Attachment Theory and Self-Disclosure of HIV Status

This study examined the influence of attachment style on self-disclosure of HIV seropositive status. Subjects were classified according to Bartholomew\u27s model of adult attachment (i.e., secure, preoccupied, fearful, or dismissing). Steps were then taken to assess differences in the subjects\u27 willingness to disclose their HIV seropositive status, the communication style chosen for disclosure, the subjects\u27 perceptions of the importance of disclosing their HIV seropositive status, and the feared negative consequences of disclosure. To increase generalizability subjects were asked to assess their self-disclosure to three types of target persons: lover, same-sex friend, and opposite-sex friend. Attachment style significantly affected perceived importance of disclosure, specific communication directness/indirectness measures, and feared consequences measures. Overall the results reflected the differing stereotypical characteristics of each attachment style. Results also suggested that self-disclosure of one\u27s HIV seropositive status is affected by the intimacy of the relationship. It was concluded that subjects appeared most confident in the relationship with their lover and viewed this particular disclosure with the most importance

Comparing in-person and webinar delivery of an immunization quality improvement program: a process evaluation of the adolescent AFIX trial

Abstract Background Immunization quality improvement programs are often limited by the cost and inconvenience associated with delivering face-to-face consultations to primary care providers. To investigate a more efficient mode of intervention delivery, we conducted a process evaluation that compared in-person consultations to those delivered via interactive webinar. Methods The Centers for Disease Control and Prevention’s Assessment, Feedback, Incentives, and eXchange (AFIX) Program is an immunization quality improvement program implemented in all 50 states. In 2011, we randomly assigned 61 high-volume primary care clinics in North Carolina to receive an in-person or webinar AFIX consultation focused on adolescent immunization. We used surveys of participating vaccine providers and expense tracking logs to evaluate delivery modes on participation, satisfaction, and cost. Clinics served 71,874 patients, ages 11 to 18. Results Clinics that received in-person and webinar consultations reported similar levels of participation on key programmatic activities with one exception: more webinar clinics reported improving documentation of previously administered, ‘historical’ vaccine doses. Both in-person and webinar clinics showed sustained improvement in confidence to use reminder/recall systems (both p < 0.05). Participants rated delivery modes equally highly on satisfaction measures such as convenience (mean = 4.6 of 5.0). Delivery cost per clinic was $152 for in-person consultations versus$100 for webinar consultations. Conclusions In-person and webinar delivery modes were both well received, but webinar AFIX consultations cost substantially less. Interactive webinar delivery shows promise for considerably extending the reach of immunization quality improvement programs. Trial registration Clinicaltrials.gov, NCT0154476

Organizational correlates of adolescent immunization: Findings of a state-wide study of primary care clinics in North Carolina

To analyze organization-level correlates of immunization coverage among adolescents served by high-volume primary care providers in North Carolina

Exploring the role of competing demands and routines during the implementation of a self-management tool for type 2 diabetes: A theory-based qualitative interview study

Background The implementation of new medical interventions into routine care involves healthcare professionals adopting new clinical behaviours and changing existing ones. Whilst theory-based approaches can help understand healthcare professionals’ behaviours, such approaches often focus on a single behaviour and conceptualise its performance in terms of an underlying reflective process. Such approaches fail to consider the impact of non-reflective influences (e.g. habit and automaticity) and how the myriad of competing demands for their time may influence uptake. The current study aimed to apply a dual process theoretical approach to account for reflective and automatic determinants of healthcare professional behaviour while integrating a multiple behaviour approach to understanding the implementation and use of a new self-management tool by healthcare professionals in the context of diabetes care. Methods Following Diabetes UK’s national release of the ‘Information Prescription’ (DUK IP; a self-management tool targeting the management of cholesterol, blood pressure and HbA1c) in January 2015, we conducted semi-structured interviews with 13 healthcare professionals (general practitioners and nurses) who had started to use the DUK IP during consultations to provide self-management advice to people with type 2 diabetes. A theory-based topic guide included pre-specified constructs from a previously developed logic model. We elicited healthcare professionals’ views on reflective processes (outcome expectations, self-efficacy, intention, action and coping planning), automatic processes (habit), and multiple behaviour processes (goal priority, goal conflict and goal facilitation). All interviews were audio recorded and transcribed verbatim and all transcripts were independently double coded and analysed using content analysis. Results The majority of healthcare professionals interviewed reported strong intentions to use the DUK IP and having formed a habit of using them after a minimum of one month continuous use. Pop-up cues in the electronic patient records were perceived to facilitate the use of the tool. Factors that conflicted with the use of the DUK IP included existing pathways of providing self-management advice. Conclusion Data suggests that constructs from dual process and multiple behaviour approaches are useful to provide supplemental understanding of the implementation of new self-management tools such as the DUK IP and may help to advance behavioural approaches to implementation science

Hypoxia Potentiates Glioma-Mediated Immunosuppression

Glioblastoma multiforme (GBM) is a lethal cancer that exerts potent immune suppression. Hypoxia is a predominant feature of GBM, but it is unclear to the degree in which tumor hypoxia contributes to this tumor-mediated immunosuppression. Utilizing GBM associated cancer stem cells (gCSCs) as a treatment resistant population that has been shown to inhibit both innate and adaptive immune responses, we compared immunosuppressive properties under both normoxic and hypoxic conditions. Functional immunosuppression was characterized based on production of immunosuppressive cytokines and chemokines, the inhibition of T cell proliferation and effector responses, induction of FoxP3+ regulatory T cells, effect on macrophage phagocytosis, and skewing to the immunosuppressive M2 phenotype. We found that hypoxia potentiated the gCSC-mediated inhibition of T cell proliferation and activation and especially the induction of FoxP3+T cells, and further inhibited macrophage phagocytosis compared to normoxia condition. These immunosuppressive hypoxic effects were mediated by signal transducer and activator of transcription 3 (STAT3) and its transcriptionally regulated products such as hypoxia inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF). Inhibitors of STAT3 and HIF-1α down modulated the gCSCs' hypoxia-induced immunosuppressive effects. Thus, hypoxia further enhances GBM-mediated immunosuppression, which can be reversed with therapeutic inhibition of STAT3 and HIF-1α and also helps to reconcile the disparate findings that immune therapeutic approaches can be used successfully in model systems but have yet to achieve generalized successful responses in the vast majority of GBM patients by demonstrating the importance of the tumor hypoxic environment

Smoking cessation care provision and support procedures in Australian community mental health centers

Objective: The study assessed the association of supportive clinical systems and procedures with smoking cessation care at community mental health centers. Methods: Managers (N584) of community mental health centers in New South Wales, Australia, were asked to complete a survey during 2009 about smoking cessation care. Results: Of the 79 managers who responded, 56% reported that the centers assessed smoking for over 60% of clients, and 34% reported that more than 60% of clients received minimum acceptable smoking cessation care. They reported the use of guidelines and protocols (34%), the use of forms to record smoking status (65%), and the practice of always enforcing smoking bans (52%). Minimum acceptable smoking cessation care was associated with encouraging nicotine replacement therapy for staff who smoke (odds ratio [OR]59.42), using forms for recording smoking status (OR55.80), and always enforcing smoking bans (OR53.82). Conclusions: Smoking cessation care was suboptimal, and additional supportive systems and procedures are required to increase its delivery