Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

INTRODUCTION: The objective of the study was to determine HIV-1 RNA load profile during pregnancy and assess the eligibility for the maternal triple antiretroviral prophylaxis. It was an observational cohort of pregnant HIV positive women ignorant of antiretroviral therapy with CD4 cell count of > 350/mm(3) METHODS: Routine CD4 cell count assessment in HIV positive pregnant women completed by non exclusive measurement of the viral load by PCR /ARN in those with CD4 cell count > 350/mm(3). Exclusion criteria: highly active antiretroviral therapy prior to pregnancy. RESULTS: Between January and December 2010, CD4 cell count was systematically performed in all pregnant women diagnosed as HIV-infected (n=266) in a referral center of 25 antenatal clinics. 63% (N=170) had CD4 cell count > 350/mm(3), median: 528 (IQR: 421-625). 145 underwent measurement of viral load by PCR/RNA at a median gestational of 23 weeks of pregnancy (IQR: 19-28). Median viral load 4.4 log(10)/ml, IQR (3.5-4.9).19/145(13%) had an undetectable viral load of = 1.8 log(10)/ml. 89/145(61%) had a viral load of = 4 log(10)/ml and were eligible for maternal triple ARV prophylaxis. CONCLUSION: More than 6 in 10 pregnant HIV positive women with CD4 cell count of > 350/mm(3) may require triple antiretroviral for prophylaxis of MTCT. Regardless of cost, such results are conclusive and may be considered in HIV high burden countries for universal access to triple antiretroviral prophylaxis in order to move towards virtual elimination of HIV MTCT

Effectiveness of Multidrug Antiretroviral Regimens to Prevent Mother-to-Child Transmission of HIV-1 in Routine Public Health Services in Cameroon

International audienceBACKGROUND: Multidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6-10 weeks and 12 months of age, respectively. METHODOLOGY/FINDINGS: We conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 or = 37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6-10 weeks) was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80%) received multidrug ARV regimens (1, 2, and 3) and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3-9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen < 4 weeks [OR = 4.7, 95%CI: 1.3-17.6], mother's CD4 < 350 cells/mm(3) [OR = 6.4, 95%CI: 1.8-22.5] and low birth weight [OR = 4.0, 95%CI: 1.4-11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6-20.6], prematurity [HR = 2.3, 95%CI: 1.2-4.3] and low birth weight were associated with children's risk of progressing to infection or death. CONCLUSIONS: Multidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT

Échecs thérapeutiques chez les enfants infectés par le VIH en suivi de routine dans un contexte à ressources limitées au Cameroun

Abstract Introduction: L&apos;objectif de cette étude était de déterminer les facteurs associés aux échecs thérapeutiques chez les enfants infectés par le VIH

Masennuksen lääkkeetön hoito ja ennaltaehkäisy vanhusten palveluasumisessa

Vanhusten masennus ja yksinäisyys on yksi aikamme ongelma, jota viime aikoina on nostettu varsin näkyvästi esiin yhteiskunnallisessa keskustelussa. Tässä opinnäytetyössä esitellään vanhusten masennuksen lääkkeettömän hoidon ja ennaltaehkäisyn kehittämistyötä vanhusten palveluasumisessa. Kehittämistyö on toteutettu työelämäyhteistyössä Riistavuoren vanhustenkeskuksen palveluasumisen henkilökunnan kanssa. Kehittämistyön tarkoituksena oli luoda Riistavuoren palvelutaloon ohjeistus masennuksen lääkkeettömään hoitoon. Tavoitteena oli kehittää masennuksen lääkkeetöntä hoitoa palvelutalossa lisäämällä tietoisuutta hoitotyön mahdollisuuksista masentuneiden vanhusten auttamiseksi sekä luomalla ohjeistus, jonka avulla näyttöön perustuvia lääkkeettömiä hoitotyön auttamismenetelmiä pystyttäisiin suunnitelmallisesti käyttämään masennuksen ennaltaehkäisyyn ja hoitoon vanhuksilla. Työssä etsittiin kirjallisuuskatsauksella vastausta kysymykseen: Millaisia lääkkeettömiä näyttöön perustuvia hoitotyön keinoja on masennuksen ennaltaehkäisyyn ja hoitoon vanhuksilla? Kirjallisuuskatsauksen pohjalta henkilökunta jatkoi valitsemiensa teemojen kehittämistä 8x8-menetelmää käyttäen. Kirjallisuuskatsauksen tulokset ja jatkokehitystyön perusteella saadut ideat yhdistettiin yhtenäiseksi ohjeistukseksi työyhteisölle. Tuloksissa on nähtävissä vanhuksen sosiaalisen elämän jatkumisen tärkeys myös vanhustenhuollon piiriin joutumisen jälkeen. Vanhusten luonnollisten kontaktien vahvistamisen, vanhuksen arvostamisen ja henkilökunnan tuen ulottamisen vanhuksen lisäksi myös omaisiin ja läheisiin ovat olennaisia asioita, jotta vanhuksen omanlaista elämää pystyttäisiin tukemaan myös hoidon piirissä ja ehkäisemään näin yksinäisyyden tunteita. Tämä vaatii uudenlaista ajattelua, keskustelua ja toiminnan avaamista myös läheisten mukana oloon Kirjallisuuskatsauksen tulokset ovat sovellettavissa vanhusten masennuksen lääkkeettömän hoidon suunnitteluun hoitohenkilökunnalle. Riistavuoren vanhustenkeskuksessa työn tulokset toimivat pohjana masennuksen lääkkeettömän hoidon kehittämiselle sekä sosiaalisen kuntoutuksen suunnittelulle palveluasumisessa.Depression and loneliness of the elderly are the problems of our time and these problems have been noticeably brought up lately in sociological conversation. This final project presents the development work of non-pharmacological treatment and prevention of depression at supported living of the elderly. The development work was executed in alliance with the supported living staff of the Riistavuori center for the elderly. The purpose of the development work was to create directions for the non-pharmacological treatment of depression for the supported living in Riistavuori. The aim was to develop non-pharmacological treatment of depression by increasing awareness of the possibilities of nursing and by creating directions. With the help of the directions, evidence based non-pharmacological nursing methods could be used systematically for the treatment and prevention of depression of the elderly. In this work, the research question was: What kind of evidence based nursing methods there are for the non-pharmacological treatment of depression of the elderly? From the results staff chose themes they wanted to continue developing by using 8x8-methods. The results from literature and group work were put together into uniform directions for the work community. The importance of the continuation of the elderly person's social life also after the person has become a customer of the public welfare is visible from the results. In addition to the fortification of the elderly person's natural contacts, respecting and supporting of the elderly, the support of the nursing staff should also be directed to relatives and near ones. This is important because in that way the elderly person's personal life could be supported and loneliness could be prevented. This needs new kind of thinking, discussion and opening the operation of institutions also for relatives. The results can be used in planning the non-pharmacological treatment of depression. In the supported living of Riistavuori, results can be used to develop the non-pharmacological treatment of depression and planning of social rehabilitation

