Attachment and spiritual coping in patients with chronic schizophrenia

Many studies on spirituality in psychosis have shown that, compared to a nonclinical population, patients make more use of spiritual beliefs/religious practices to deal with their problems. Our research question was to test whether attachment to spiritual figures could be a good explanation for religious coping strategies in patients with psychosis. First, adult attachment was investigated in 28 patients with chronic psychosis and 18 controls, using the Adult Attachment Interview. Diagnostic evaluations were performed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) Axis I disorders and symptomatic evaluation with the Brief Psychiatric Rating Scale. Results also show a high prevalence of insecure avoidant attachment in patients, and suggest that a significant part of religious coping might be explained by the theory of attachment (64% of the patients, 78% of controls). The implications of these results are interpreted in light of correspondence and compensation hypotheses.

Noticeability of corrective feedback, L2 development and learner beliefs

Cette étude quasi-expérimentale a pour but de 1) comparer la prise en compte et les effets de trois conditions rétroactives, à savoir la reformulation, l’incitation et un mélange des deux techniques, 2) déterminer le lien entre la prise en compte et l’apprentissage, et 3) identifier l’effet des perceptions des apprenants quant à la rétroaction corrective sur la prise en compte et l’apprentissage. Quatre groupes d’apprenants d’anglais langue seconde ainsi que leurs enseignants provenant d’un CEGEP francophone de l’île de Montréal ont participé à cette étude. Chaque enseignant a été assigné à une condition rétroactive expérimentale qui correspondait le plus à ses pratiques rétroactives habituelles. La chercheure a assuré l’intervention auprès du groupe contrôle. L’utilisation du passé et de la phrase interrogative était ciblée durant l’intervention expérimentale. Des protocoles de pensée à haute voie ainsi qu’un questionnaire ont été utilisés pour mesurer la prise en compte de la rétroaction corrective. Des tâches de description d’images et d’identification des différences entre les images ont été administrées avant l’intervention (pré-test), immédiatement après l’intervention (post-test immédiat) et 8 semaines plus tard (post-test différé) afin d’évaluer les effets des différentes conditions rétroactives sur l’apprentissage des formes cibles. Un questionnaire a été administré pour identifier les perceptions des apprenants quant à la rétroaction corrective. En termes de prise en compte, les résultats indiquent que les participants sont en mesure de remarquer la rétroaction dépendamment de la forme cible (les erreurs dans l’utilisation du passé sont détectées plus que les erreurs d’utilisation de la phrase interrogative) et de la technique rétroactive utilisée (l’incitation et le mélange d’incitation et de reformulations sont plus détectés plus que la reformulation). En ce qui a trait à l’apprentissage, l’utilisation du passé en général est marquée par plus de développement que celle de la phrase interrogative, mais il n'y avait aucune différence entre les groupes. Le lien direct entre la prise en compte et l’apprentissage ne pouvait pas être explicitement établi. Pendant que la statistique inférentielle a suggéré une relation minimale entre la prise en compte du passé et son apprentissage, mais aucune relation entre la prise en compte de la phrase interrogative et son apprentissage, les analyses qualitatives ont montrés à une association entre la prise en compte et l’apprentissage (sur les deux cibles) pour certains étudiants et augmentations sans prise en compte pour d'autres. Finalement, l’analyse factorielle du questionnaire indique la présence de quatre facteurs principaux, à savoir l’importance de la rétroaction corrective, la reformulation, l’incitation et les effets affectifs de la rétroaction. Deux de ces facteurs ont un effet modérateur sur la prise en compte de la rétroaction sans, toutefois, avoir d’impact sur l’apprentissage.

