Psychosocial and behavioural correlates of attitudes towards antiretroviral therapy (ART) in a sample of South African mineworkers

Despite being one of the worst affected sectors in South Africa, the mining sector has proven to be one of the most active in intervention efforts in the fight against HIV and AIDS (Ellis, 2007). Owing to low uptake rates of antiretroviral therapy (ART) in mining companies in recent years (Connelly & Rosen, 2006) and the positive relationship between attitudes towards ART and ART uptake (Cooper et al., 2002; Horne, Cooper, Gellaitry, Leake, & Fisher, 2007), this study sought to describe and investigate the psychosocial and behavioural correlates of attitudes towards ART in a sample of South African mineworkers. A total of 806 mineworkers from a large South African mine participated in this quantitative study. Despite a high rate of HIV testing behaviour (83.0%) as well as favourable attitudes towards ART, analysis indicated that temporary employees and contractors were more vulnerable in terms of HIV risk, HIV testing behaviours and ART knowledge and attitudes. Employees who had more positive attitudes towards ART were more knowledgeable of ART and, importantly, had a more favourable attitude towards the mine’s HIV/AIDS treatment programme. These findings are discussed in relation to the low ART uptake rates in this context and recommendations for the improvement of ART uptake amongst employees at this mining site.Keywords: mining sector, workplace, ART uptake, attitudes.Le secteur minier reste l’un des secteurs les plus affectés par le VIH et SIDA en Afrique du Sud et aussi l’un des plus actifs dans la lutte contre la maladie (Ellis, 2007). En raison du faible taux d’utilisation de la thérapie antirétrovirale (ART) dans les années récentes par des compagnies minières (Connelly & Rosen, 2006) et les attitudes positives envers ART et ART absorption (Cooper et al., 2002; Horne, Cooper, Gellaitry, Leake, & Fisher, 2007) pour trouver des solutions pour les malades du VIH/SIDA, cette étude á pour objectif d’examiner les comportements psychosociaux et le traitement de la thérapie antirétrovirale d’un groupe de mineurs Sud-Africains. Huit cent six mineurs Sud-Africains ont participé à cette étude quantitative. Soit un taux de dépistage VIH élevé (83.0%) et des attitudes très favorables envers ART, les analyses indiquent qu’en termes de risque du VIH les employés temporaires et les entrepreneurs sont plus exposés á la maladie. Mais cependant, les employés qui sont bien informés de la méthode ART grâce à la connaissance et à l’information bénéficient d’un programme de traitement contre le VIH/SIDA. Ces résultats font l’objet de discussion sur le faible taux d’ART dans ce contexte et quelques recommandations et améliorations de l’absorption de l’ART pour les employés de ce site minier

Prevalence and Correlates of Common Mental Disorders among Mothers of Young Children in Kilimanjaro Region of Tanzania.

Although poor maternal mental health is a major public health problem, with detrimental effects on the individual, her children and society, information on its correlates in low-income countries is sparse. This study investigates the prevalence of common mental disorders (CMD) among at-risk mothers, and explores its associations with sociodemographic factors. This population-based survey of mothers of children aged 0-36 months used the 14-item Shona Symptom Questionnaire (SSQ). Mothers whose response was "yes" to 8 or more items on the scale were defined as "at risk of CMD." Of the 1,922 mothers (15-48 years), 28.8% were at risk of CMD. Risk of CMD was associated with verbal abuse, physical abuse, a partner who did not help with the care of the child, being in a polygamous relationship, a partner with low levels of education, and a partner who smoked cigarettes. Cohabiting appeared to be protective. Taken together, our results indicate the significance of the quality of relations with one's partner in shaping maternal mental health. The high proportion of mothers who are at risk of CMD emphasizes the importance of developing evidence-based mental health programmes as part of the care package aimed at improving maternal well-being in Tanzania and other similar settings

Critical care resources in the Solomon Islands: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>There are minimal data available on critical care case-mix, care processes and outcomes in lower and middle income countries (LMICs). The objectives of this paper were to gather data in the Solomon Islands in order to gain a better understanding of common presentations of critical illness, available hospital resources, and what resources would be helpful in improving the care of these patients in the future.</p> <p>Methods</p> <p>This study used a mixed methods approach, including a cross sectional survey of respondents' opinions regarding critical care needs, ethnographic information and qualitative data.</p> <p>Results</p> <p>The four most common conditions leading to critical illness in the Solomon Islands are malaria, diseases of the respiratory system including pneumonia and influenza, diabetes mellitus and tuberculosis. Complications of surgery and trauma less frequently result in critical illness. Respondents emphasised the need for basic critical care resources in LMICs, including equipment such as oximeters and oxygen concentrators; greater access to medications and blood products; laboratory services; staff education; and the need for at least one national critical care facility.</p> <p>Conclusions</p> <p>A large degree of critical illness in LMICs is likely due to inadequate resources for primary prevention and healthcare; however, for patients who fall through the net of prevention, there may be simple therapies and context-appropriate resources to mitigate the high burden of morbidity and mortality. Emphasis should be on the development and acquisition of simple and inexpensive tools rather than complicated equipment, to prevent critical care from unduly diverting resources away from other important parts of the health system.</p

