Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania.

It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to testing services and unequal gender dynamics in relationships. Innovative approaches are needed to address barriers to couple's testing and increase uptake of HIV testing. Using qualitative data collection methods, a formative study was conducted to assess the acceptability of a home-based couples counseling and testing (HBCCT) approach. Eligible study participants included married men and women, HIV-infected individuals, health care and home-based care providers, voluntary counseling and testing counselors, and community leaders. A total of 91 individuals participated in focus group discussions (FGDs) and in-depth interviews conducted between September 2009 and January 2010 in rural settings in Northern Tanzania. An HBCCT intervention appears to be broadly acceptable among participants. Benefits of HBCCT were identified in terms of access, confidentiality, and strengthening the relationship. Fears of negative consequences from knowing one's HIV status, including stigma, blame, physical abuse, or divorce, remain a concern and a potential barrier to the successful provision of the intervention. Lessons for implementation highlighted the importance of appointments for home visits, building relationships of confidence and trust between counselors and clients, and assessing and responding to a couple's readiness to undergo HIV testing. HBCCT should addresses HIV stigma, emphasize confidentiality, and improve communication skills for disclosure and decision-making among couples.

Socio-economic status and malaria-related outcomes in Mvomero District, Tanzania.

While policies often target malaria prevention and treatment - proximal causes of malaria and related health outcomes - too little attention has been given to the role of household- and individual-level socio-economic status (SES) as a fundamental cause of disease risk in developing countries. This paper presents a conceptual model outlining ways in which SES may influence malaria-related outcomes. Building on this conceptual model, we use household data from rural Mvomero, Tanzania, to examine empirical relationships among multiple measures of household and individual SES and demographics, on the one hand, and malaria prevention, illness, and diagnosis and treatment behaviours, on the other. We find that access to prevention and treatment is significantly associated with indicators of households' wealth; education-based disparities do not emerge in this context. Meanwhile, reported malaria illness shows a stronger association with demographic variables than with SES (controlling for prevention). Greater understanding of the mechanisms through which SES and malaria policies interact to influence disease risk can help to reduce health disparities and reduce the malaria burden in an equitable manner.

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders

�� Cambridge University Press 2014.Background Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. Method We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. Results NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. Conclusions Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.

A review of glaucoma treatment in Scotland 1994-2004

Objective: This study evaluated the changing trends in glaucoma management in Scotland between 1994 and 2004. Methods: A retrospective analysis of national health statistics in Scotland from 1994 to 2004. The Scottish morbidity record was used to collect information on all episodes of trabeculectomy. Data on number of prescriptions were gathered for individual drugs and also for groups of active ingredient. The population likely to have glaucoma (PLG) was calculated from estimates of prevalence in individuals aged 40 years and older, based on published epidemiological studies. The outcome measures were trabeculectomy rates, corrected for population likely to be at risk of glaucoma (PLG), and prescribing volume and cost for glaucoma medications. Results: Trabeculectomy rates have fallen by 67% from 46 per 1000 PLG in 1994 to 15.4 per 1000 PLG in 2004. Over the same time period, the population likely to be at risk of glaucoma (PLG) increased by 16.6%. The cost of prescribing has increased by 122% over 11 years compared with an increase in number of items per 1000 PLG by 27.5%. In 1994, ��-blockers accounted for 65.2% of prescribed drugs but by 2004 this had dropped to 33%. Since their introduction, the prescribing of prostaglandin analogues has increased rapidly and in 2004, they accounted for 39.4% of prescribed drugs. Conclusion: The increasing useof prostaglandin analogues has led to an increase in prescribing rates and a rapid increase in cost. At the same time, prescribing of ��-blockers has declined and trabeculectomy rates have fallen.

