Treatment Buddies Improve Clinic Attendance among Women but Not Men on Antiretroviral Therapy in the Nyanza Region of Kenya.

Background. Kenyan antiretroviral (ART) guidelines encourage treatment buddies (TBy) to maximize treatment adherence. This study examined the effect of TBys on clinic attendance in men and women on ART. Methods. This retrospective cohort study included all adult patients initiating ART from August 2007 to December 2011 at four health facilities in Kenya. Data were abstracted from electronic medical records and analyzed using Poisson regression. Results. Of 2,430 patients, 2,199 (91%) had a TBy. Relationship between TBy and clinic attendance differed in females and males (interaction p = 0.09). After demographic and clinic factor adjustment, females with a TBy were 28% more likely to adhere to all appointments than those without (adjusted aRR = 1.28; 95% CI 1.08-1.53), whereas males were no more likely to adhere (aRR = 1.01; 95% CI 0.76-1.32). Males reported partner/spouse (33%) or brother (11%) as the TBy while females reported sister (17%), partner/spouse (14%), or another family member (12%). Multivariable analysis found no association between clinic attendance and TBy relationship in either gender. Conclusion. Clinic attendance was higher among women with TBys but not men. Results support TBys to help women achieve ART success; alternate strategies to bolster TBy benefits are needed for men

Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya.

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32-5.56), HIV education (aOR 3.28, 95% CI 1.92-6.83), and wait time (aOR 1.97 95% CI 1.03-3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06-3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33-8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction

Autocorrelation analysis for the unbiased determination of power-law exponents in single-quantum-dot blinking

We present an unbiased and robust analysis method for power-law blinking statistics in the photoluminescence of single nano-emitters, allowing us to extract both the bright- and dark-state power-law exponents from the emitters' intensity autocorrelation functions. As opposed to the widely-used threshold method, our technique therefore does not require discriminating the emission levels of bright and dark states in the experimental intensity timetraces. We rely on the simultaneous recording of 450 emission timetraces of single CdSe/CdS core/shell quantum dots at a frame rate of 250 Hz with single photon sensitivity. Under these conditions, our approach can determine ON and OFF power-law exponents with a precision of 3% from a comparison to numerical simulations, even for shot-noise-dominated emission signals with an average intensity below 1 photon per frame and per quantum dot. These capabilities pave the way for the unbiased, threshold-free determination of blinking power-law exponents at the micro-second timescale

Erhöhte Depressivität ist mit systemischen Inflammationsmarkern bei Diabetes mellitus assoziiert.

Einleitung: Bei Nichtdiabetikern ist eine erhöhte Depressivität mit erhöhten systemischen Inflammationsmarkern assoziiert. In dieser Studie wurde untersucht, inwieweit hsCRP, IL-6, IL-18, IL-1RA, MCP-1 und Adiponektin bei Diabetikern mit einer erhöhten Depressivität assoziiert sind. Zusätzlich wurde geprüft, ob eine signifikante Verbesserung der Depressivität auch mit einer Reduktion der oben genannten Inflammationsparameter nach einem Jahr einhergeht. Methodik: Die Depressivität wurde mittels des CES-D gemessen. Eine signifikante Verbesserung der Depressivität lag vor, wenn sich der Depressionsscore im 1-Jahres-Follow-up um mehr als 9,1 Punkte (reliabler Veränderungsindex) reduzierte. Zur Baseline und nach einem Jahr wurden die oben genannten Inflammationsparameter bestimmt. Die multivariate Analyse wurde für Alter, Geschlecht, BMI, HbA1c, Diabetestyp und Medikamenteneinnahme (Statine, NSAID, Antikoagulanzien und Thyroide) adjustiert. Ergebnisse: Die Stichprobe umfasste 125 Diabetespatienten (Alter 44,5 ± 13,7 Jahre, 44,1% weiblich, HbA1c 8,8 ± 1,7%, 64,1% Typ-1-Diabetes, CES-D 23,4 ± 8,0). Zur Baseline korrelierte IL-1RA signifikant mit dem Depressionsscore (ß= 0,135, p = 0,026). Diabetespatienten mit einer deutlichen Reduktion ihrer Depressionssymptomatik wiesen im 1-Jahres-Follow-Up signifikant niedrige IL-1RA- (381 ± 51 vs. 534 ± 32 pg/ml; p = 0,041) und IL-18-Spiegel (269 ± 29 vs. 336 ± 19 pg/ml; p = 0,028) auf. Bei IL-1RA gab es einen signifikanten Interaktionseffekt mit dem Diabetestyp (stärkere Reduktion bei Typ-2-Diabetes). Diskussion: IL-1RA-Spiegel weisen sowohl in der Querschnitts- als auch Längsschnittanalyse einen signifikanten Zusammenhang zu einer erhöhten Depressivität auf. Systemische Inflammationsprozesse könnten neben der glykämischen Kontrolle und Lebensstilfaktoren einen pathophysiologischen Mechanismus darstellen, wie sich eine erhöhte Depressivität negativ auf die langfristige Diabetesprognose auswirkt. Unterstützt vom Kompetenznetz Diabetes mellitus (FKZ01GI0809)