Living with mesothelioma: A systematic review of patient and caregiver psychosocial support needs

Objective: Practice guidelines emphasize the importance of investigating psychosocial distress in mesothelioma patients and family caregivers. We aimed to synthesize research on the psychosocial support needs of mesothelioma patients and their family caregivers. Methods: We conducted a systematic review with a narrative synthesis and quality assessment. The review process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: MEDLINE, EMBASE, Scopus, PsychArticles, and PsycINFO were searched until December 2020 and 37 studies in English met inclusion criteria. Most (n = 24) included mesothelioma patients as a very small proportion of their cancer samples. A narrative synthesis was conducted on the 13 studies including only mesothelioma patients (n = 297) and/or caregivers (n = 82). Patients and caregivers want improvements in the diagnosis delivery and access to palliative care. Patients want emotional support, patient-centered treatment, improved information about illness progression and death, and to meet others with mesothelioma. Caregivers want one-on-one practical and emotional support. Study quality varied. Conclusions: Few studies focus on the psychosocial support needs relevant to mesothelioma. Mesothelioma patients and family caregivers highlight targeted psychosocial care as an unmet need. Practice Implications: Efforts are required to design and test psychosocial interventions for this vulnerable and overlooked group. Protocol Registration: PROSPERO (registration number CRD42020167852)

Significant population genetic structure of the Cameroonian fresh water snail, Bulinus globosus, (Gastropoda: Planorbidae) revealed by nuclear microsatellite loci analysis

International audienceIn order to characterize the demographic traits and spatial structure of Cameroonians Bulinus globosus, intermediate host of Schistosoma haematobium, genetic structure of seven different populations, collected from the tropical zone, was studied using six polymorphic microsatellites. Intrapopulation genetic diversity ranged from 0.37 to 0.55. Interpopulation genetic diversity variation clearly illustrated their significant isolation due to distance with gene flow substantially limited to neighbouring populations. The effective population sizes (Ne) were relatively low (from 3.0 to 18.6), which supposes a high rate from which populations would lose their genetic diversity by drift. Analysis of genetic temporal variability indicated fluctuations of allelic frequencies (35 of 42 locus-population combinations, P<0.05) characteristic of stochastic demography, and this is reinforced by events of bottlenecks detected in all populations. These findings demonstrated that Cameroonian B. globosus were mixed-maters with some populations showing clear preference for outcrossing. These data also suggest that genetic drift and gene flow are the main factors shaping the genetic structure of studied population

The Value of a Gardening Service for the Frail Elderly and People With a Disability Living in the Community

Little is known about the significance of gardening services for frail elderly people. This study explored the value of a gardening service for frail older people and people with a disability living in the community. Using qualitative and quantitative data collected from pre-gardening (n = 38) and post-gardening service delivery interviews (n = 35) and the Housing Enabler, the value of a gardening service was examined. Findings suggest that the service had a positive impact on the independence and emotional well-being of frail aged people and younger people with a functional disability, with little impact on physical health. Results indicate that gardening services should be fundamental to planning for these populations to remain or return to living in the community