Treatment failure and mortality factors in patients receiving second-line HIV therapy in resource-limited countries

Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. Objectives To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death. Design, Setting, and Participants Multicohort study of 632 patients >14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008. Main Outcome Measures Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death. Results The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for <80% vs ≥95% [percentage adherent, as represented by percentage of appointments attended with no delay]). Failure rates increased with lower CD4 cell counts when second-line therapy was started, from 156.3 vs 96.2 per 1000 person-years; IRR, 1.59 (95% CI, 0.78-3.25) for 100 to 199/μL to 336.8 per 1000 person-years; IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/μL vs 200/μL or higher; and decreased with time using second-line therapy, from 250.0 vs 123.2 per 1000 person-years; IRR, 1.90 (95% CI, 1.19-3.02) for 6 to 11 months to 212.0 per 1000 person-years; 1.71 (95% CI, 1.01-2.88) for 12 to 17 months vs 18 or more months. Mortality for those taking second-line therapy was lower in women (32.4 vs 68.3 per 1000 person-years; hazard ratio [HR], 0.45; 95% CI, 0.23-0.91); and higher in patients with treatment failure of any type (91.9 vs 28.1 per 1000 person-years; HR, 2.83; 95% CI, 1.38-5.80). Sensitivity analyses showed similar results. Conclusions Among patients in Africa and Asia receiving second-line therapy for HIV, treatment failure was associated with low CD4 cell counts at second-line therapy start, use of suboptimal second-line regimens, and poor adherence. Mortality was associated with diagnosed treatment failure.

Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in the Swiss HIV Cohort Study

BACKGROUND: Alcohol consumption leading to morbidity and mortality affects HIV-infected individuals. Here, we aimed to study self-reported alcohol consumption and to determine its association with adherence to antiretroviral therapy (ART) and HIV surrogate markers. METHODS: Cross-sectional data on daily alcohol consumption from August 2005 to August 2007 were analysed and categorized according to the World Health Organization definition (light, moderate or severe health risk). Multivariate logistic regression models and Pearson's chi(2) statistics were used to test the influence of alcohol use on endpoints. RESULTS: Of 6,323 individuals, 52.3% consumed alcohol less than once a week in the past 6 months. Alcohol intake was deemed light in 39.9%, moderate in 5.0% and severe in 2.8%. Higher alcohol consumption was significantly associated with older age, less education, injection drug use, being in a drug maintenance programme, psychiatric treatment, hepatitis C virus coinfection and with a longer time since diagnosis of HIV. Lower alcohol consumption was found in males, non-Caucasians, individuals currently on ART and those with more ART experience. In patients on ART (n=4,519), missed doses and alcohol consumption were positively correlated (P<0.001). Severe alcohol consumers, who were pretreated with ART, were more often off treatment despite having CD4+ T-cell count <200 cells/microl; however, severe alcohol consumption per se did not delay starting ART. In treated individuals, alcohol consumption was not associated with worse HIV surrogate markers. CONCLUSIONS: Higher alcohol consumption in HIV-infected individuals was associated with several psychosocial and demographic factors, non-adherence to ART and, in pretreated individuals, being off treatment despite low CD4+ T-cell counts.

Pediatric antiretroviral adherence and child disclosure in Botswana

The scale-up of antiretrovirals (ARVs) to treat HIV/AIDS in Africa has been rapid over the last five years. Botswana was the first African nation to roll out a comprehensive ARV program, where ARVs are available to all citizens who qualify. Excellent adherence to these ARVs is necessary to maintain HIV suppression and on-going health of all individuals taking them. Children rely almost entirely on their caregivers for the administration of these medications, and very little research has been done to examine the factors which affect both adherence and disclosure to the child of their HIV status. ^ Methods. This cross-sectional study used multiple methods to examine adherence, disclosure, and stigma across various dimensions of the child and caregiver's lives, including 30 caregiver questionnaires, interviewer-administered 3-day adherence recalls, pharmacy pill counts, and chart reviews. Fifty in-depth interviews were conducted with caregivers, male caregivers, teenagers, and health care providers. ^ Results. Perceived family stigma was found to be a predictor of excellent adherence. After controlling for age, children who live with their mothers were significantly less likely to know their HIV status than children living with any other relative (OR=0.403, p=0.014). Children who have a grandmother living in the household or taking care of them each day are significantly more likely to have optimal adherence than children who don't have grandmother involvement in their daily lives. ^ Discussion. Visible illness plays an intermediary role between adherence and perceived family stigma: Caregivers know that ARVs suppress physical manifestations of HIV, and in an effort to avoid unnecessary disclosure of the child's status to family members, therefore have children with excellent adherence. Grandmothers play a vital role in supporting the care and treatment of children in Botswana. ^