Can I Count on Getting Better? Association between Math Anxiety and Poorer Understanding of Medical Risk Reductions

<p>BACKGROUND: Lower numerical ability is associated with poorer understanding of health statistics, such as risk reductions of medical treatment. For many people, despite good numeracy skills, math provokes anxiety that impedes an ability to evaluate numerical information. Math-anxious individuals also report less confidence in their ability to perform math tasks. We hypothesized that, independent of objective numeracy, math anxiety would be associated with poorer responding and lower confidence when calculating risk reductions of medical treatments.</p><p>METHODS: Objective numeracy was assessed using an 11-item objective numeracy scale. A 13-item self-report scale was used to assess math anxiety. In experiment 1, participants were asked to interpret the baseline risk of disease and risk reductions associated with treatment options. Participants in experiment 2 were additionally provided a graphical display designed to facilitate the processing of math information and alleviate effects of math anxiety. Confidence ratings were provided on a 7-point scale.</p><p>RESULTS: Individuals of higher objective numeracy were more likely to respond correctly to baseline risks and risk reductions associated with treatment options and were more confident in their interpretations. Individuals who scored high in math anxiety were instead less likely to correctly interpret the baseline risks and risk reductions and were less confident in their risk calculations as well as in their assessments of the effectiveness of treatment options. Math anxiety predicted confidence levels but not correct responding when controlling for objective numeracy. The graphical display was most effective in increasing confidence among math-anxious individuals.</p><p>CONCLUSIONS: The findings suggest that math anxiety is associated with poorer medical risk interpretation but is more strongly related to confidence in interpretations.</p>

Supervisor Continuity or Co-Location: Which Matters in Residency Education? Findings From a Qualitative Study of Remote Supervisor Family Physicians in Australia and Canada

<p>Purpose: Changes to health care systems andworking hours have fragmentedresidents��� clinical experiences withpotentially negative effects ontheir development as professionals.Investigation of off-site supervision,which has been implemented in isolatedrural practice, could reveal importantbut less overt components of residencyeducation.��</p><p>Method: Insights from sociocultural learningtheory and work-based learning provideda theoretical framework. In 2011���2012,16 family physicians in Australia andCanada were asked in-depth how theyremotely supervised residents��� workand learning, and for their reflectionson this experience. The verbatiminterview transcripts and researchers���memos formed the data set. Templateanalysis produced a description andinterpretation of remote supervision.��</p><p>Results: Thirteen Australian family physiciansfrom five states and one territory, andthree Canadians from one province,participated. The main themes werehow remoteness changed the dynamicsof care and supervision; the importanceof ongoing, holistic, nonhierarchical,supportive supervisory relationships; andthat residents learned ���clinical courage���through responsibility for patients��� careover time. Distance required supervisorsto articulate and pass on their expertiseto residents but made monitoringdifficult. Supervisory continuityencouraged residents to build on pastexperiences and confront deficiencies.��</p><p>Conclusions: Remote supervision enabled residents todevelop as clinicians and professionals.This questions the supremacy of co-locationas an organizing principle forresidency education. Future specialists maybenefit from programs that give themongoing and increasing responsibilityfor a group of patients and supportive.</p>

Alcohol use and positive screening results for depression and anxiety are highly prevalent among chinese children with strabismus

Purpose: To study associations between strabismus and alcohol use, anxiety, and depression among 10- to 17-year-old children in Guangdong, southern China. Design: Cross-sectional, population-based study. Methods: Among 7537 children aged 6-17 years from 9 randomly selected primary and middle schools, ocular alignment was assessed with the Hirschberg light reflex, cover-uncover testing, and alternate cover testing at distance (6 m) and near (40 cm). Additionally, 4000 children (53.1%) aged 10+ years received self-administered questionnaires containing screening questions on alcohol use, anxiety, and depression. Results: Examinations were completed on 7464 of 7537 subjects (99.0%), including 3928 boys (52.6%), with a mean age of 11.1 �� 1.8 years. The prevalence of any strabismus, including exotropia (2.7%), esotropia (0.2%), and intermittent exotropia (3.9%), was 6.8%. Strabismus was more prevalent in urban students (7.3%) and female subjects (7.4%) compared to rural students (6.0%) and male subjects (6.2%) (all P &lt;.05). In multivariate regression models, any strabismus was associated with older age and rural vs urban residence. Among 3903 children (97.6%) answering questionnaires, history of alcohol use (62.3% vs 36.3%) and positive screening responses for depression (26.0% vs 11.6%) and anxiety (10.3% vs 4.9%) were significantly (P &lt;.01 for all) more common among children with strabismus. Conclusion: These Chinese children with strabismus had a significantly higher prevalence of alcohol use and possible markers of emotional problems than children without strabismus. Further research should focus on the appropriateness of classifying surgical treatment for strabismus as "cosmetic" (ineligible for reimbursement) under China's rural health insurance.

