Arnold, Benjamin F; Wade, Timothy J; Schiff, Kenneth; Griffith, John F; Dufour, Alfred P; Weisberg, Stephen B; Colford, John M

2017-09-01

Coliphages have been proposed as indicators of fecal contamination in recreational waters because they better mimic the persistence of pathogenic viruses in the environment and wastewater treatment than fecal indicator bacteria. We estimated the association between coliphages and gastrointestinal illness and compared it with the association with culturable enterococci. We pooled data from six prospective cohort studies that enrolled coastal beachgoers in California, Alabama, and Rhode Island. Water samples were collected and gastrointestinal illness within 10 days of the beach visit was recorded. Samples were tested for enterococci and male-specific and somatic coliphages. We estimated cumulative incidence ratios (CIR) for the association between swimming in water with detectable coliphage and gastrointestinal illness when human fecal pollution was likely present, not likely present, and under all conditions combined. The reference group was unexposed swimmers. We defined continuous and threshold-based exposures (coliphage present/absent, enterococci >35 vs. ≤35 CFU/100 ml). Under all conditions combined, there was no association between gastrointestinal illness and swimming in water with detectable coliphage or enterococci. When human fecal pollution was likely present, coliphage and enterococci were associated with increased gastrointestinal illness, and there was an association between male-specific coliphage level and illness that was somewhat stronger than the association between enterococci and illness. There were no substantial differences between male-specific and somatic coliphage. Somatic coliphage and enterococci had similar associations with gastrointestinal illness; there was some evidence that male-specific coliphage had a stronger association with illness than enterococci in marine waters with human fecal contamination.

Etiology of AIDS: biological and biochemical characteristics of HTLV-III.

PubMed

Markham, P D; Shaw, G M; Salahuddin, S Z; Hahn, B; Sarngadharan, M G; Gallo, R C

1985-01-01

The newly identified human HTLV-III virus, the etiologic agent for AIDS, shares many of the biological and physicochemical properties common to a family of retroviruses named human T-cell leukemia (lymphotropic) viruses, or HTLV. Because of the similarities, and because of the uniform nomenclature for human T-cell leukemia (lymphotropic) viruses adopted at the first Cold Spring Harbor Meeting on HTLV (19, 79), this newly discovered virus associated with AIDS as HTLV-III was named HTLV-III. Other investigators making independent isolations of virus have suggested naming the virus lymphadenopathy virus or LAV (3, 16), immunodeficiency associated virus or IADV (48), AIDS-related virus (41). Immunological and nucleic acid comparison has now demonstrated that these viruses are, not surprisingly, very similar to HTLV-III (55, 63, 78). In view of the wide range of disease manifestations caused by the virus, and previous discussions concerning a uniform nomenclature for human T-lymphotropic retroviruses, it would seem ill-advised to restrict the name of this virus to one clinical manifestation of one disease. The frequent isolation of HTLV-III from patients with AIDS and ARC, the detection of antibodies specific for HTLV-III in nearly all patients with these diseases and in a high proportion of individuals at risk, and finally its effect on cells in vitro, leaves little doubt that HTLV-III is causatively involved in the development of these diseases. This etiologic association is further strengthened by the detection of HTLV-III infection in many instances where a direct cause-and-effect association can be made, e.g., hemophiliacs and children with AIDS, and blood from HTLV-III infected donors and the otherwise normal recipients of this blood who subsequently develop AIDS.

Employability Competencies for Entry Level Emergency Medical Aides.

ERIC Educational Resources Information Center

Werner, Claire

This document describes competencies needed by persons who complete the Los Angeles Schools' emergency medical aide competency-based program, which is designed to enhance their ability to obtain certification as an Emergency Medical Technician (EMT). The overall competency statement ("goal") of the program heads each page and is defined by one or…

Special coverage: 9th Conference on Retroviruses. TB, pneumonia deaths down, but heart attacks up.

PubMed

2002-05-01

The profile of AIDS deaths has changed since HIV-infected patients began to receive highly active antiretroviral therapy in 1996. While fewer people are now dying overall, more are dying from non-AIDS-related diseases. Research from the Centers for Disease Control and Prevention and other sources is showing an increase in non-AIDS-defining illnesses. One CDC study presented at the recent retroviruses conference showed that while there have been declines in the proportions of deaths from some AIDS-related causes, there is an increase in deaths from non-AIDS-related causes, including liver and kidney disease and possibly ischemic heart disease.

Treatment of AIDS related non-Hodgkin's lymphoma with combination mitoguazone dihydrochloride and low dose CHOP chemotherapy: results of a phase II study.

PubMed

Tulpule, Anil; Espina, Byron M; Pedro Santabarbara, A B; Palmer, Maria; Schiflett, Joanne; Boswell, William; Smith, Susan; Levine, Alexandra M

2004-01-01

To evaluate the response and side effects of combination therapy with low dose CHOP chemotherapy and mitoguazone dihydrochloride in patients with non-Hodgkin's lymphoma associated with the acquired immunodeficiency syndrome (AIDS-NHL). Eighteen patients newly diagnosed with intermediate or high-grade AIDS-NHL were treated with low dose CHOP as follows: day 1, cyclophosphamide 350 mg/m(2), intravenously (IV); doxorubicin 25mg/m(2) IV; vincristine 2mg IV; and prednisone 100mg given orally on days 1 through 5. In addition, mitoguazone dihydrochloride was given at a dose of 600 mg/m(2) IV on days 1 and 15 of each 28-day treatment cycle. Seventeen males and one female patient were accrued. Twelve patients had high-grade pathologies while the remainder had an intermediate grade pathology (diffuse large cell). The median CD4+ lymphocyte count was 98/dl (range 1-924). Three patients (17%) reported an AIDS-defining illness prior to lymphoma diagnosis. Of 14 evaluable patients, 6 (43%) achieved a complete remission and 5 (35%) a partial remission. The median failure free and overall survival times were 6.5 and 8.4 months, respectively. Major toxicity was hematologic with grade 3 or 4 neutropenia in 72%; two patients died of neutropenic sepsis. Mitoguazone in combination with low dose CHOP is a safe regimen, associated with a response rate of 79% (CR 43%, PR 36%, 95% CI=49-95%). These preliminary results suggest no major improvement in terms of response over use of CHOP without mitoguazone.

Terminal illness and access to Phase 1 experimental agents, surgeries and devices: reviewing the ethical arguments.

PubMed

Schüklenk, Udo; Lowry, Christopher

2009-01-01

The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended--at the time--on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Existing ethics and health policy literature on the topic of access to experimental drugs. The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients--the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to Phase 1 agents for terminally ill patients. Finding a compromise between providing free or no access to Phase 1 drugs for terminally ill patients. We ought to investigate means to increase access to experimental drugs for terminally ill patients without sacrificing necessary clinical trials' sounds scientific methods.

Why do parents use the emergency department for minor injury and illness? A cross-sectional questionnaire.

PubMed

Ogilvie, Sarah; Hopgood, Katie; Higginson, Ian; Ives, Andrew; Smith, Jason E

2016-03-01

To understand decision-making when bringing a child to an emergency department. A cross-sectional survey of parents attending with children allocated a minor triage category. Emergency department in South West England, serving 450,000 people per annum. All English-speaking parents/caregivers whose children attended the emergency department and were triaged as minor injury/illness. Parental and child characteristics, injury/illness characteristics, advice seeking behaviour, views regarding emergency department service improvement, GP access and determinants of emergency department use. In sum, 373 responses were analysed. The majority of attendances were for minor injury, although illness was more common in <4 year olds. Most presentations were within 4 h of injury/illness and parents typically sought advice before attending. Younger parents reported feeling more stressed. Parents of younger children perceived the injury/illness to be more serious, reporting greater levels of worry, stress, helplessness and upset and less confidence. Parents educated to a higher level were more likely to administer first-aid/medication. Around 40% did not seek advice prior to attending and typically these were parents aged <24 and parents of <1 year olds. The main determinants of use were: advised by someone other than a GP; perceived urgency; perceived appropriateness. The need for reassurance also featured. The findings suggest that it is difficult for parents to determine whether their child's symptoms reflect minor conditions. Efforts should focus on building parental confidence and self-help and be directed at parents of younger children and younger parents. This is in addition to appropriate minor injury/illness assessment and treatment services.

Music as Illness; Music as Healing.

PubMed

Pritchard, Maureen

2015-09-01

Throughout the Soviet Union, the arts became tied to ethnicity through the project of Socialist Realism. When, in 1991, the Kyrgyz Republic became independent from the Soviet Union, its national narrative continued to be built upon tropes of Kyrgyz ethnicity. Through their engagement with images of the ethno-national self, the arts provide a great source of beauty. Defining beauty as a representation of the self that is pure whole, and stable, Julia Kristeva asserts that beauty and suffering are part of the same phenomena. Arthur Kleinman argues that suffering is best understood as existing within the triangulated relationship of cultural representation, collective experience, and subjectivity. Music too is part of this triangulated relationship, and therefore, a part of suffering. Drawing upon ten months of ethnographic fieldwork in Kyrgyzstan, this article explores the illness experience of a single Kyrgyz musician. In doing so, it illustrates music's role in self-formation and the development of social, economic, and political ties and the shifts that occur in these during illness. In drawing forth the role of music in the construction of racialized ethnicities, this article demonstrates how the experience of transformative beauty can coexist with turmoil, marginalization, and violence.

Obesity, cardiovascular disease and type 2 diabetes in people with a mental illness: a need for primary health care.

PubMed

Stanley, Susanne H; Laugharne, Jonathan D E

2012-01-01

People with a mental illness show a growing incidence of obesity, and higher rates of metabolic syndrome when compared with the general population. This paper reviews research on obesity, cardiovascular disease and type 2 diabetes, with the aim of directing clinical attention towards the improvement of patient physical health. A systematic search of cross-discipline databases and journals provided peer-reviewed research for analysis, and national statistics allowed for the investigation of differences in rates of occurrence between people experiencing a mental illness and the general population. Treatment effects via psychotropic medications and lifestyle factors such as poor diet and low levels of exercise suggest that ongoing monitoring is necessary to prevent major physical disorders in people experiencing a mental illness. To aid clinicians, a comprehensive set of clinical guidelines have been developed for the physical assessment and ongoing monitoring of mental health patients.

Need-Based Aid and College Persistence: The Effects of the Ohio College Opportunity Grant

ERIC Educational Resources Information Center

Bettinger, Eric

2015-01-01

This article exploits a natural experiment to estimate the effects of need-based aid policies on first-year college persistence rates. In fall 2006, Ohio abruptly adopted a new state financial aid policy that was significantly more generous than the previous plan. Using student-level data and very narrowly defined sets of students, I estimate a…

Perceived reasons for loss of housing and continued homelessness among homeless persons with mental illness.

