Family resources study: part 1: family resources, family function and caregiver strain in childhood cancer

<p>Abstract</p> <p>Background</p> <p>Severe illness can disrupt family life, cause family dysfunction, strain resources, and cause caregiver burden. The family's ability to cope with crises depends on their resources. This study sought to assess families of children with cancer in terms of family function-dysfunction, family caregiver strain and the adequacy of family resources using a new family resources assessment instrument.</p> <p>Methods</p> <p>This is a cross-sectional study involving 90 Filipino family caregivers of children undergoing cancer treatment. This used a self-administered questionnaire composed of a new 12-item family resources questionnaire (SCREEM-RES) based on the SCREEM method of analysis, Family APGAR to assess family function-dysfunction; and Modified Caregiver Strain Index to assess strain in caring for the patient.</p> <p>Results</p> <p>More than half of families were either moderately or severely dysfunctional. Close to half of caregivers were either predisposed to strain or experienced severe strain, majority disclosed that their families have inadequate economic resources; many also report inaccessibility to medical help in the community and insufficient educational resources to understand and care for their patients. Resources most often reported as adequate were: family's faith and religion; help from within the family and from health providers. SCREEM-RES showed to be reliable with Cronbach's alpha of 0.80. There is good inter-item correlation between items in each domain: 0.24-0.70. Internal consistency reliability for each domain was also good: 0.40-0.92. Using 2-point scoring system, Cronbach's alpha were slightly lower: full scale (0.70) and for each domain 0.26-.82. Results showed evidence of association between family resources and family function based on the family APGAR but none between family resources and caregiver strain and between family function and caregiver strain.</p> <p>Conclusion</p> <p>Many Filipino families of children with cancer have inadequate resources, especially economic; and are moderately or severely dysfunctional. Many caregivers are predisposed to caregiver strain or are already experiencing severe strain. To provide appropriate care for these families, physicians should regularly assess family function, resources and strain experienced by caregivers. The SCREEM-RES questionnaire used in this study is a helpful and reliable instrument to assess adequacy of family resources.</p

Efficacy and Safety of Three Antiretroviral Regimens for Initial Treatment of HIV-1: A Randomized Clinical Trial in Diverse Multinational Settings

Background:Antiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world.Methods and Findings:1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure.An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72-1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54-0.76; p<0.001) and there was a significant interaction between sex and regimen safety (HR 0.50, CI 0.39-0.64 for women; HR 0.79, CI 0.62-1.00 for men; p = 0.01). Comparing ATV+DDI+FTC to EFV+3TC-ZDV, during a median follow-up of 81 wk there were 108 failures (21%) among 526 participants assigned to ATV+DDI+FTC and 76 (15%) among 519 participants assigned to EFV+3TC-ZDV (HR 1.51, CI 1.12-2.04; p = 0.007).Conclusion: EFV+FTC-TDF had similar high efficacy compared to EFV+3TC-ZDV in this trial population, recruited in diverse multinational settings. Superior safety, especially in HIV-1-infected women, and once-daily dosing of EFV+FTC-TDF are advantageous for use of this regimen for initial treatment of HIV-1 infection in resource-limited countries. ATV+DDI+FTC had inferior efficacy and is not recommended as an initial antiretroviral regimen.Trial Registration:http://www.ClinicalTrials.gov NCT00084136

Food habits of the Cinereous Harrier (Circus cinereus) in the Araucania, southern Chile

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Abundance, habitat and body measurements of the rare Long-clawed Mouse (<i>Pearsonomys annectens</i>) in the coastal temperate rainforest of southern Chile

<div><p>Based on rodent trappings in eight localities from 1998 to 2005 (14,984 trap-nights), we provide detailed information on abundance, habitat and additional body measurements of the Long-clawed Mouse (<i>Pearsonomys annectens</i>), a rare rodent in the Valdivian temperate rainforest. The Long-clawed Mouse was collected in three localities only in both highly fragmented and continuous forests, including forestry plantations. The sites had relatively mature and closed vegetation and deep soils covered with leaf litter. Males appeared to be larger and heavier than females. Sexually active individuals were found in spring. We conclude that small and geographically restricted populations, low population densities, microhabitat specialization, and dependence on southern temperate forest make long-clawed mice vulnerable to the disappearance of the forest.</p> </div

Long-Term Remission of HIV-Associated Primary CNS Lymphoma Achieved With Highly Active Antiretroviral Therapy Alone

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Deep sowing of dry direct-seeded rice: cultivar differences in seedling establishment and grain yield

ABSTRACTDry direct seeding of rice (DDSR) is being increasingly used in water-scarce areas across Asia. When drought occurs, deep sowing may enable germinating seeds to utilize the residual moisture below the surface. Our objective was to examine the effects of different sowing depths on DDSR crop growth. Two yield experiments, one in the Philippines and the other in Japan, were established in rainfed lowlands, but drought did not occur. Across the experiments, sowing at a depth of 6 to 7 cm reduced the percentage of emergence compared with sowing at a depth of 1 to 2 cm (25% vs. 73%), which resulted in lower yield (3.5 vs. 4.4 t ha−1). The relative yield (deep-sowing/shallow-sowing) was positively correlated with the percentage emergence under deep sowing. Cultivars with no significant yield reduction under deep sowing maintained high emergence (>30%) under deep sowing. Seedling’s ability to emerge after deep sowing greatly differed among cultivars: the percentage emergence ranging from 0% to 18% from a depth of 8 to 10 cm, and from 11% to 44% from a depth of 6 to 7 cm. An ancillary field experiment was conducted under drought during the dry season in the Philippines: deep sowing increased the percentage emergence compared with shallow sowing (41% vs. 5%), when the soil surface was severely dry. Our results suggest that choosing cultivars that can tolerate deep sowing is a prerequisite for using deep sowing in DDSR, and that future breeding of DDSR should focus on this tolerance