Rec��m-nascidos de muito baixo peso e fam��lias migrantes : maternidade Dr. Alfredo da Costa : uma janela sobre a sociedade contempor��nea portuguesa���

RESUMO - A migra����o transnacional de pessoas tem-se afirmado como um fen��meno global e crescente, provocando, nos diversos contextos nacionais implicados, mudan��a social e desafios adaptativos das sociedades e institui����es. O universo da sa��de poder�� contudo constituir uma esfera privilegiada de interac����o sen��o de inclus��o e coes��o social, requestionando os conceitos de cidadania. A sustenta����o de bons indicadores de sa��de, nomeadamente materna e infantil, decorre de estrat��gias abrangentes de sa��de p��blica e de pol��ticas vision��rias que contemplem sempre e tamb��m os mais necessitados. Procurando conhecer melhor os contextos em que ocorre o nascimento de rec��m-nascidos de muito baixo peso, este projecto corresponde a um estudo explorat��rio na maior maternidade do pa��s, procurando entender a eventual associa����o de factores de ��ndole social e familiar, nomeadamente ser de origem migrante. --------------------------- ABSTRACT - Transnational migration of people has clearly become a global and growing issue causing, on different national grounds, social change and adaptative challenges to society and its institutions. The health universe may, however, be a privileged scenery for integration and social cohesion making one re-think the concept of citizenship. Keeping up good health statistics, including maternal and child health results from wide public health strategies and fore seeking health policies not disregarding the underprivileged or the less visible fringes of society. Aiming to clarify on what context very low birth weight happens this project consists mainly in an explorative study on the biggest maternity in Portugal. Social and familiar factors are screened for possible association with migrant origin in ver

A Multilingual Query Processing System using Software Agents

The goal of this work was developing a query processing system using software agents. Open Agent Architecture framework is used for system development. The system supports queries in both Hindi and Malayalam; two prominent regional languages of India. Natural language processing techniques are used for meaning extraction from the plain query and information from database is given back to the user in his native language. The system architecture is designed in a structured way that it can be adapted to other regional languages of India. . This system can be effectively used in application areas like e-governance, agriculture, rural health, education, national resource planning, disaster management, information kiosks etc where people from all walks of life are involved.

Complicaciones postoperatorias tempranas de la colporrafia anterior por t��cnica tradicional versus t��cnica de sitio espec��fico

El prolapso del piso p��lvico es una entidad frecuente, especialmente en pacientes postmenop��usicas y en su gran mayor��a requiere tratamiento quir��rgico. En este estudio comparamos la aparici��n de complicaciones postoperatorias tempranas entre la colporrafia anterior con t��cnica cl��sica (TC) versus la colporrafia anterior con t��cnica de sitio especifico (CSE). Se realiz�� un estudio observacional anal��tico, retrospectivo, de dos cohortes de pacientes que requirieron colporrafia anterior entre agosto de 2009 hasta junio de 2012. Las caracter��sticas de cada grupo fueron homog��neas y comparables. El desenlace de mayor frecuencia fue dehiscencia de la l��nea de sutura, sin embargo, no se encontraron diferencias estad��sticamente significativas entre las dos t��cnicas. La aparici��n de reprolapso temprano y el diagn��stico de abscesos o hematomas presentaron frecuencias que carecen de diferencia significativa. No hubo complicaciones tempranas graves tales como sangrado intraoperatoria mayor o lesiones vesicouretrales. Los resultados sugieren que las dos t��cnicas tienen una incidencia baja de complicaciones postoperatorias tempranas y por lo tanto parecen ser seguros dentro del manejo quir��rgico del prolapso del componente anterior del piso p��lvico.

Complicaciones de la preeclampsia severa y su relaci��n con variables demogr��ficas y obst��tricas