PubMed

Mojtabai, Ramin

2005-02-01

The objective of this study was to examine the reasons for the most recent loss of housing and for continued homelessness as perceived by homeless persons with mental illness. A total of 2,974 currently homeless participants in the 1996 National Survey of Homeless Assistance Providers and Clients (NSHAPC) were asked about the reasons for their most recent loss of housing and continued homelessness. The responses of participants who had mental illness, defined both broadly and narrowly, were compared with responses of those who were not mentally ill. The broad definition of mental illness was based on a set of criteria proposed by NSHAPC investigators. The narrow definition included past psychiatric hospitalization in addition to the NSHAPC criteria. A total of 1,620 participants (56 percent) met the broad definition of mental illness, and 639 (22 percent) met the narrow definition; 1,345 participants (44 percent) did not meet any of these criteria and were categorized as not having a mental illness. Few differences in reasons for the most recent loss of housing were noted between the participants with and without mental illness. Both groups attributed their continued homelessness mostly to insufficient income, unemployment, and lack of suitable housing. Homeless persons with mental illness mostly report the same reasons for loss of housing and continued homelessness as those who do not have a mental illness. This finding supports the view that structural solutions, such as wider availability of low-cost housing and income support, would reduce the risk of homelessness among persons with mental illness, as among other vulnerable social groups.

The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

PubMed

Makhele, M F; Mulaudzi, F M

2012-01-01

The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.

Serious altitude illness in travelers who visited a pre-travel clinic.

PubMed

Croughs, Mieke; Van Gompel, Alfons; Rameckers, Sarah; Van den Ende, Jef

2014-01-01

Few data are available on the incidence and predictors of serious altitude illness in travelers who visit pre-travel clinics. Travel health consultants advise on measures to be taken in case of serious altitude illness but it is not clear if travelers adhere to these recommendations. Visitors to six travel clinics who planned to travel to an altitude of ≥3,000 m were asked to complete a diary from the first day at 2,000 m until 3 days after reaching the maximum sleeping altitude. Serious altitude illness was defined as having symptoms of serious acute mountain sickness (AMS score ≥ 6) and/or cerebral edema and/or pulmonary edema. The incidence of serious altitude illness in the 401 included participants of whom 90% reached ≥4,000 m, was 35%; 23% had symptoms of serious AMS, 25% symptoms of cerebral edema, and 13% symptoms of pulmonary edema. Independent predictors were young age, the occurrence of dark urine, travel in South America or Africa, and lack of acclimatization between 1,000 and 2,500 m. Acetazolamide was brought along by 77% of the responders of whom 41% took at least one dose. Of those with serious altitude illness, 57% had taken at least one dose of acetazolamide, 20% descended below 2,500 m on the same day or the next, and 11% consulted a physician. Serious altitude illness was a very frequent problem in travelers who visited pre-travel clinics. Young age, dark urine, travel in South America or Africa, and lack of acclimatization nights at moderate altitude were independent predictors. Furthermore, we found that seriously ill travelers seldom followed the advice to descend and to visit a physician. © 2014 International Society of Travel Medicine.

Five dramas of illness.

PubMed

Frank, Arthur W

2007-01-01

First-person narratives of illness experience are dramatic: the narrator, who is also the sufferer, is caught in conflicts of forces that permit understanding more than control. Among the dramas of illness, five occur frequently in autobiographical accounts of illness. These dramas overlap and have varying emphases in different people's stories. They are the drama of genesis (what instigated the illness); the drama of emotion work (what emotional displays are required or prohibited); the drama of fear and loss; the drama of meaning; and finally, the drama of self. This five-drama framework can focus critical and clinical attention on which conflicting forces the ill person is working to reconcile, what makes that work difficult, and how conceiving of one's illness as a drama can be a source of meaning and value.

Pilot undergraduate course teaches students about chronic illness in children: an educational intervention study.

PubMed

Montenegro, Roberto E; Birnie, Krista D; Fisher, Paul Graham; Dahl, Gary V; Binkley, John; Schiffman, Joshua D

2014-01-01

Recent data question whether medical education adequately prepares physicians to care for the growing number of children with chronic medical conditions. We describe a 10-week course designed to provide undergraduate students with the knowledge and skills required to understand and care for children with chronic or catastrophic illnesses. The course presented the illness experience from the child's perspective and thus presented information in a manner that was efficient, conducive, and memorable. The curriculum was designed like a graduate-level seminar that included workshops, lectures, readings, writing, and lively discussions. This is an educational intervention study that used survey data to assess changes in attitudes among and between participants completing this course versus students not exposed to this course. We used Somers' D test and Fisher's z-transformation to perform both pre- and post-nonparametric comparisons. Course participants were more likely to change their attitudes and agree that chronically ill children "feel comfortable talking with their peers about their condition" (P=0.003) and less likely to agree that these children "want to be treated differently," "want more sympathy," or "care less about romantic relationships" (P = 0.003, 0.002 and 0.02, respectively). Controls were more likely to continue to agree that chronically ill children "want to be treated differently" (P = 0.009) and "care less about romantic relationships" (P = 0.02), and less likely to agree that these children "talk openly" or "feel comfortable talking with their peers about their condition" (P = 0.04). This classroom-based course serves as a feasible and cost-effective model for universities and medical schools to aid in improving student attitudes toward treating chronically ill children. The course provides the unique opportunity to learn directly from those who care for and those who have lived with chronic illness.

HIV/AIDS, artisanal fishing and food security in the Okavango Delta, Botswana

NASA Astrophysics Data System (ADS)

Ngwenya, B. N.; Mosepele, K.

Generally, rural households pursue all year round natural and non-natural resource-based livelihood systems to diversify these options in order to cope with risks emanating from a range of shocks and stressors. Artisanal fishing in the Delta is not only a major livelihood option but also a source of food security. This paper is based on analysis of primary data collected from a survey of 248 subsistence fishers’ households through simple random sampling in 22 villages in the Delta. The overall objectives of the survey were to assess the general prevalence of HIV/AIDS in the Ngamiland district of Botswana, to investigate potential effects of AIDS-related stressors, particularly chronic illness on artisanal fishing activities, and to assess implications towards food security. Results from this study indicate that HIV prevalence rates for pregnant women attending antenatal clinics in the Delta are approximately 30% and are related to factors such as marriage, education, and employment. Despite this relatively high prevalence percentage, most of the affected households do not have adequate access to HIV/AIDS support facilities. Support services are provided on the basis of population size and/or status of the settlement (i.e. urban, urban village, rural or remote). Therefore, since about 50% of the Delta’s population lives in settlements of less than 500 people, they receive health services indirectly through major population centres whose capacity to deliver timely HIV/AIDS services is limited. This disproportionate access to HIV/AIDS services disadvantages the majority of fishing communities in the Delta, and may affect their ability to fish. Moreover, about 53% of sampled households had cared for a continuously ill person/s (CIP’s) in the last 5 years, out of which approximately 29% felt that this seriously impacted fishing activities. These serious impacts included sale of family assets, depletion of savings, and switching or abandoning fishing activities

Creating the final conversations scale: a measure of end-of-life relational communication with terminally ill individuals.

PubMed

Generous, Mark Alan; Keeley, Maureen P

2014-01-01

Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the "Final Conversations Scale" was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality/religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness/death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale.

Cancer as a cause of death among people with AIDS in the United States

PubMed Central

Simard, Edgar P.; Engels, Eric A.

2010-01-01

Background People with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), are at increased risk for cancer. Highly active antiretroviral therapy [(HAART), widely available since 1996] has resulted in dramatic declines in AIDS-related deaths. Methods We evaluated cancer as a cause of death in a U.S. registry-based cohort of 83,282 people with AIDS (1980–2006). Causes of death due to AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) were assessed. We evaluated mortality rates and the fraction of deaths due to cancer. Poisson regression assessed rates according to calendar year of AIDS onset. Results Overall mortality declined from 302 (1980–1989), to 140 (1990–1995), to 29 per 1,000 person-years (1996–2006). ADC mortality declined from 2.95 (1980–1989) to 0.65 per 1,000 person-years (1996–2006) (P<0.01), but the fraction of ADC-deaths increased from 1.05% to 2.47%, due to declines in other AIDS-related deaths. Non-Hodgkin lymphoma was the commonest cancer-related cause of death (36% during 1996–2006). Likewise, NADC mortality declined from 2.21 to 0.84 per 1,000 person-years (1980–1989 vs. 1996–2006, P<0.05), but the fraction of NADC-deaths increased to 3.16% during 1996–2006. Lung cancer was the most common NADC cause of death (21% of cancer-related deaths in 1996–2006). Conclusions Cancer mortality declined in the HAART era, but due to declining mortality from AIDS, cancers account for a growing fraction of deaths. Improved cancer prevention and treatment, particularly for non-Hodgkin lymphoma and lung cancer, would reduce mortality among people with AIDS. PMID:20825305

The neglected topic: presentation of cost information in patient decision AIDS.

PubMed

Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

2015-05-01

Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. © The Author(s) 2015.

Gendered constructions of the impact of HIV and AIDS in the context of the HIV-positive seroconcordant heterosexual relationship

PubMed Central

Bhagwanjee, Anil; Govender, Kaymarlin; Reardon, Candice; Johnstone, Leigh; George, Gavin; Gordon, Sarah

2013-01-01

Introduction This article explores the complex, dynamic and contextual frameworks within which men working in a mining community and their live-in long-term partners or spouses (termed “couples” in this study) respond to the introduction of HIV into their heterosexual relationships; the way in which partners adopt gendered positions in enabling them to make sense of their illness; how they negotiate their respective masculine and feminine roles in response to the need for HIV-related lifestyle changes; as well as the gendered nature of partner support in relation to antiretroviral therapy (ARV) adherence. Methods We conducted an in-depth qualitative study with a sample of 12 HIV-positive seroconcordant heterosexual couples in a South African mining organization. Transcripts based on semi-structured couple's interviews were analyzed using an inductive emergent thematic analytical method. Results The findings present compelling evidence that the impact of HIV and AIDS is mitigated, in the main, by the nature of the dyadic relationship. Where power and agency were skewed in accordance with traditional gender scripts, the impact of HIV and AIDS was deleterious in terms of negotiating disclosure, meeting expectations of care and support, and promoting treatment adherence. As a corollary, the study also revealed that where the relational dynamic evidenced a more equitable distribution of power, the challenge of negotiating illness was embraced in a way that strengthened the couples’ affiliation in profound ways, manifested not simply in a reduction in risk behaviours, but in both partner's courage to re-visit sensitive issues related to managing their relationship in the context of a debilitating illness. Conclusions Gendered positioning (by self and others) was found to play a crucial role in the way couples experienced HIV and ARV treatment, and underscored the positive role of a couples-counselling approach in the negotiation of the illness experience. However

Gendered constructions of the impact of HIV and AIDS in the context of the HIV-positive seroconcordant heterosexual relationship.

