Substance Use Experiences and Hepatitis C Treatment Decision-Making Among HIV/HCV Co-infected Adults: A Dissertation

Hepatitis C virus (HCV) infection affects between 150,000 to 300,000 human immunodeficiency (HIV) positive adults in the US (Alter et al., 1999; Sherman, Rouster, Chung, & Rajicic, 2002). The majority of co-infected adults (50%-90%) have acquired HCV through substance abuse (Centers for Disease Control [CDC], 1998; CDC, 2006b). A patient\u27s decision to begin HCV treatment is not straightforward. HCV evaluation and treatment involves a significant amount of time, energy, effort, and compliance on the part of the patient. There is limited information on how adults with HCV mono-infection make decisions about HCV evaluation and treatment (Fraenkel, McGraw, Wongcharatraee, & Garcia-Tsao, 2005). Even less is known about how adults with HIV/HCV co-infection with a history of substance abuse make treatment decisions. The purpose of this study was to describe substance abuse experiences and to explore how these related to patient decision-making about HCV treatment in HIV/HCV co-infected adults. Qualitative descriptive design and secondary data analysis were used to study these phenomena. Data were managed by using NVivo software and analyzed by secondary data analysis and qualitative content analysis. Five major themes with sub-themes emerged during the data analysis. They were: (1) The Evolution of Substance Abuse (with sub-themes: substance abuse initiation, escalation, polysubstance abuse, normalcy: a family of addicts, the enemy within, and transmission and disclosure), (2) Revolving Door: Going Back Out (with sub-themes: specific events as a trigger, emotions as a trigger, alcohol as a trigger, and destructive relationships as a trigger), and (3) Reconstructing Life (with sub-themes: defining moments in substance abuse addiction and maintaining sobriety), (4) HCV Infection Treatment Issues (with sub-themes: HCV treatment: not a priority, fear, and misinformation, and desire to use stimulated during HCV treatment), and (5) Get Clean and Try It. The participants spoke about how their substance abuse evolved from inception to sobriety, and for some it remained a problem. Relapse and recovery were fragile in nature especially in these adults with HIV/HCV co-infection. The decision-making process is influenced by substance abuse experiences, however more research is needed to uncover specific factors influencing these decisions

Clustered Planarity Variants for Level Graphs

We consider variants of the clustered planarity problem for level-planar drawings. So far, only convex clusters have been studied in this setting. We introduce two new variants that both insist on a level-planar drawing of the input graph but relax the requirements on the shape of the clusters. In unrestricted Clustered Level Planarity (uCLP) we only require that they are bounded by simple closed curves that enclose exactly the vertices of the cluster and cross each edge of the graph at most once. The problem y-monotone Clustered Level Planarity (y-CLP) requires that additionally it must be possible to augment each cluster with edges that do not cross the cluster boundaries so that it becomes connected while the graph remains level-planar, thereby mimicking a classic characterization of clustered planarity in the level-planar setting. We give a polynomial-time algorithm for uCLP if the input graph is biconnected and has a single source. By contrast, we show that y-CLP is hard under the same restrictions and it remains NP-hard even if the number of levels is bounded by a constant and there is only a single non-trivial cluster

Ibuprofen delays ovulation by several hours: prospective controlled study in natural cycles with HCG-triggered ovulation.

RESEARCH QUESTION Does ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), delay ovulation? DESIGN Two-stage, proof-of-concept, controlled study, assessing the percentage of non-ovulated follicles 42 h after HCG injection in patients taking ibuprofen. The intervention group consisted of women undergoing natural cycle IVF treatment taking ibuprofen 3 × 400 mg per day. The control group consisted of women undergoing timed sexual intercourse or intrauterine insemination. The proportion of patients with non-ovulated follicles in the ibuprofen group was first compared against a reference of 50% using a one-sample binomial test, and second against the proportion observed in the control group using an adjusted logistic regression. RESULTS A total of 26 women were recruited in the ibuprofen intervention group. Twenty-five patients were recruited in the control group. The proportion of patients with delayed ovulation observed (22/26 [84.6%]; 95% CI 65.1% to 95.6%) was significantly higher than the reference of 50% (P < 0.001). In the control group, the proportion of patients with delayed ovulation was 20.0% ([5/25], 95% CI 6.8% to 40.7%). Compared with the ibuprofen group, a significantly increased probability of a delayed ovulation was found in the ibuprofen intervention group (adjusted OR 22.72, 95% CI 5.77 to 115; P < 0.001). Of the 22 women with delayed ovulation, oocytes were retrieved in 20 women (90.9%) and all oocytes were mature (metaphase II). CONCLUSIONS Women trying to conceive should avoid non-selective NSAIDs around the time of ovulation. Ibuprofen or other NSAID can be used to delay ovulation for several hours in assisted reproductive technology and other infertility treatments if required

The BDS checklist as measure of illness severity:A cross-sectional cohort study in the Danish general population, primary care and specialised setting

Objective The bodily distress syndrome (BDS) checklist has proven to be useful in the diagnostic categorisation and as screening tool for functional somatic disorders (FSD). This study aims to investigate whether the BDS checklist total sum score (0–100) can be used as a measure of physical symptom burden and FSD illness severity.Design Cross-sectional.Setting Danish general population, primary care and specialised clinical setting.Participants A general population cohort (n=9656), a primary care cohort (n=2480) and a cohort of patients with multiorgan BDS from specialised clinical setting (n=492).Outcome measures All data were self-reported. Physical symptoms were measured with the 25-item BDS checklist. Overall self-perceived health was measured with one item from the 36-item Short-Form Health Survey (SF-36). Physical functioning was measured with an aggregate score of four items from the SF-36/SF-12 scales ‘physical functioning’, ‘bodily pain’ and ‘vitality’. Emotional distress was measured with the mental distress subscale (SCL-8) from the Danish version of the Hopkins Symptom Checklist-90. Illness worry was measured with the six-item Whiteley Index.Results For all cohorts, bifactor models established that despite some multidimensionality the total sum score of the BDS checklist adequately reflected physical symptom burden and illness severity. The BDS checklist had acceptable convergent validity with measures of overall health (r=0.25–0.58), physical functioning (r=0.22–0.58), emotional distress (r=0.47–0.62) and illness worry (r=0.36–0.55). Acceptability was good with a low number of missing responses to items (&lt;3%). Internal consistency was high (α ≥0.879). BDS score means varied and reflected symptom burden across cohorts (13.03–46.15). We provide normative data for the Danish general population.Conclusions The BDS checklist total sum score can be used as a measure of symptom burden and FSD illness severity across settings. These findings establish the usefulness of the BDS checklist in clinics and in research, both as a diagnostic screening tool and as an instrument to assess illness severity