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

BACKGROUND: To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. METHODS: Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. RESULTS: From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). CONCLUSION: There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

Psychometric properties and longitudinal validation of the self-reporting questionnaire (SRQ-20) in a Rwandan community setting: a validation study

Background: This study took place to enable the measurement of the effects on mental health of a psychosocial intervention in Rwanda. It aimed to establish the capacities of the Self-Reporting Questionnaire (SRQ-20) to screen for mental disorder and to assess symptom change over time in a Rwandan community setting. Methods. The SRQ-20 was translated into Kinyarwanda in a process of forward and back-translation. SRQ-20 data were collected in a Rwandan setting on 418 respondents; a random subsample of 230 respondents was assessed a second time with a three month time interval. Internal reliability was tested using Cronbach's alpha. The optimal cut-off point was determined by calculating Receiver Operating Curves, using semi-structured clinical interviews as standard in a random subsample of 99 respondents. Subsequently, predictive value, likelihood ratio, and interrater agreement were calculated. The factor structure of the SRQ-20 was determined through exploratory factor analysis. Factorial invariance over time was tested in a multigroup confirmatory factor analysis. Results: The reliability of the SRQ-20 in women ( = 0.85) and men ( = 0.81) could be considered good. The instrument performed moderately well in detecting common mental disorders, with an area

CLINICAL CHARACTERISTICS, OUTCOMES AND RISK FACTORS FOR DEATH AMONG CRITICALLY ILL PATIENTS WITH HIV-RELATED ACUTE KIDNEY INJURY

SUMMARY Background: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death

The development and evaluation of a manualised participatory HIV/AIDS risk reduction programme (Sex and Risk) for tertiary level learners: a pilot study

This paper reports on a pilot study of the development and evaluation (using outcome and process measures) of a manualised participatory risk reduction programme, aimed at reducing high-risk sexual behaviour amongst tertiary level learners, called 'Sex and Risk' (S&R), at the University of Durban-Westville in South Africa. The programme was grounded in a focused ethnographic study of the risk behaviours and life context of tertiary level learners at this institution, as well as informed by literature on successful behavioural risk reduction programmes on Western and African populations. Significantly, the S&R programme was shown to facilitate greater awareness in males of how social influences inform high-risk sexual behaviour. This greater awareness did not, however, translate into greater self-efficacy in relation to negotiating safer sexual relationships for either males or females and was attributed to the dominant social norms, which promote and sustain gender inequity that places the sexual health of young women and men at risk. Given that the S&R programme operates largely at the level of the individual, although it does address the subjective aspects of social influences on behaviour, these findings highlight the need for proximal situation-centred interventions, which promote more egalitarian social norms in sexual relationships, to accompany such curriculum interventions at tertiary institutions.

A comparison of the effect of reduced illumination and tinted lenses on stereospsis at near

Relative depth may be appreciated with the use of one eye using linear perspective, shadows, parallax and texture as monocular cues to depth. Stereopsis, on the other hand, is the direct appreciation of relative depth that requires the use of both eyes to construct a three-dimension-al percept from disparate two-dimensional retinal images. The advantage of stereopsis is with respect to complex visual tasks especially that requiring accurate hand-eye coordination. Tinted lenses are prescribed for a variety of reasons, including but not limited to photophobia, asthenopia, improving colour perception in colour deficient individuals, enhancing cosmesis and protection against glare or harmful radiation and enhancing visual performance as in sports. The aim of this study was to investigate the comparative effects of six specific CR39 tinted spectacle lenses (grade B), and a white CR39 lens, against a no lens condition, on stereoacuity over a range of illumination levels. Illumination was varied with the use of neutral density (ND) filters, while the Titmus Fly Stereotest (TFS) wasused to measure stereoacuity. Participants (n =60) between the ages of 17 - 29 years (mean =23.58; sd = 3.14) were purposively sampled from a clinical practice to participate in this research study.  Using repeated measures ANOVA and appropriate post-hoc multivariate analysis, it was evident that there was a significant decline in stereopsis as the level ofillumination decreased,regardless of tint condition; also there was no statistically significant difference in stereopsis between the no lens and white lens conditions at each level of illumination; and stereopsis wassignificantly superior with the no lens conditioncompared to all six other tint conditions (grade B), at each level of illumination. These results indicate that stereoacuity, as measured by the TFS, is adversely affected by a decline in retinal illuminance and by the use of tinted lenses. This information could be utilised to advise patients on the performance implications of the six tinted lenses tested with respect to their effects on stereoacuity under different illumination levels