PubMed

Bhagwanjee, Anil; Govender, Kaymarlin; Reardon, Candice; Johnstone, Leigh; George, Gavin; Gordon, Sarah

2013-05-15

This article explores the complex, dynamic and contextual frameworks within which men working in a mining community and their live-in long-term partners or spouses (termed "couples" in this study) respond to the introduction of HIV into their heterosexual relationships; the way in which partners adopt gendered positions in enabling them to make sense of their illness; how they negotiate their respective masculine and feminine roles in response to the need for HIV-related lifestyle changes; as well as the gendered nature of partner support in relation to antiretroviral therapy (ARV) adherence. We conducted an in-depth qualitative study with a sample of 12 HIV-positive seroconcordant heterosexual couples in a South African mining organization. Transcripts based on semi-structured couple's interviews were analyzed using an inductive emergent thematic analytical method. The findings present compelling evidence that the impact of HIV and AIDS is mitigated, in the main, by the nature of the dyadic relationship. Where power and agency were skewed in accordance with traditional gender scripts, the impact of HIV and AIDS was deleterious in terms of negotiating disclosure, meeting expectations of care and support, and promoting treatment adherence. As a corollary, the study also revealed that where the relational dynamic evidenced a more equitable distribution of power, the challenge of negotiating illness was embraced in a way that strengthened the couples' affiliation in profound ways, manifested not simply in a reduction in risk behaviours, but in both partner's courage to re-visit sensitive issues related to managing their relationship in the context of a debilitating illness. Gendered positioning (by self and others) was found to play a crucial role in the way couples experienced HIV and ARV treatment, and underscored the positive role of a couples-counselling approach in the negotiation of the illness experience. However, as part of a broader social project, the

Psychiatric Illness in Relation to Frailty in Community-Dwelling Elderly People without Dementia: A Report from the Canadian Study of Health and Aging

ERIC Educational Resources Information Center

Andrew, Melissa K.; Rockwood, Kenneth

2007-01-01

We investigated whether frailty, defined as the accumulation of multiple, interacting illnesses, impairments and disabilities, is associated with psychiatric illness in older adults. Five-thousand-six-hundred-and-seventy-six community dwellers without dementia were identified within the Canadian Study of Health and Aging, and self-reported…

[Care for the mentally ill in the Norwegian counties Troms and Finnmark 1891-1940].

PubMed

Fause, Ashild

2008-12-18

The article discusses care for the mentally ill, as it emerged and developed in Troms and Finnmark counties in 1891 - 1940. The main objective was to document how publicly supported private care functioned with respect to the well-being of the mentally ill and their situation. How mental illness was defined and perceived by close relatives, care providers, medical practitioners and public authorities was also assessed. Medical records written by district physicians have been central sources; other sources were records from the county council proceedings and public statistics on poverty and health. The private care arrangement was the dominant type of care for the mentally ill in the region throughout the period. This arrangement was subject to public supervision, but its functioning depended on periodic support from somatic institutions and even prisons. The study shows that private care was a well-functioning arrangement in many cases. The mentally ill were often included in the household work and daily-life practices on the farm. The private care system however displayed wide variations, as its quality depended on the care providers, district physicians and last but not least economic support from the local community.

"Tangled wires in the head": older migrant Chinese's perception of mental illness in Britain.

PubMed

Li, Sarah; Hatzidimitriadou, Eleni; Psoinos, Maria

2014-08-01

In this article, the authors explored Cantonese-speaking older Chinese migrants knowledge, attitudes and expectations regarding mental illness. They obtained verbatim data from semi-structured interviews with eight participants recruited from London-based Chinese and church communities in Britain. They analyzed the data using the principles of Grounded Theory and in-depth content analysis. They examined cultural idioms in participants' accounts. Findings suggested that Western diagnostic categories of mental illness were alien to participants. They had a culturally constructed way of defining and characterizing mental illness. Participants used idioms of 'nerve', 'mood', 'behavior', 'personality', 'normal life', 'compassion' and the idiom of 'others' to construct an alternative world for stigma management. They erected an invisible but permeable barrier to limit access to their normal world. The role of traditional Chinese culture of Confucianism was significant in shaping perceptions and conceptions of mental illness. This article offered another perspective on the alternative world of Chinese migrants' cultural understandings of mental illness, an area with limited understanding at present. The authors discussed important implications for future research and social policy. Copyright © 2014 Elsevier Inc. All rights reserved.

What Do Young Adult Novels Say about HIV/AIDS?

ERIC Educational Resources Information Center

Gross, Melissa

1998-01-01

Using a content analysis approach, this investigation systematically studies messages about HIV/AIDS contained in young adult novels and considers the effects of these messages as an information source for the reader. Young adults and young adult fiction are defined, and coding sheets and bibliographies are appended. (Author/LRW)

Hypocaloric support in the critically ill.

PubMed

Patiño, J F; de Pimiento, S E; Vergara, A; Savino, P; Rodríguez, M; Escallón, J

1999-06-01

The critically ill patient exhibits a well defined endocrine and metabolic adaptive response to stressor agents, characterized by incremented resting energy expenditure (hypermetabolism, which is believed to signify increased energy requirements), accelerated whole-body proteolysis (hypercatabolism), and lipolysis. These phenomena occur in the acute stage, which is also characterized by hyperglycemia, typically accompanied by a hyperdynamic cardiovascular reaction manifested by high cardiac output, increased oxygen consumption, high body temperature, and decrease peripheral vascular resistance. High provisions of glucose-derived calories tend to accentuate these reactions and increase the degree of hyperglycemia. We have adopted a hypocaloric-hyperproteic regimen which is provided only during the first days of the flow phase of the adaptive response to injury, sepsis, or critical illness. Our regimen includes a daily supply of 100 to 200 g of glucose and 1.5 to 2.0 g of protein (synthetic amino acids) per kilogram of ideal body weight. We have analyzed the data on 107 critically ill patients, 70 men and 37 women, who were admitted to the surgical intensive care unit and who received nutritional support by the TPN hypocaloric modality for a minimum of 3 days. We found that the high caloric loads contained in TPN regimens results in additional metabolic stress, with consequent hyperdynamic cardiorespiratory repercussion, high CO2 production, and frequently hepatic steatosis. In contrast, our hypocaloric-hyperproteic approach has resulted in a more physiologic clinical course and considerable reduction in cost. The infusion of high glucose loads, such as those used in hypercaloric TPN, does not seem to suppress the excessive endogenous production of glucose but instead markedly exacerbates the hyperglycemia of the postinjury and acute stress condition. We believe that the hypocaloric-hyperproteic regimen we utilize during the first few days of the stress situation is

Growing up with an ill parent: An examination of family characteristics and parental illness features.

PubMed

Stoeckel, Maggie; Weissbrod, Carol

2015-12-01

Existing literature suggests that the children of ill parents are vulnerable to a variety of psychosocial difficulties such as depression and anxiety. The purpose of the current study is to investigate the impact of family characteristics (parental involvement, familial support, stress experienced as a result of parental illness) and parental illness features (severity, duration, recovery status, frequency of symptoms, course) on the psychosocial functioning (depression, anxiety, life satisfaction) of late adolescents who have grown up with an ill parent but no longer live with their parents. Participants were 71 college students with a parent who experienced a chronic medical condition while they were growing up. Participants provided information regarding family characteristics, parental illness features, and the impact of parental illness. Impact of parental illness was assessed using the Impact of Illness Scale. Participants also completed measures of depression, anxiety, and life satisfaction. Participants' reported impact of parent illness was positively correlated with participant depression and anxiety. Several family characteristics and parental illness features were significantly associated with participant psychosocial functioning. In particular, lower parental involvement was correlated with greater participant depression and anxiety, as well as lower life satisfaction. These findings extend our understanding of the impact of parental illness on late adolescents' psychosocial functioning. Results could have clinical applications for psychosocial interventions in children and families coping with chronic illness. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Pediatric nursing in the context of the HIV/AIDS epidemic in resource-poor settings--balancing the "art and the science".

PubMed

Govender, Linda; Rochat, Tamsen; Richter, Linda; Rollins, Nigel

2006-01-01

Pediatric wards in South Africa are largely occupied by children with AIDS-related illnesses. This study uses qualitative inquiry involving focus groups with nurses into the needs of children, caregivers, and healthcare providers. The findings indicate changes to the nature of nursing practice, knowledge of nursing, and ethics of nursing care.

Improving clinical trials in the critically ill.

PubMed

Angus, Derek C; Mira, Jean-Paul; Vincent, Jean-Louis

2010-02-01

To propose ways in which clinical trials in intensive care can be improved. An international roundtable conference was convened focused on improvement in three broad areas: translation of new knowledge from bench to bedside; design and conduct of clinical trials; and clinical trial infrastructure and environment. The roundtable recommendations were: improvement in clinical trials is a multistep process from better preclinical studies to better clinical trial methodology; new technologies should be used to improve models of critical illness; diseasomes and theragnostics will aid inpatient population selection and more appropriate targeting of interventions; broader study end points should include morbidity as well as mortality; more multicenter studies should be conducted by national and international networks or clinical trials groups; and better collaboration is needed with the industry. There was broad agreement among the roundtable participants regarding a number of explicit opportunities for the improvement of clinical trials in critical care.

Mathematical models of the AIDS epidemic: An historical perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stanley, E.A.

1988-01-01

Researchers developing mathematical models of the spreading of HIV, the Human Immunodeficiency Virus that causes AIDS, hope to achieve a number of goals. These goals may be classified rather broadly into three categories: understanding, prediction, and control. Understanding which are the key biological and sociological processes spreading this epidemic and leading to the deaths of those infected will allow AIDS researchers to collect better data and to identify ways of slowing the epidemic. Predicting the groups at risk and future numbers of ill people will allow an appropriate allocation of health-care resources. Analysis and comparison of proposed control methods willmore » point out unexpected consequences and allow a better design of these programs. The processes which lead to the spread of HIV are biologically and sociologically complex. Mathematical models allow us to organize our knowledge into a coherent picture and examine the logical consequences, therefore they have the potential to be extremely useful in the search to control this disease. 24 refs., 3 figs.« less

Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials.