Assessing physicians’ satisfaction with diabetes therapy: development and evaluation of a new questionnaire.

Questionnaires assessing the satisfaction of patients already exist, but no questionnaire assesses the satisfaction of physicians. However, physicians’ satisfaction with patient-communication and with diabetes therapy is a crucial factor for the effi cacy of diabetes therapy. A relevant part of patientcommunication is the discussion of blood glucose values with the patient. In order to systematically assess the perspective of physicians, we developed WITHDRAWN A232 For author disclosure information, see page A810. CATEGORY & Guided Audio Tour poster ADA-Funded Research Behavioral Medicine, Clinical Nutrition, Education, and Exercise POSTERS PSYCHOSOCIAL, BEHAVIORAL MEDICINE a questionnaire that assesses satisfaction of physicians with diabetes therapy in general (Sat-DT) and with the discussion of blood glucose values (SatBG) in particular. Data from 188 physicians who completed the questionnaire was analyzed. The fi nal Sat-DT scale comprised 13 items and achieved a Cronbach’s Alpha of 0.93 wit a mean item-total correlation of r=0.71. The fi nal Sat-BG scale comprised 10 items and achieved a Cronbach’s Alpha of 0.92 with a mean item-total correlation of r=0.73. Factor analysis (Varimax rotation) revealed two factors within the Sat-DT scale (65% explained variance): “Effects of diabetes therapy” and “costs and benefi ts.” The Sat-BG scale could be divided into “Usage of blood glucose data” and “effi cacy of the discussion” by factor analysis (76% explained variance). A greater satisfaction in both scales was associated with a greater satisfaction with the work as a physician (Sat-DT: r=0.2, p<.05; Sat-BG: r=0.32, p<.05), a greater satisfaction with therapy outcomes (Sat-DT: r=0.34, p<.05; Sat-BG: r=0.3, p<.05), and with a greater satisfaction with the results of working as a physician (Sat-DT: r=0.27, p<.05; Sat-BG: r=0.25, p<.05). This new questionnaire with its two scales is a reliable and valid assessment tool to measure the satisfaction of physicians. In future studies, this questionnaire can be used to investigate the infl uence of physicians’ satisfaction on diabetes therapy as well as how physicians’ satisfaction can be altered

Family model of HIV care and treatment: a retrospective study in Kenya

<p>Abstract</p> <p>Background</p> <p>Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.</p> <p>Methods</p> <p>A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.</p> <p>Results</p> <p>Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.</p> <p>Conclusions</p> <p>The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.</p

Photothermal correlation spectroscopy of gold nanoparticles in solution

Biological and Soft Matter PhysicsMicrobial Biotechnolog