Antiretroviral therapy adherence and the use of condoms among African American HIV-positive crack cocaine users

Safer sex practices, such as consistent condom use, are essential to reduce HIV transmission. Determining causes and/or co-variants related to the likelihood of participating in high-risk sexual behaviors may allow the content of interventions and treatments to minimize HIV transmission to be tailored more effectively. The goal of this study was to examine whether a relationship exists between consistent condom use among African American HIV-positive crack cocaine users and both (1) the use of antiretroviral therapy, and (2) adherence to antiretroviral therapy regimens. The study population consisted of 390 participants. They were at least 18 years old, African American, HIV-positive, and had used crack cocaine within a month prior to an interview conducted sometime between April, 2004, and September, 2007. Bivariate associations were examined using contingency tables and χ2-statistics. The Mantel-Haenszel method was used to control for confounding. This study found neither a significant relationship between use of antiretroviral therapy and consistent condom use (Odds ratio (OR) = 1.38; 95% Confidence interval (95%CI) = 0.86–2.22), nor an association between antiretroviral therapy adherence and consistent condom use (OR = 1.02, 95%CI = 0.60–1.75). The exception was more consistent condom use when sex was traded for money or drugs in those on antiretroviral therapy, compared to those not on such therapy (OR = 2.28, 95%CI = 1.08–4.85). Further studies examining condom use and HIV treatment adherence are recommended. ^

Concretes and mortars recycled with water treatment sludge and construction and demolition rubble

There are about 7500 water treatment plants in Brazil. The wastes these plants generate in their decantation tanks and filters are discharged directly into the same brooks and rivers that supply water for treatment. Another serious environmental problem is the unregulated disposal of construction and demolition rubble, which increases the expenditure of public resources by degrading the urban environment and contributing to aggravate flooding and the proliferation of vectors harmful to public health. In this study, an evaluation was made of the possibility of recycling water treatment sludge in construction and demolition waste recycling plants. The axial compressive strength and water absorption of concretes and mortars produced with the exclusive and joint addition of these two types of waste was also determined. The ecoefficiency of this recycling was evaluated by determining the concentration of aluminum in the leached extract resulting from the solubilization of the recycled products. The production of concretes and mortars with the joint addition of water treatment sludge and recycled concrete rubble aggregates proved to be a viable recycling alternative from the standpoint of axial compression strength, modulus of elasticity, water absorption and tensile strength by the Brazilian test method. (C) 2008 Elsevier Ltd. All rights reserved.

Mechanical properties of concrete produced with a composite of water treatment sludge and sawdust

In developing countries such as Brazil, the wastes generated in the decanters and filters of water treatment plants are discharged directly into the same rivers and streams that supply water for treatment. Another environmental problem is the unregulated discard of wood wastes. The lumber and wood products industry generates large quantities of this waste, from logging to the manufacture of the end product. Brazil has few biomass plants and therefore only a minor part of these wastes are reused. This paper presents the results of the first study involving a novel scientific and technological approach to evaluate the possibility of combining these two types of wastes in the production of a light-weight composite for concrete. The concrete produced with cement:sand:composite:water mass ratios of 1:2.5:0.67:0.6 displayed an axial compressive strength of 11.1 MPa, a compressive and diametral tensile strength of 1.2 MPa, water absorption of 8.8%, and a specific mass of 1.847 kg/m(3). The mechanical properties obtained with this concrete render it suitable for application in non-structural elements. (C) 2010 Elsevier Ltd. All rights reserved.