PubMed

Jeste, Dilip V; Dunn, Laura B; Folsom, David P; Zisook, Dan

2008-01-01

Psychiatric practice is becoming increasingly more complex in terms of the available treatment options, use of new technologies for assessments, and a need for psychiatric patients and their caregivers to be familiar with general medical procedures. This trend will only intensify in the years to come. Routine methods of providing information relevant to clinical decision making about healthcare evaluations or management are often suboptimal. Relatively little research has been done on enhancing the capacity of psychiatric patients and the caregivers to make truly informed decisions about management. In this paper, we review studies that compared the effects of multimedia (video- or computer-based) educational aids with those of routine procedures to inform healthcare consumers about medical evaluations or management. Although most of these investigations were conducted in non-psychiatric patients, the results should be relevant for psychiatric practice of tomorrow. We searched MEDLINE, PsycINFO, and CINAHL bibliographic databases. Randomized controlled trials that used objective measures of knowledge or understanding of the information provided were selected. Studies were rated as positive if the multimedia educational aid resulted in a greater improvement in knowledge or understanding than the control condition. The quality of each study was also rated using a newly developed Scale for Assessing Scientific Quality of Investigations (SASQI). A total of 37 randomized controlled trials were identified. Nearly two-thirds of the studies (23/37) in diverse patient populations and for varied medical assessments and treatments reported that multimedia educational aids produced better understanding of information compared to routine methods. SASQI scores for the positive and negative studies were comparable, suggesting that lower quality was not related to positive findings. In conclusion, multimedia educational aids hold promise for improving the provision of complex

Factors affecting smoking cessation efforts of people with severe mental illness: a qualitative study.

PubMed

Rae, Jennifer; Pettey, Donna; Aubry, Tim; Stol, Jacqueline

2015-01-01

People with severe mental illness are much more likely to smoke than are members of the general population. Smoking cessation interventions that combine counseling and medication have been shown to be moderately effective, but quit rates remain low and little is known about the experiences of people with severe mental illness in smoking cessation interventions. To address this gap in knowledge, we conducted a qualitative study to investigate factors that help or hinder the smoking cessation efforts of people with severe mental illness. We recruited 16 people with severe mental illness who had participated in a clinical trial of two different smoking cessation interventions, one involving nicotine replacement therapy only and the other nicotine replacement therapy combined with motivational interviewing and a peer support group. We conducted open-ended, semi-structured interviews with participants, who ranged in age from 20 to 56 years old, were equally distributed by gender (eight men and eight women), and were predominantly Caucasian (n = 13, 81%). Primary mental illness diagnoses included schizophrenia/schizoaffective disorder (n = 6, 38%), depression (n = 5, 31%), bipolar disorder (n = 4, 25%), and anxiety disorder (n = 1, 6%). At entry into the clinical trial, participants smoked an average of 22.6 cigarettes per day (SD = 13.0). RESULTS indicated that people with mental illness have a diverse range of experiences in the same smoking cessation intervention. Smoking cessation experiences were influenced by factors related to the intervention itself (such as presence of smoking cessation aids, group supports, and emphasis on individual choice and needs), as well as individual factors (such as mental health, physical health, and substance use), and social-environmental factors (such as difficult life events and social relationships). An improved understanding of the smoking cessation experiences of people with severe mental illness can inform the delivery of

Cocaine Use and Sexual Risk Among Individuals With Severe Mental Illness.

PubMed

Bishop, Todd M; Maisto, Stephen A; Spinola, Suzanne

2016-01-01

Rates of HIV remain elevated in select populations such as those with severe mental illness and also among those who abuse cocaine, a vehicle through which risky sexual behavior may occur. The objective of the present narrative review was to synthesize the literature regarding stimulant use and its association with sexual risk among individuals with severe mental illness. This narrative review of the literature utilized Boolean search logic and the PsycINFO and PsycARTICLES databases to identify articles that explored the relationships among stimulant use, risky sexual behavior, and severe mental illness. Only one article was identified that examined a stimulant other than cocaine. Thus, the review was further limited to the impact that cocaine has on risky sexual behavior among those with severe mental illness. Of the 87 abstracts obtained, 58 underwent a full text review and eight were included in the final review. Studies had a mean sample size of 110 and predominantly consisted of male (64%) outpatients. Study designs were largely cross-sectional and almost exclusively relied on retrospective participant report of sexual behavior and drug use. The extant literature indicates a positive association between cocaine and risky sexual behavior among those with a diagnosed severe mental illness. Risky behaviors associated with cocaine included reporting a greater number of partners as well as a higher degree of involvement in the sex trade. The positive association observed between cocaine and partner-related risk, however, did not extend to condom use. Further research that utilizes better defined and operationalized constructs to investigate relationships among stimulant use, severe mental illness, and sexual risk, particularly condom use, is warranted and is necessary to advance the field.

Inclusiveness: a mental health strategy for preventing future mental health problems among adolescents orphaned by AIDS.

PubMed

Thupayagale-Tshweneagae, G; Mokomane, Z

2012-10-01

The purpose of this paper is to raise an argument that inclusiveness will lessen the pain of losing a parent among adolescents orphaned by AIDS and as a result, prevent future mental health problems that may occur because of inappropriate grieving and maladaptive coping strategies. Participation of adolescents orphaned by AIDS in decisions pertaining to their parents' illnesses and funeral arrangements, for example, may shorten the grieving process and allow for closure. The paper draws data from focus group discussions that were held with 15 adolescents orphaned by AIDS in urban South Africa. The focus group discussions that were structured around four themes: grieving patterns; coping strategies; experience with loss; and expectations. The results of the study demonstrate inclusiveness as an overarching factor in the healing process. The concept is thus a strong recommendation for mental health practice and further study. © 2011 Blackwell Publishing.

Does calling alcoholism an illness make a difference? The public image of alcoholism in Italy.

PubMed

Piras, Anna Paola; Preti, Antonio; Moro, Maria Francesca; Giua, Alice; Sini, Giulia; Piras, Martina; Pintus, Mirra; Pintus, Elisa; Manca, Annaraffaela; Cannas, Glenda; Cossu, Giulia; Angermeyer, Matthias Claus; Carta, Mauro Giovanni

2016-09-01

Using data from a population survey in two communities in the region of Sardinia, Italy, we examined the association between illness definition and attribution of personal characteristics to people with alcoholism. Quota samples, stratified by gender and age, were drawn from the general population (males: 48%; mean age 48±18; range: 15-90). A fully-structured interview was conducted face-to-face with 404 respondents. The assessment of the public view of 'alcoholics' was measured by their reactions to stimulus words rated on bipolar scales, and defined with adjectives with opposite meanings at each end. 322 participants (80%) rated the 'alcoholic' as 'ill'. The definition of the 'alcoholic' as being ill showed a statistically higher odd of stigma across all the dimensions of personal attributes. The expectation that people adopting the illness model would tend to blame less those afflicted for their condition and, consequently, stigmatize them less, was not confirmed. Copyright © 2016. Published by Elsevier Ireland Ltd.

Defining and measuring the costs of the HIV epidemic to business firms.

PubMed Central

Farnham, P G

1994-01-01

Most published estimates of the costs of the epidemic of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have been developed from the societal perspective, attempting to measure the burden of the epidemic to society in this country. Although societal cost analysis is well-developed, relatively little is known about many of the factors influencing the costs of the epidemic to business firms. The business community may bear a substantial portion of those costs in the form of health-related benefits provided to workers. Other effects of the epidemic in the workplace are related to fears and stigma associated with the illness. The author compares frameworks for analyzing the costs of the epidemic to the business community and to society. Societal costs include direct costs, the resources used in providing health care, and indirect costs, the resources lost to society as a result of the epidemic. Costs to business include illness-based employment costs, legal or administrative costs, prevention costs, perception-based employment costs, care giver costs, and nonmonetary costs. Not all societal costs are borne by business, and businesses may incur costs that are not traditionally measured from the societal perspective. PMID:8190854

Assessing and planning home-based care for persons with AIDS.

PubMed

McDonnell, S; Brennan, M; Burnham, G; Tarantola, D

1994-12-01

The HIV/AIDS pandemic continues to gather momentum in many developing countries, increasing the already heavy burden on health care facilities. As a result, donors, implementing partners and communities are beginning to create home-based care programmes to provide care for persons with HIV/AIDS. This paper recommends reorienting this home care provision as a service founded in, and coming from, the community rather than the health system. A methodology, in the form of an assessment matrix, is provided to facilitate the assessment of a community's capacity to provide care for people with AIDS. The focus is on rapid assessment methods using, where possible, readily available information to clearly and systematically define current circumstances. The matrix created for a specific community is then used in the development of an action plan with interventions prioritized and tailored to local needs. A case study from a hypothetical developing country, where HIV/AIDS is a significant problem, is used to illustrate the process.

Connect to protect and the creation of AIDS-competent communities.

PubMed

Reed, Sarah J; Miller, Robin Lin

2013-06-01

The development of community capacity is integral to reducing the burden of HIV in high-risk populations (Kippax, 2012). This study examines how coalitions addressing structural level determinants of HIV among youth are generating community capacity and creating AIDS-competent communities. AIDS-competent communities are defined as communities that can facilitate sexual behavior change, reduce HIV/AIDS–related stigma, support people living with HIV/AIDS, and cooperate in HIV–related prevention practices. This study shows how the coalitions are fostering the resources indicative of AIDS-competent communities: knowledge and skills, enhanced dialogue among relevant sectors of the community, local ownership of a problem, confidence in local strengths, solidarity or bonding social capital, and bridging partnerships. These data show that the coalitions catalyzed several outcomes aside from the completion of their structural changes. Coalition members are developing the skills, resources, and relationships that can ostensibly build a heightened community response to HIV prevention.

CONNECT TO PROTECT® AND THE CREATION OF AIDS-COMPETENT COMMUNITIES

PubMed Central

Reed, Sarah J.; Miller, Robin Lin

2013-01-01

The development of community capacity is integral to reducing the burden of HIV in high-risk populations (Kippax, 2012). This study examines how coalitions addressing structural level determinants of HIV among youth are generating community capacity and creating AIDS-competent communities. AIDS-competent communities are defined as communities that can facilitate sexual behavior change, reduce HIV/AIDS–related stigma, support people living with HIV/AIDS, and cooperate in HIV–related prevention practices. This study shows how the coalitions are fostering the resources indicative of AIDS-competent communities: knowledge and skills, enhanced dialogue among relevant sectors of the community, local ownership of a problem, confidence in local strengths, solidarity or bonding social capital, and bridging partnerships. These data show that the coalitions catalyzed several outcomes aside from the completion of their structural changes. Coalition members are developing the skills, resources, and relationships that can ostensibly build a heightened community response to HIV prevention. PMID:23762979

Concepts of illness in Icelandic children.

PubMed

Hansdottir, I; Malcarne, V L

1998-06-01

To investigate the development of illness concepts among healthy Icelandic children. Participants were 68 schoolchildren, 6-7, 10-11, and 14-15 years of age, and their parents. Cognitive developmental level and understanding of physical illness were assessed within a Piagetian framework. In addition, illness experience and illness behaviors (Child Illness Behavior Questionnaire) were assessed. Results were consistent with previous studies in that the development of illness concepts among Icelandic children was consistent with Piaget's theory of cognitive development. No relation was found between illness experience and understanding of illness. A more mature understanding of illness was related to willingness to report the onset of illness. The results suggest that findings from previous studies may be generalized to a broader population.