Introducci��n: La preeclampsia severa es una de las principales patolog��as que afectan a las mujeres embarazadas, sus complicaciones tienen un alto impacto en la salud del binomio madre-hijo. Materiales y m��todos: Se realizo una serie de casos, durante un periodo de 1 a��o se revisaron las historias cl��nicas de las pacientes que ingresaron a la unidad de cuidado intensivo obst��trico de la Cl��nica Orqu��deas, con diagn��stico de preeclampsia severa. Se describieron los datos demogr��ficos y las complicaciones. Se realiz�� an��lisis univariado con las variables de inter��s y se calcularon diferencias significativas por medio del test exacto de Fisher. Resultados: Se registraron 196 pacientes con preeclampsia severa en el periodo de estudio. Las complicaciones mas frecuentes fueron s��ndrome HELLP (30,6%), insuficiencia renal aguda (16,3%) y edema pulmonar (10,2%); el ingreso de las pacientes con preeclampsia severa a la UCIO en embarazo aumenta el riesgo de sufrir complicaciones. El s��ndrome de HELLP se presento con mayor frecuencia en pacientes que realizaron 6 o mas controles prenatales (p=0.066). Discusi��n: Los resultados evidencian una prevalencia de preeclampsia severa mayor que la observada por otros autores, probablemente por ser una UCI exclusivamente obst��trica. Las complicaciones mas frecuentes son concordantes con otros estudios publicados. El mayor riesgo de complicaciones asociadas en pacientes que ingresan embarazadas a la UCIO podr��a estar en relaci��n a la severidad de la patolog��a. Se requieren estudios anal��ticos para establecer asociaciones entre cada una de las complicaciones y sus factores condicionantes.

Caracterizaci��n cl��nica, citoqu��mica y microbiol��gica de pacientes cirr��ticos con peritonitis bacteriana en la Fundaci��n Cardioinfantil

Introducci��n: La peritonitis bacteriana espontanea es la infecci��n m��s frecuente en pacientes cirr��ticos causado generalmente por Escherichia coli. Existen factores de riesgo relacionados con la aparici��n y recurrencia de infecci��n peritoneal por lo que la implementaci��n de estrategias tempranas y preventivas podr��a impactar en la disminuci��n de la morbimortalidad. Metodolog��a: Estudio descriptivo, serie de casos, se efectu�� la b��squeda de los resultados del estudio citoqu��mico de l��quidos asc��ticos de pacientes entre los a��os 2009 y 2013, seleccionando aquellos compatibles con infecci��n y que correspondieran a sujetos cirr��ticos, para posteriormente realizar la recolecci��n de datos cl��nicos y paracl��nicos con el fin de conformar la base de datos y finalizar con su respectivo an��lisis. Resultados: El alcohol es la principal causa de cirrosis en pacientes infectados; el principal microorganismo aislado fue Escherichia coli, documentando un 78% de cultivos negativos, 20% m��s que lo reportado por la literatura. La ampicilina sulbactam fue el antibi��tico de elecci��n en el 65% de los casos, de estos el 61% continuaron sin requerir cambio del mismo. Discusi��n: El presente estudio confirma al alcohol como principal etiolog��a de cirrosis en nuestro pa��s y a la Escherichia coli multisensible como principal agente. Debido al bajo porcentaje de cambios que requiri�� la ampicilina sulbactam durante el ajuste de la terapia se puede sugerir a este antibiotico dentro del manejo, sin embargo se require de estudios complementarios para comparar su efectividad en relaci��n con cefalosporinas de tercera generaci��n. De igual forma debe priorizarse la toma de cultivos en botellas de hemocultivos para aumentar la cantidad de aislamientos y optimizar el tratamiento antibi��tico guiado de acuerdo al microorganismo obtenido.

Influencia de las creencias religiosas cristianas en la decisi��n de realizar suicidio asistido al final de la vida

El suicidio asistido como una posible opci��n al final de la vida, es una idea que hasta ahora est�� siendo considerada, ya que existen argumentaciones a favor y en contra que han generado controvertidos debates a su alrededor. Algunos de los argumentos en contra est��n basados en los principios de las instituciones religiosas de orden cristiano, las cuales defienden el valor sagrado de la vida de las personas y la aceptaci��n del sufrimiento como un acto de amor profundo y sumisi��n a los mandatos de Dios, el creador. Mientras del lado contrario, se encuentran quienes defienden el procedimiento, impulsando la autonom��a y la autodeterminaci��n que cada persona tiene sobre su vida. La revisi��n de la literatura realizada no s��lo permite ampliar los argumentos de estas dos posiciones, sino que tambi��n permite conocer la historia del suicidio asistido, la posici��n que este procedimiento tiene en diferentes pa��ses del mundo, incluyendo a Colombia, y finalmente se presentan las contribuciones de la psicolog��a entorno al procedimiento en discusi��n.