Lightweight composite concrete produced with water treatment sludge and sawdust: Thermal properties and potential application

The main objective of this study was to evaluate the potential application of a lightweight concrete produced with lightweight coarse aggregate made of the water treatment sludge and sawdust (lightweight composite), by determining the thermal properties and possible environmental impact of future residue of this concrete. Two types of concrete were prepared: concrete produced with the lightweight composite dosed with cement/sand/composite/water in a mass ratio of 1:2.5:0.67:0.6 and conventional concrete dosed with cement/sand/crushed stone/water in a mass ratio of 1:4.8:5.8:0.8. The thermal properties were determined by the hot wire parallel technique. The possible environmental impact was measured using the procedures and guidelines of the Brazilian Association of Technical Standards - ABNT. The concrete produced with the lightweight composite presented a 23% lower thermal conductivity than the conventional concrete. The concrete produced with the lightweight composite presented a set of thermal properties suitable for the application of this concrete in non-structural sealing elements. The concentration of aluminum in the solubilized extract of the concrete produced with the lightweight composite was much lower than the concentration of aluminum in the water treatment sludge, confirming the possible reduction of environmental impact of this composite for use in concrete. (C) 2010 Elsevier Ltd. All rights reserved.

Impact of on-site testing for maternal syphilis on treatment delays, treatment rates, and perinatal mortality in rural South Africa: a randomised controlled trial

Background: Syphilis remains a significant cause of preventable perinatal death in developing countries with many women remaining untested and thus untreated. Syphilis testing in the clinic (on-site testing) may be a useful strategy to overcome this. We studied the impact of on-site syphilis testing on treatment delays and rates, and perinatal mortality. Methods: We conducted a cluster randomised controlled trial among seven pairs of primary healthcare clinics in rural South Africa, comparing on-site testing complemented by laboratory confirmation versus laboratory testing alone. Intervention clinics used the on-site test conducted by primary care nurses, with results and treatment available within an hour. Control clinics sent blood samples to the provincial laboratory, with results returned 2 weeks later. Results: Of 7134 women seeking antenatal care with available test results, 793 (11.1%) tested positive for syphilis. Women at intervention clinics completed treatment 16 days sooner on average (95% confidence interval: 11 to 21), though there was no significant difference in the proportion receiving adequate treatment at intervention (64%) and control (69%) clinics. There was also no significant difference in the proportion experiencing perinatal loss (3.3% v 5.1%; adjusted risk difference: -0.9%; 95% Cl -4.4 to 2.7). Conclusions: Despite reducing treatment delays, the addition of on-site syphilis testing to existing laboratory testing services did not lead to higher treatment rates or reduce perinatal mortality. However on-site testing for syphilis may remain an important option for improving antenatal care in settings where laboratory facilities are not available.

Differences between older volunteers and nonvolunteers - Attitudinal, normative, and control beliefs

It has been suggested that older people are a rich potential source of volunteers, as prior literature has highlighted the benefits and rewards of volunteering in later life. This article examines differences between volunteers and nonvolunteers in a random sample of older people resident in Brisbane, Australia. Using the theory of planned behavior as a framework, the article focuses on the beliefs that distinguish those who volunteer from those who do not. Findings from the study allowed for an assessment of both the costs and benefits associated with volunteering; beliefs about the support of others, including the broader community, to volunteer; and beliefs about the barriers that might prevent volunteering. The implications of these finding's to a country with an aging population are discussed.

Communication and health beliefs - Mass and interpersonal influences on perceptions of risk to self and others

This study investigated the impact of media coverage of a health issue (skin cancer) on judgements of risk to self and others and the role of related communication processes. Consistent with predictions derived from the impersonal impact hypothesis, the effects of mass communication were more evident in perceptions of risk to others rather than in perceptions of personal risk. Perceptions of personal risk were more strongly correlated with interpersonal communication. However, as suggested by media system dependency theory, the relationship between mass communication and beliefs was complex. The impact of mass communication on both personal and impersonal perceptions was bound to be moderated by self-reported dependence on mass mediated information. The effect of this two-way interaction 071 perceptions of personal risk was partially mediated through interpersonal communication. Results point to the interdependence of mass and interpersonal communication as sources of social influence and the role of media dependency in shaping media impact.