Mass Psychogenic Illness: Demography and Symptom Profile of an Episode.

PubMed

Tarafder, Binoy Krishna; Khan, Mohammad Ashik Imran; Islam, Md Tanvir; Mahmud, Sheikh Abdullah Al; Sarker, Md Humayun Kabir; Faruq, Imtiaz; Miah, Md Titu; Arafat, S M Yasir

2016-01-01

Background. Mass psychogenic illness has been a recurrent phenomenon in Bangladesh over recent times. Objectives. This study was aimed at investigating the demographic characteristics and symptom profile of an outbreak of mass psychogenic illness occurring in a girls' high school. Methods and Materials. In 14 April 2013, a total of 93 students of a girls' high school suddenly developed various symptoms following intake of tiffin cake which resulted in panic and hospital admission. A descriptive, cross-sectional observational survey was done to define various characteristics of the outbreak. Results. No organic explanation for the reported illnesses was found. 93 female students were included who were hospitalized during the incident. Trigger factor was found in 98% of students. Most of the students were 13 years old. Average interval between exposure to the trigger and onset of symptoms was 151.5 minutes. Commonest symptoms were abdominal pain (83%), headache (73%), chest pain (69%), body ache (63%), nausea (69%), and generalized weakness and fatigue (61%). Hospital stay following the incident was about 12 hours on average. Conclusion. To avoid unnecessary panic in the community a prompt, coordinated response is important in resolving widespread community anxiety surrounding these episodes.

Stigma and social participation in Southern India: differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS.

PubMed

Stevelink, S A M; van Brakel, W H; Augustine, V

2011-12-01

Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n = 95) and leprosy-affected respondents (n = 95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.

Evaluation of M-AID, a first aid application for mobile phones.

PubMed

Zanner, Robert; Wilhelm, Dirk; Feussner, Hubertus; Schneider, Gerhard

2007-09-01

When performed effectively, cardiopulmonary resuscitation (CPR) by bystanders reduces mortality due to sudden cardiac arrest. Telemedicine applications offer a means by which bystanders can get specific instructions for handling the emergency situation. M-AID, a first aid application for mobile phones, uses an intelligent algorithm of 'yes' or 'no' questions to judge the ongoing situation and give the user detailed instructions. The aim of this study was to evaluate the benefit of this mobile phone application in a scenario of sudden cardiac arrest. One hundred and nineteen volunteers were assigned at random either to the test or the control group. All participants were confronted with the same scenario of acute coronary syndrome leading to cardiac arrest. The participants were either equipped with a mobile phone running the software (test group) or had to handle the situation without support (control group). The participants received a certain amount of credits for each action taken according to a pre-defined protocol and these credits were added to a score and compared between the groups. Participants were divided into subgroups according to their medical and technical experience. The test group generally achieved a slightly higher average score that was not statistically significant (21.11 versus 19.97; p=0.302). In contrast, the performance of the individuals in the control group was significantly faster (2.41 min versus 4.24 min; p<0.001). Use of the mobile phone software did not enhance the chance of survival. Subgroup analysis showed that experienced mobile phone users performed significantly better than non-experienced individuals, but not as well as participants with advanced first aid knowledge. Experience in the use of mobile phones is a prerequisite for the efficient use of the tested M-AID version. This application cannot replace skills acquisition by practical training. In a subgroup with experience in mobile phone use and basic knowledge in CPR, the

Vascular and Skeletal Muscle Function in Gulf War Veterans Illness

DTIC Science & Technology

2016-07-01

Approximately 40% of Gulf War Veterans (over ¼ million Veterans) have GWI by the Center for Disease Control criteria for GWI (a recommended method for defining...for Disease Control and Prevention (CDC)’s clinical diagnostic criteria for GWI is one of two recommended by an Expert Committee, and is based on...other illnesses with muscle fatigue, pain, and abnormal muscle metabolism, such as peripheral artery disease and chronic heart failure, and advance

Social behaviour and illness information interact to influence the peer acceptance of children with chronic illness.

PubMed

Alderfer, M A; Wiebe, D J; Hartmann, D P

2001-09-01

Social behaviour was investigated as a contributor to the peer acceptance of children with chronic illness. We predicted that children with illness would receive less acceptance than children without illness, and that prosocial behaviour would improve acceptance, while aggressive behaviour would hamper it. Based upon attribution and cognitive bias theories, we also predicted that prosocial behaviour would be more beneficial and aggressive behaviour less damaging to the acceptance of children with illness compared to healthy children. A 3 (social behaviour: prosocial, aggressive, no information) x 2 (physical status: chronically ill, healthy) within-subjects analogue design was used. Preadolescents (N = 149) indicated social acceptance of hypothetical children portrayed in vignettes as either chronically ill or healthy with prosocial, aggressive, or no social behaviour. A 13-item social intentions scale gauged acceptance. The hypotheses were supported. Although children described as ill received lower acceptance ratings than healthy children, prosocial/ill children were more accepted than aggressive/ill children. Social behaviour interacted with physical status to affect acceptance. Social behaviour influences the peer acceptance of hypothetical children with chronic illness. Prosocial behaviour enhances acceptance of children described with illness, while aggressive behaviour hampers it. Additionally, prosocial behaviour is more beneficial, and aggressive behaviour is less damaging for children described as ill versus healthy. The potential processes by which peers judge acceptance of children with illness are discussed.

Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness.

PubMed

Lavin, Kyle; Davydow, Dimitry S; Downey, Lois; Engelberg, Ruth A; Dunlap, Ben; Sibley, James; Lober, William B; Okimoto, Kelson; Khandelwal, Nita; Loggers, Elizabeth T; Teno, Joan M; Curtis, J Randall

2017-08-01

Little is known about psychiatric illness and utilization of end-of-life care. We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All

High-Altitude Illness

MedlinePlus

... after you travel. Make sure you pack enough water while you are active. Avoid or limit the amount of alcohol you consume. High-altitude illness treatment It is important to treat high-altitude illness ...

Profiling illness perceptions to identify patients at-risk for decline in health status after heart valve replacement.

PubMed

Kohlmann, Sebastian; Rimington, Helen; Weinman, John

2012-06-01

Identification of risk factors for decline in health status by profiling illness perceptions before and one year after heart valve replacement surgery. Prospective data from N=225 consecutively admitted first time valve replacement patients was assessed before and one year after surgery. Patients were asked about their illness perceptions (Illness Perception Questionnaire-Revised) and mood state (Hospital Anxiety and Depression Scale). Health status was defined by quality of life (Short-Form 36) and New York Heart Association (NYHA) class. Cluster analyses were conducted to identify illness perception profiles over time. Predictors of health status after surgery were analyzed with multivariate methods. Patients were grouped according to the stability and nature (positive, negative) of their illness perception profile over one year. One year after surgery patients holding a negative illness perception profile showed a lower physical quality of life and were diagnosed in a higher New York Heart Association class than patients changing to positive and patients with stable positive illness perceptions (P<.001). Over and above biological determinants, post-surgery physical quality of life and NYHA class were both predicted by pre-surgery illness perception profiles (P<.05). Patients going for heart valve replacement surgery can be easily categorized into illness perception profiles that predict health status one year after surgery. These patients could benefit from early screening as negative illness perceptions are modifiable risk factors. Copyright © 2012 Elsevier Inc. All rights reserved.

Injury and illness epidemiology at a summer sport-camp program, 2008 through 2011.

PubMed

Oller, Daria M; Buckley, W E; Sebastianelli, Wayne J; Vairo, Giampietro L

2015-03-01

University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians. To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period. Descriptive epidemiology study. A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer. A total of 44, 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite. Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the National Athletic Injury/Illness Reporting System. Participant-personnel contacts, defined as any instance when a participant sought health care services from personnel, were calculated per 100 participants. Injury and illness rates were calculated per 10 ,000 exposures, measured in participant-days. The distribution of injury and illness conditions and affected body regions were calculated. There were 11 ,735 contacts, for an overall rate of 26 per 100 participants, and 4949 injuries and illnesses, for a rate of 1 per 10, 000 participant-days. Participants at single-sex camps were less likely to sustain injuries and illnesses than participants at coeducational camps (rate ratio [RR] = 0.49; 95% confidence interval = 0.45, 0. 35; P < .001, and RR = 0.47; 95% confidence interval = 0.43, 0.51; P < .001, respectively). The lower extremity was injured most frequently (27.9%). Most injury and illness conditions were dermatologic (37.1%). The contact and injury and illness differences observed among sports and between sexes demonstrated potential differences in the sports health care needs

Exploring the relationship between stigma and help-seeking for mental illness in African-descended faith communities in the UK.

PubMed

Mantovani, Nadia; Pizzolati, Micol; Edge, Dawn

2017-06-01

Stigma related to mental illness affects all ethnic groups, contributing to the production and maintenance of mental illness and restricting access to care and support. However, stigma is especially prevalent in minority communities, thus potentially increasing ethnically based disparities. Little is known of the links between stigma and help-seeking for mental illness in African-descended populations in the UK. Building on the evidence that faith-based organizations (FBOs) can aid the development of effective public health strategies, this qualitative study used semi-structured interviews with faith groups to explore the complex ways in which stigma influences help-seeking for mental illness in African-descended communities. A thematic approach to data analysis was applied to the entire data set. Twenty-six men and women who had varying levels of involvement with Christian FBOs in south London were interviewed (e.g. six faith leaders, thirteen 'active members' and seven 'regular attendees'). Key factors influencing help-seeking behaviour were as follows: beliefs about the causes of mental illness; 'silencing' of mental illness resulting from heightened levels of ideological stigma; and stigma (re)production and maintenance at community level. Individuals with a diagnosis of mental illness were likely to experience a triple jeopardy in terms of stigma. 'One-size-fits-all' approaches cannot effectively meet the needs of diverse populations. To ensure that services are more congruent with their needs, health and care organizations should enable service users, families and community members to become active creators of interventions to remove barriers to help-seeking for mental illness. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Recreational water–related illness

PubMed Central

Sanborn, Margaret; Takaro, Tim

2013-01-01

Abstract Objective To review the risk factors, management, and prevention of recreational water–related illness in family practice. Sources of information Original and review articles from January 1998 to February 2012 were identified using PubMed and the search terms water-related illness, recreational water illness, and swimmer illness. Main message There is a 3% to 8% risk of acute gastrointestinal illness (AGI) after swimming. The high-risk groups for AGI are children younger than 5 years, especially if they have not been vaccinated for rotavirus, and elderly and immunocompromised patients. Children are at higher risk because they swallow more water when swimming, stay in the water longer, and play in the shallow water and sand, which are more contaminated. Participants in sports with a lot of water contact like triathlon and kite surfing are also at high risk, and even activities involving partial water contact like boating and fishing carry a 40% to 50% increase in risk of AGI compared with nonwater recreational activities. Stool cultures should be done when a recreational water illness is suspected, and the clinical dehydration scale is a useful clinical tool for assessing the treatment needs of affected children. Conclusion Recreational water illness is the main attributable cause of AGI during swimming season. Recognition that swimming is a substantial source of illness can help prevent recurrent and secondary cases. Rotavirus vaccine is highly recommended for children who will swim frequently. PMID:23673583

Writing about an experience of illness in medical students

PubMed Central

Hwang, Kun; Fan, Huan; Hwang, Se Won

2013-01-01

Pathography is defined as “historical biography from a medical, psychological, and psychiatric viewpoint.” We thought that writing about an experience of illness might help students understand patients’ experience and in turn grow in terms of self-understanding. Participants included 151 medical students. Students wrote about their own experience of illness and were asked to answer questions from the Likert scale. Most students wrote about themselves (79.2%); however, some students (20.8%) wrote about the illness of others. Among the 149 pathographies, ecopathography was most frequent (30.9%), followed by testimonial pathography (25.5%); angry pathography (13.4%) and alternative pathography (12.1%) were relatively less frequent. Eighty-eight pathographies (59.1%) showed 120 expressions of family relationship. Among the 120 cases, worrying about family members was most frequent (47.5%), followed by reliance on a family member (32.5%). All students wrote about the enlightenment experienced on returning to daily life. The sense of belonging together was most frequent (38.3%), followed by gratitude for living (20.8%), resolution to be a good doctor (18.1%), and a will to live and be healthy (12.1%). Answers on the Likert scale (total 5) for pathography beneficence were very high in understanding desirable doctor image (4.46), attaining morals and personality as a health care professional (4.49), and understanding basic communication skills (4.46). Writing about an experience of illness allows students to better understand patients’ experience and to grow in self-understanding. PMID:24062621

Tailoring nutrition therapy to illness and recovery.

PubMed

Wischmeyer, Paul E

2017-12-28

Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of critical illness? We have long lived under the assumption that critical illness and trauma lead to a consistent early increase in metabolic/caloric need, the so-called "hypermetabolism" of critical illness. What if this is incorrect? Recent data indicate that early underfeeding of calories (trophic feeding) may have benefits and may require consideration in well-nourished patients. However, we must confront the reality that currently ICU nutrition delivery worldwide is actually leading to "starvation" of our patients and is likely a major contributor to poor long-term quality of life outcomes. To begin to ascertain the actual calorie and protein delivery required for optimal ICU recovery, an understanding of "starvation" and recovery from starvation and lean body mass (LBM) loss is needed. To begin to answer this question, we must look to the landmark Minnesota Starvation Study from 1945. This trial defines much of the world's knowledge about starvation, and most importantly what is required for recovery from starvation and massive LBM loss as occurs in the ICU. Recent and historic data indicate that critical illness is characterized by early massive catabolism, LBM loss, and escalating hypermetabolism that can persist for months or years. Early enteral nutrition during the acute phase should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein, and moderate nonprotein calories in well-nourished patients, as in the acute phase they are capable of generating significant endogenous energy. Post resuscitation, increasing protein (1.5-2.0 g/kg/day) and calories are needed to attenuate LBM loss and promote recovery. Malnutrition screening is essential and parenteral nutrition can be safely

Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

PubMed

Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

2014-10-01

Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

Insuring Consumption Against Illness.

PubMed

Gertler, Paul; Gruber, Jonathan

One of the most sizable and least predictable shocks to economic opportunities in developing countries is major illness. We investigate the extent to which families are able to insure consumption against major illness using a unique panel data set from Indonesia that combines excellent measures of health status with consumption information. We find that there are significant economic costs associated with major illness, and that there is very imperfect insurance of consumption over illness episodes. These estimates suggest that public disability insurance or subsidies for medical care may improve welfare by providing consumption insurance.

FcgammaRIIa genotype predicts progression of HIV infection.

PubMed

Forthal, Donald N; Landucci, Gary; Bream, Jay; Jacobson, Lisa P; Phan, Tran B; Montoya, Benjamin

2007-12-01

Polymorphisms in FcgammaR genes are associated with susceptibility to or severity of a number of autoimmune and infectious diseases. We found that HIV-infected men in the Multicenter AIDS Cohort Study with the FcgammaRIIa RR genotype progressed to a CD4(+) cell count of <200/mm(3) at a faster rate than individuals with the RH or HH genotypes (relative hazard = 1.6; p = 0.0001). However, progression to AIDS (using the broad definition of either a CD4(+) cell count <200/mm(3) or development of an AIDS-defining illness) was less impacted by FcgammaRIIa genotype, largely because HH homozygotes had an increased risk of Pneumocystis jiroveci pneumonia as an AIDS-defining illness. We also showed that chronically infected subjects develop a substantial anti-gp120-specific IgG2 response. Moreover, HIV-1 immune complexes are more efficiently internalized by monocytes from HH subjects compared with RR subjects, likely because of the presence of IgG2 in the complexes. Finally, the FcgammaRIIIa F/V gene polymorphism was not associated with progression of HIV infection, but, as demonstrated previously, did predict the risk of Kaposi's sarcoma. These results demonstrate the importance of FcgammaRs in AIDS pathogenesis and point toward a critical role for interactions between FcgammaRs and immune complexes in disease progression.

Severity of Illness Scores May Misclassify Critically Ill Obese Patients.

PubMed

Deliberato, Rodrigo Octávio; Ko, Stephanie; Komorowski, Matthieu; Armengol de La Hoz, M A; Frushicheva, Maria P; Raffa, Jesse D; Johnson, Alistair E W; Celi, Leo Anthony; Stone, David J

2018-03-01

Severity of illness scores rest on the assumption that patients have normal physiologic values at baseline and that patients with similar severity of illness scores have the same degree of deviation from their usual state. Prior studies have reported differences in baseline physiology, including laboratory markers, between obese and normal weight individuals, but these differences have not been analyzed in the ICU. We compared deviation from baseline of pertinent ICU laboratory test results between obese and normal weight patients, adjusted for the severity of illness. Retrospective cohort study in a large ICU database. Tertiary teaching hospital. Obese and normal weight patients who had laboratory results documented between 3 days and 1 year prior to hospital admission. None. Seven hundred sixty-nine normal weight patients were compared with 1,258 obese patients. After adjusting for the severity of illness score, age, comorbidity index, baseline laboratory result, and ICU type, the following deviations were found to be statistically significant: WBC 0.80 (95% CI, 0.27-1.33) × 10/L; p = 0.003; log (blood urea nitrogen) 0.01 (95% CI, 0.00-0.02); p = 0.014; log (creatinine) 0.03 (95% CI, 0.02-0.05), p < 0.001; with all deviations higher in obese patients. A logistic regression analysis suggested that after adjusting for age and severity of illness at least one of these deviations had a statistically significant effect on hospital mortality (p = 0.009). Among patients with the same severity of illness score, we detected clinically small but significant deviations in WBC, creatinine, and blood urea nitrogen from baseline in obese compared with normal weight patients. These small deviations are likely to be increasingly important as bigger data are analyzed in increasingly precise ways. Recognition of the extent to which all critically ill patients may deviate from their own baseline may improve the objectivity, precision, and generalizability of ICU mortality

Critical illness polyneuropathy: a case report.

PubMed

Celik, Canan; Ucan, Halil; Alemdaroglu, Ebru; Oktay, Fugen

2011-01-01

Critical illness polyneuropathy (CIP) is defined as a common complication of critically ilness patients who were admitted to the intensive care unit due to sepsis, multiple trauma and/or multi-organ failure. We aimed to present a patient who was diagnosed as CIP. He was admitted to our outpatient clinic due to weakness and pain in his lower extremities. He had been followed in an intensive care unit due to suicid five months ago. There were symmetrically and predominantly muscle weakness, sensory impairment, absence of deep tendon reflexes in his lower extremities. Electrophysiological evaluation demonstrated motor and sensory axonal distal polyneuropathy predominantly in lower extremities. At follow up, he had high fever, and elevated acute phase responses. Therefore source of infection was investigated and was suspected to a diagnosis of infective endocarditis. He was discharged to be hospitalized in cardiology clinic. With this case, we think that physiatrists should take into consideration a diagnosis of critical illness polyneuropathy in patients with symmetric motor weakness. In CIP, muscle weakness, sensory loss, neuropathic pain, and autonomic problems lengthened the rehabilitation period. Due to a diagnosis of infective endocarditis in our case, we point out that source of infection should be carefully investigated if there is acute phase responses in CIP patients even if during rehabilitation period.

Nursing needs of acutely ill older people.

PubMed

Hancock, Karen; Chang, Esther; Chenoweth, Lynn; Clarke, Marie; Carroll, Adrian; Jeon, Yun-Hee

2003-12-01

Investigating older acutely ill hospitalized patients' nursing needs and quality of care is paramount, given the growing pressure on nurses to provide increasingly intensive levels of care to a growing older population while at the same time working with reduced staffing levels. The aims of this study were to determine: (1) important aspects of nursing care as perceived by older patients, their family member/carer who observed care during hospitalization, and nurses; (2) satisfaction levels of patients, family/carers and nurses on nursing care received; and (3) mismatches between nursing care priorities and satisfaction with nursing care. Two hundred and thirty-two acutely ill patients aged over 65 years, 99 carers/family members and 90 nurses completed the Caregiving Activities Survey, which measures importance of and satisfaction with various aspects of nursing care. Qualitative data, which qualified responses to survey items, were also obtained from participants. Patients, carers and nurses perceived that carrying out doctors' orders was the most important aspect of nursing care, followed by physical care, psychosocial care and discharge planning. Nurses and carers rated physical care, psychosocial care and discharge planning more highly than patients. Physical care was rated highly by patients in terms of importance, but rated moderately in terms of satisfaction. Carers' and patients' ratings of satisfaction with physical care were lower than nurses' ratings of opportunities to provide it. The importance of discharge planning was rated highly by nurses but all groups were only moderately satisfied with this aspect of care. The findings do not apply to acutely ill older patients with confusion, mental illness or more than early stage dementia. Patients, nurses and family/carers were generally in agreement about the relative importance of particular aspects of nursing care. Nurses may need to communicate more effectively with older patients and their family

Heat-Related Illnesses

MedlinePlus

... Share this! EmergencyCareForYou » Emergency 101 » Heat-Related Illnesses Heat-Related Illnesses Dr. Glenn Mitchell , Emergency physician at ... about heat cramps and heat stroke and exhaustion. Heat Cramps Symptoms include muscle spasms, usually in the ...

Empirical Testing of an Algorithm for Defining Somatization in Children

PubMed Central

Eisman, Howard D.; Fogel, Joshua; Lazarovich, Regina; Pustilnik, Inna

2007-01-01

Introduction A previous article proposed an algorithm for defining somatization in children by classifying them into three categories: well, medically ill, and somatizer; the authors suggested further empirical validation of the algorithm (Postilnik et al., 2006). We use the Child Behavior Checklist (CBCL) to provide this empirical validation. Method Parents of children seen in pediatric clinics completed the CBCL (n=126). The physicians of these children completed specially-designed questionnaires. The sample comprised of 62 boys and 64 girls (age range 2 to 15 years). Classification categories included: well (n=53), medically ill (n=55), and somatizer (n=18). Analysis of variance (ANOVA) was used for statistical comparisons. Discriminant function analysis was conducted with the CBCL subscales. Results There were significant differences between the classification categories for the somatic complaints (p=<0.001), social problems (p=0.004), thought problems (p=0.01), attention problems (0.006), and internalizing (p=0.003) subscales and also total (p=0.001), and total-t (p=0.001) scales of the CBCL. Discriminant function analysis showed that 78% of somatizers and 66% of well were accurately classified, while only 35% of medically ill were accurately classified. Conclusion The somatization classification algorithm proposed by Postilnik et al. (2006) shows promise for classification of children and adolescents with somatic symptoms. PMID:18421368

Prevalence of Depression in People Living with HIV/AIDS Undergoing ART and Factors Associated with it.

PubMed

Bhatia, M S; Munjal, Sahil

2014-10-01

HIV/AIDS is one of the most devastating illnesses that humans have ever faced. Depression in HIV/AIDS patients is very common but the factors affecting it are not well studied. HIV/AIDS though such a big public health problem worldwide, not enough data is available regarding association of HIV and Depression. Therefore this study was undertaken to evaluate the association between HIV/AIDS and depression in an Indian setting. The study was conducted in Guru Teg Bahadur Hospital and University College of Medical Sciences, Delhi. One hundred sixty patients were interviewed using a questionnaire containing factors that affect depression. CES-D (Center for Epidemiologic Studies - Depression) scale was used to measure depression. The data collected was analyzed using SPSS software. The prevalence of depression in patients with HIV under ART was 58.75%. The prevalence of depression increased with the severity of symptoms. The unemployed, uneducated, unmarried, belonging to joint families, having no or low family income, migrants, having indifferent or poor relationship with spouse, poor social support and had visited commercial sex workers had a greater prevalence of depression. The rate of depression in patients with HIV/AIDS is very high. Detecting depression early and treating it goes a long way in improving the compliance to treatment as well as quality of life.

Recovery and severe mental illness: The role of romantic relationships, intimacy, and sexuality.

PubMed

Boucher, Marie-Eve; Groleau, Danielle; Whitley, Rob

2016-06-01

The overall aim of this article is to examine the self-defined role of romantic relationships, intimacy and sexuality in recovery from severe mental illness. Semistructured interviews were conducted with 35 people with severe mental illness, accompanied by participant observation. Data were analyzed using thematic analysis. The vast majority of participants considered a supportive relationship that was emotionally or sexually intimate to be a key facilitator and indicator of recovery. However, only a small minority of participants were actually in such a relationship. Participants reported numerous barriers to forming and maintaining such relationships such as financial strain and enduring stigma against people with mental illness. Addressing relational and intimate needs have not been a focus of traditional psychiatric services. As such, some form of "supported dating" within the field of psychosocial rehabilitation may be an essential development to foster an oft-overlooked but important aspect of recovery. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Barriers to Family Caregivers' Coping With Patients With Severe Mental Illness in Iran.

PubMed

Ebrahimi, Hossein; Seyedfatemi, Naeimeh; Namdar Areshtanab, Hossein; Ranjbar, Fatemeh; Thornicroft, Graham; Whitehead, Bill; Rahmani, Farnaz

2018-05-01

The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers' experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers' ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient's isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.

Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis.

PubMed

May, Peter; Normand, Charles; Cassel, J Brian; Del Fabbro, Egidio; Fine, Robert L; Menz, Reagan; Morrison, Corey A; Penrod, Joan D; Robinson, Chessie; Morrison, R Sean

2018-06-01

Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations. To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017. Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders. Eight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis. Total direct hospital costs. This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged

Somali Refugees' Perceptions of Mental Illness.

PubMed

Bettmann, Joanna E; Penney, Deb; Clarkson Freeman, Pamela; Lecy, Natalie

2015-01-01

Nearly 13% of the U.S. population is comprised of foreign-born individuals, with Somalis constituting one of the largest resettled groups. Research suggests that, among Somali refugees, rates of mental illness are high. Yet research shows Somalis underutilize mental health services. Understanding their perceptions of mental illness and its cures may help practitioners to design more effective treatments for this population. Thus, this pilot study investigated Somali refugees' perceptions of mental illness and its treatments. Using purposive sampling, this qualitative study interviewed 20 Somali refugees using a semi-structured interview guide. Qualitative analysis yielded participants' perceptions of mental illness through their descriptions of physical symptoms accompanying mental illness, the stigma of mental illness, causes of mental illness, medical and non-medical treatments for mental illness, spirit possession causing mental illness, and the Qur'an as treatment for mental illness. Such information may help practitioners in the United States approach Somali clients in the most culturally coherent manner.

Shifting the burden: the private sector's response to the AIDS epidemic in Africa.

PubMed

Rosen, Sydney; Simon, Jonathon L

2003-01-01

As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved.

Shifting the burden: the private sector's response to the AIDS epidemic in Africa.

PubMed Central

Rosen, Sydney; Simon, Jonathon L.

2003-01-01

As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved. PMID:12751421

Resilience in the face of serious illness among chronically ill African Americans in later life.

PubMed

Becker, Gay; Newsom, Edwina

2005-07-01

The purpose of this work was to examine older African Americans' philosophies about their chronic illnesses and how those philosophies affected chronic illness management. Three to five in-depth interviews were conducted over the course of several years with 38 respondents between the ages of 65 and 91. Both open-ended and semistructured questions were asked. Respondents demonstrated determination, perseverance, and tenacity no matter how serious their illnesses were. Racism was instrumental in shaping the responses of these African Americans to their illnesses through cultural values that emphasized independence, spirituality, and survival. Respondents demonstrated a resilient philosophy as they faced disabling illness. This research attests to the importance of examining racism in the analysis of how older ethnic minorities live with chronic illness, as it provides the context for understanding the development of culturally specific philosophies about illness. Resilience, as a culturally specific philosophy, is an important adjunct to chronic illness management in later life, and more needs to be understood about the dimensions that shape it by cultural group.

Illness Uncertainty and Illness Intrusiveness as Predictors of Depressive and Anxious Symptomology in College Students with Chronic Illnesses

ERIC Educational Resources Information Center

Mullins, Alexandria J.; Gamwell, Kaitlyn L.; Sharkey, Christina M.; Bakula, Dana M.; Tackett, Alayna P.; Suorsa, Kristina I.; Chaney, John M.; Mullins, Larry L.

2017-01-01

Objective: To examine predictors of psychological functioning in college students with chronic illnesses. Participants: Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between…

Computer-aided diagnosis of HIE based on segmentation of MRI

NASA Astrophysics Data System (ADS)

Sun, Ziguang; Li, Chungui; Wang, Qin

2009-10-01

Computer-aided diagnosis has become one of the major research subjects in medical imaging and diagnostic radiology. Hypoxic-ischemic encephalopathy (HIE), remains a serious condition that causes significant mortality and long-term morbidity to neonates. We adopt self-organizing feature maps to segment the tissues, such as white matter and grey matter in the magnetic resonance images. The borderline between white matter and grey matter can be found and the doubtful regions along with the borderline can be localized, then the feature in doubtful regions can be quantified. The method can assist doctors to easily diagnose whether a neonate is ill with mild HIE.

Household displacement and health risk behaviors among AIDS-affected children in rural China

PubMed Central

Zhao, Qun; Zhao, Junfeng; Li, Xiaoming; Fang, Xiaoyi; Zhao, Guoxiang; Lin, Xiuyun; Zhang, Liying

2011-01-01

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangement and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children) and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AID orphans and vulnerable children in communities of high prevalence of HIV/AIDS. The government, community and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents. PMID:21400311

Use of unsolicited first-person written illness narratives in research: systematic review.

PubMed

O'Brien, Mary R; Clark, David

2010-08-01

This paper is a report of a methodological systematic review conducted to critically analyze the use of unsolicited first-person written illness narratives for research purposes. Documenting illness experiences through written narratives enables individuals to record the impact of illness on themselves and those closest to them. In health research, unsolicited first-person written illness narratives are recognized increasingly as legitimate data sources. To date there has been no critical evaluation of the method. The ISI Web of Knowledge; CINAHL; PubMed; MEDLINE; PsycINFO; Science Direct; Cochrane Library databases and the internet metasearch engine 'Dogpile' were searched for the period up to 2009. The search terms were: 'patient experience', 'narratives', 'autobiography', 'pathography', 'written narratives', 'illness narratives', 'internet', 'published', 'unsolicited'. Recommendations within the Centre for Reviews and Dissemination guidance informed the review. Eligible studies were evaluated according to inclusion/exclusion criteria. The data were extracted by one reviewer and monitored by the second reviewer. Eighteen papers met the inclusion criteria, 12 from the original search in 2008 and six from the updated search in October 2009. Nine used unpublished (internet) narratives, eight used published (print) accounts and one drew on both genres. The method has been used to explore a wide range of illness experiences. There was lack of agreement on key terminology. Methodological issues were often poorly-described, and confused ethical stances were reported. The lack of methodological detail in published papers requires attention if this method is to be used effectively in healthcare research. The confused ethical stance adopted needs to be addressed and clarified. A theoretical conceptual framework to define and describe the method accurately is urgently required.

Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era.

PubMed

Lewden, Charlotte; Drabo, Youssoufou J; Zannou, Djimon M; Maiga, Moussa Y; Minta, Daouda K; Sow, Papa S; Akakpo, Jocelyn; Dabis, François; Eholié, Serge P

2014-01-01

We aimed to describe the morbidity and mortality patterns in HIV-positive adults hospitalized in West Africa. We conducted a six-month prospective multicentre survey within the IeDEA West Africa collaboration in six adult medical wards of teaching hospitals in Abidjan, Ouagadougou, Cotonou, Dakar and Bamako. From April to October 2010, all newly hospitalized HIV-positive patients were eligible. Baseline and follow-up information until hospital discharge was recorded using standardized forms. Diagnoses were reviewed by a local event validation committee using reference definitions. Factors associated with in-hospital mortality were studied with a logistic regression model. Among 823 hospitalized HIV-positive adults (median age 40 years, 58% women), 24% discovered their HIV infection during the hospitalization, median CD4 count was 75/mm(3) (IQR: 25-177) and 48% had previously received antiretroviral treatment (ART). The underlying causes of hospitalization were AIDS-defining conditions (54%), other infections (32%), other diseases (8%) and non-specific illness (6%). The most frequent diseases diagnosed were: tuberculosis (29%), pneumonia (15%), malaria (10%) and cerebral toxoplasmosis (10%). Overall, 315 (38%) patients died during hospitalization and the underlying cause of death was AIDS (63%), non-AIDS-defining infections (26%), other diseases (7%) and non-specific illness or unknown cause (4%). Among them, the most frequent fatal diseases were: tuberculosis (36%), cerebral toxoplasmosis (10%), cryptococcosis (9%) and sepsis (7%). Older age, clinical WHO stage 3 and 4, low CD4 count, and AIDS-defining infectious diagnoses were associated with hospital fatality. AIDS-defining conditions, primarily tuberculosis, and bacterial infections were the most frequent causes of hospitalization in HIV-positive adults in West Africa and resulted in high in-hospital fatality. Sustained efforts are needed to integrate care of these disease conditions and optimize earlier

The impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses.

PubMed

Wang, Chi-Jane; Fetzer, Susan J; Yang, Yi-Ching; Wang, Jing-Jy

2013-01-01

It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders. Copyright © 2013 Mosby, Inc. All rights reserved.

Food Insecurity among Homeless Adults with Mental Illness

PubMed Central

Parpouchi, Milad; Moniruzzaman, Akm; Russolillo, Angela; Somers, Julian M.

2016-01-01

Background The prevalence of food insecurity and food insufficiency is high among homeless people. We investigated the prevalence and correlates of food insecurity among a cohort of homeless adults with mental illness in Vancouver, British Columbia, Canada. Methods Data collected from baseline questionnaires in the Vancouver At Home study were analysed to calculate the prevalence of food insecurity within the sample (n = 421). A modified version of the U.S. Department of Agriculture’s Adult Food Security Survey Module was used to ascertain food insecurity. Univariable and multivariable logistic regression were used to examine potential correlates of food insecurity. Results The prevalence of food insecurity was 64%. In the multivariable model, food insecurity was significantly associated with age (adjusted odds ratio [aOR] = 0.97; 95% CI: 0.95–0.99), less than high school completion (aOR = 0.57; 95% CI: 0.35–0.93), needing health care but not receiving it (aOR = 1.65; 95% CI: 1.00–2.72), subjective mental health (aOR = 0.97; 95% CI: 0.96–0.99), having spent over $500 for drugs and alcohol in the past month (aOR = 2.25; 95% CI: 1.16–4.36), HIV/AIDS (aOR = 4.20; 95% CI: 1.36–12.96), heart disease (aOR = 0.39; 95% CI: 0.16–0.97) and having gone to a drop-in centre, community meal centre or program/food bank (aOR = 1.65; 95% CI: 1.01–2.68). Conclusions The prevalence of food insecurity was extremely high in a cohort with longstanding homelessness and serious mental illness. Younger age, needing health care but not receiving it, poorer subjective mental health, having spent over $500 for drugs and alcohol in the past month, HIV/AIDS and having gone to a drop-in centre, community meal centre or program/food bank each increased odds of food insecurity, while less than high school completion and heart disease each decreased odds of food insecurity. Interventions to reduce food insecurity in this population are urgently needed. PMID:27437937

The Relationship Between Traumatic Brain Injury and Rates of Chronic Symptomatic Illness in 202 Gulf War Veterans.

PubMed

Chao, Linda L

2018-05-18

Although not a "signature injury" of Operation Desert Shield/Desert Storm (i.e., Gulf War, GW), some GW veterans have a history traumatic brain injury (TBI). For example, a previous study found that 12.2% of the GW veterans from the Fort Devens Cohort Study had self-reported TBIs. The present study sought to build upon this finding by examining the relationship between TBI and chronic symptomatic illness in a different sample of GW veterans. Participants were 202 GW veterans recruited from 2014 to 2018 at the San Francisco Veterans Affairs Medical Center as part of a VA-funded study on the effects of predicted exposure to low levels of sarin and cyclosarin on brain structure and function. The Ohio State University TBI identification method was used to determine lifetime history of TBI. The Kansas Gulf War Military History and Health Questionnaire was used to assess symptoms and to determine cases of Kansas Gulf War Illness (GWI) and Centers for Disease Control and Prevention (CDC) Chronic Multisymptom Illness (CMI). Nearly half (47%) the sample had a history of TBI, but only 7% of the TBIs were sustained in injuries that occurred during the GW. Most of the TBIs were sustained in injuries that occurred prior to (73%) or after (34%) the GW. History of TBI was not associated with higher rates of symptomatic illness when it was narrowly defined (i.e., Kansas GWI cases or cases of severe CMI). History of TBI was only associated with higher rates of symptomatic illness when it is broadly defined (i.e., CDC CMI or mild-moderate CMI). There was suggestive evidence that veterans who sustained TBIs during the GW (only seven in the present sample) have poorer functional outcomes compared with GW veterans with non-GW related TBIs. While TBIs were uncommon during the GW, many GW veterans sustained TBIs prior or after the GW. Because TBI and GWI/CMI share some overlapping symptoms, history of TBI may appear to be associated with increased rates of chronic symptomatic illness in

Use of focus groups to study absenteeism due to illness.

PubMed

Høverstad, T; Kjølstad, S

1991-10-01

Reasons for sick leaves are often complex and influenced by nonmedical factors. We have used focus groups, a qualitative research method, to study the relationship between working conditions and absenteeism due to illness in both an industrial company and an insurance company. We organized 10 focus groups within each company, with participants randomly selected from departments having similar work tasks within each company. According to the groups, the most important working conditions that influenced absenteeism were (a) feeling of well-being at work (mainly defined as security in social relations), (b) the organization of the work, and (c) the department leader. Factors considered to be less important included: number of employees, male/female ratios, group norms for absenteeism, age distribution, work-related illness, substance abuse, and work loads. There was substantial agreement between the groups, indicating that our findings may be relevant to other companies.

A rule based computer aided design system

NASA Technical Reports Server (NTRS)

Premack, T.

1986-01-01

A Computer Aided Design (CAD) system is presented which supports the iterative process of design, the dimensional continuity between mating parts, and the hierarchical structure of the parts in their assembled configuration. Prolog, an interactive logic programming language, is used to represent and interpret the data base. The solid geometry representing the parts is defined in parameterized form using the swept volume method. The system is demonstrated with a design of a spring piston.

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness.

PubMed

Shen, Chan; Sambamoorthi, Usha; Rust, George

2008-06-01

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for

Heat illness and death among workers - United States, 2012-2013.

PubMed

Arbury, Sheila; Jacklitsch, Brenda; Farquah, Opeyemi; Hodgson, Michael; Lamson, Glenn; Martin, Heather; Profitt, Audrey

2014-08-08

Exposure to heat and hot environments puts workers at risk for heat stress, which can result in heat illnesses and death. This report describes findings from a review of 2012‒2013 Occupational Safety and Health Administration (OSHA) federal enforcement cases (i.e., inspections) resulting in citations under paragraph 5(a)(1), the "general duty clause" of the Occupational Safety and Health Act of 1970. That clause requires that each employer "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees". Because OSHA has not issued a heat standard, it must use 5(a)(1) citations in cases of heat illness or death to enforce employers' obligations to provide a safe and healthy workplace. During the 2-year period reviewed, 20 cases of heat illness or death were cited for federal enforcement under paragraph 5(a)(1) among 18 private employers and two federal agencies. In 13 cases, a worker died from heat exposure, and in seven cases, two or more employees experienced symptoms of heat illness. Most of the affected employees worked outdoors, and all performed heavy or moderate work, as defined by the American Conference of Governmental Industrial Hygienists. Nine of the deaths occurred in the first 3 days of working on the job, four of them occurring on the worker's first day. Heat illness prevention programs at these workplaces were found to be incomplete or absent, and no provision was made for the acclimatization of new workers. Acclimatization is the result of beneficial physiologic adaptations (e.g., increased sweating efficiency and stabilization of circulation) that occur after gradually increased exposure to heat or a hot environment. Whenever a potential exists for workers to be exposed to heat or hot environments, employers should implement heat illness prevention programs (including acclimatization requirements) at their

HIV/AIDS - resources

MedlinePlus

Resources - HIV/AIDS ... The following organizations are good resources for information on AIDS : AIDS.gov -- www.aids.gov AIDS Info -- aidsinfo.nih.gov The Henry J. Kaiser Family Foundation -- www. ...

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis.

PubMed

Richardson, Emma M; Schüz, Natalie; Sanderson, Kristy; Scott, Jennifer L; Schüz, Benjamin

2017-06-01

Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer. Copyright © 2016 John Wiley & Sons, Ltd.

Mood and anxiety disorders as early manifestations of medical illness: a systematic review.

PubMed

Cosci, Fiammetta; Fava, Giovanni A; Sonino, Nicoletta

2015-01-01

Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed. A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

The Effect of Saffron on Depression among Recovered Consumers of Methamphetamine Living with HIV/AIDS.

PubMed

Jalali, Farzad; Hashemi, Seyedeh Fatemeh

2018-03-15

From one hand, depression is one of the symptoms that occur after abstinence from methamphetamine. On the other people living with HIV/AIDS are in isolation due to the nature of their illness and depression is one of the most common mental health problems they experience. This study was aimed at determining the effectiveness of saffron on reducing depression among recovered consumers of methamphetamine living with HIV/AIDS. The design of this study was semi-experimental with pre-test, post-test and control (placebo) groups. The statistical population consisted of all recovered consumers of methamphetamine living with HIV/AIDS who were referred to the Positive Club. Fifty-seven (57) recovered consumers of methamphetamine, living with HIV/AIDS, were selected by convenience sampling method. They were randomly assigned to an experimental (saffron) group and a control (placebo) group. The experimental group received 30 ml of saffron per day for 8 weeks, whereas the control (placebo) group received placebo the same way. BDI-II was used in this study as a measurement instrument. ANCOVA models were used for statistical inference. The findings showed that saffron and its ingredients had been effective in reducing depression among this group (P < 0.05). In fact, saffron with its active ingredients (Crusin and Saffranal) by serotonin and dopamine secretion in the brain, help in reducing depression among recovered consumers of methamphetamine living with HIV/AIDS.

The Effects of Tuition Level and Financial Aid on the Demand for Undergraduate and Advanced Terminal Degrees.