Family Caregiving to AIDS Patients: The Role of Gender in Caregiver Burden in Uganda

The objectives of the study were: 1) What is the burden of care for male and female family caregivers of AIDS patients? and 2) Which factors influence the family care burden for AIDS patients at home? A questionnaire was completed by 29 male and 91 female family caregivers of AIDS patients living in four rural areas in western Uganda. Participating caregivers were selected from a patient list of the home-based care program for AIDS patients and then interviewed. The responses from the questionnaire were used to calculate care burden scores for caregivers of both genders and the scores in each group were compared. In addition, other factors relevant to the burden of family care were extracted and tested in bivariate and multivariate analysis to test whether they were predictors of the care burden. Results show that the care burden scores were high in all domains, except those regarding relationship within the families and substance abuse. Both male and female caregivers reported a similar care burden. Caregivers for spouses had higher care burden scores compared to those who cared for other relatives. The intensity of care was also a significant predictor of the care burden, while other factors such as age, duration of care, and cognitive function of the care recipient were not associated with the care burden score. The high burden of care-giving puts family caregivers at risk for a lower health status, social isolation and depression. As both male and female caregivers report similar care burden scores for the same responsibilities, men are not unduly overburdened with the family care of AIDS patients compared to women and should be more actively involved in the care-giving process at home

Knowledge of and Perceptions about Sexually Transmitted Diseases and Pregnancy: A Qualitative Study among Adolescent Students in Uganda

This article reports the findings of a qualitative research study carried out in Kabarole district, western Uganda. Knowledge of and perceptions about HIV/AIDS and pregnancy and how both relate to one another were elucidated from eight focus-group discussions with 38 female and 32 male secondary students from four different schools. Widespread misinformation and misconceptions about contraceptives still exist as previously found in this area. There was a serious gap in knowledge and understanding of ‘dual protection’ against sexually transmitted diseases, including HIV/AIDS, and against pregnancy. Fertility was very highly valued, and many girls stated that they would want a child even if they were HIV-positive. Responses of girls showed that they were quite assertive in making decisions to use contraceptives. The reasons for students not being able to understand the interconnectedness of sexually transmitted diseases and pregnancy may lie in the fragmented fashion in which relevant health education is delivered through two separate programmes

Critical ethnography, cultural safety, and international nursing research

Critical qualitative methodology provides a strategy to examine the human experience and its relationship to power and truth. Cultural safety is a concept that has been applied to nursing education and practice and refers to interactions that acknowledge and respect the unique cultural background of patients. It recognizes power inequities between caregivers who belong to dominant cultures and patients who may belong to oppressed groups. Culture is interpreted from a critical constructivist perspective as a fluid relational process that is enacted contextually. The purpose of this paper is to examine the congruence between and among critical methodology, cultural safety, and the conduct of nursing research in low- and middle-income countries by nurses from high-income countries. It is argued that if cultural safety is important and relevant to education and practice, then it might be appropriate to address it in research endeavors

Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Little is known about the fertility desires of HIV infected individuals on highly active antiretroviral therapy (HAART). In order to contribute more knowledge to this topic we conducted a study to determine if HIV-infected persons on HAART have different fertility desires compared to persons not on HAART, and if the knowledge about HIV transmission from mother-to-child is different in the two groups.</p> <p>Methods</p> <p>The study was a cross-sectional survey comparing two groups of HIV-positive participants: those who were on HAART and those who were not. Semi-structured interviews were conducted with 199 HIV patients living in a rural area of western Uganda. The desire for future children was measured by the question in the questionnaire "Do you want more children in future." The respondents' HAART status was derived from the interviews and verified using health records. Descriptive, bivariate and multivariate methods were used to analyze the relationship between HAART treatment status and the desire for future children.</p> <p>Results</p> <p>Results from the multivariate logistic regression model indicated an adjusted odds ratio (OR) of 1.08 (95% CI 0.40-2.90) for those on HAART wanting more children (crude OR 1.86, 95% CI 0.82-4.21). Statistically significant predictors for desiring more children were younger age, having a higher number of living children and male sex. Knowledge of the risks for mother-to-child-transmission of HIV was similar in both groups.</p> <p>Conclusions</p> <p>The conclusions from this study are that the HAART treatment status of HIV patients did not influence the desire for children. The non-significant association between the desire for more children and the HAART treatment status could be caused by a lack of knowledge in HIV-infected persons/couples about the positive impact of HAART in reducing HIV transmission from mother-to-child. We recommend that the health care system ensures proper training of staff and appropriate communication to those living with HIV as well as to the general community.</p

Adipose-Specific PPARα Knockout Mice Have Increased Lipogenesis by PASK–SREBP1 Signaling and a Polarity Shift to Inflammatory Macrophages in White Adipose Tissue

The nuclear receptor PPARα is associated with reducing adiposity, especially in the liver, where it transactivates genes for β-oxidation. Contrarily, the function of PPARα in extrahepatic tissues is less known. Therefore, we established the first adipose-specific PPARα knockout (PparaFatKO) mice to determine the signaling position of PPARα in adipose tissue expansion that occurs during the development of obesity. To assess the function of PPARα in adiposity, female and male mice were placed on a high-fat diet (HFD) or normal chow for 30 weeks. Only the male PparaFatKO animals had significantly more adiposity in the inguinal white adipose tissue (iWAT) and brown adipose tissue (BAT) with HFD, compared to control littermates. No changes in adiposity were observed in female mice compared to control littermates. In the males, the loss of PPARα signaling in adipocytes caused significantly higher cholesterol esters, activation of the transcription factor sterol regulatory element-binding protein-1 (SREBP-1), and a shift in macrophage polarity from M2 to M1 macrophages. We found that the loss of adipocyte PPARα caused significantly higher expression of the Per-Arnt-Sim kinase (PASK), a kinase that activates SREBP-1. The hyperactivity of the PASK–SREBP-1 axis significantly increased the lipogenesis proteins fatty acid synthase (FAS) and stearoyl-Coenzyme A desaturase 1 (SCD1) and raised the expression of genes for cholesterol metabolism (Scarb1, Abcg1, and Abca1). The loss of adipocyte PPARα increased Nos2 in the males, an M1 macrophage marker indicating that the population of macrophages had changed to proinflammatory. Our results demonstrate the first adipose-specific actions for PPARα in protecting against lipogenesis, inflammation, and cholesterol ester accumulation that leads to adipocyte tissue expansion in obesity

230Th Normalization: New Insights on an Essential Tool for Quantifying Sedimentary Fluxes in the Modern and Quaternary Ocean

230Th normalization is a valuable paleoceanographic tool for reconstructing high-resolution sediment fluxes during the late Pleistocene (last ~500,000 years). As its application has expanded to ever more diverse marine environments, the nuances of 230Th systematics, with regard to particle type, particle size, lateral advective/diffusive redistribution, and other processes, have emerged. We synthesized over 1000 sedimentary records of 230Th from across the global ocean at two time slices, the late Holocene (0–5,000 years ago, or 0–5 ka) and the Last Glacial Maximum (18.5–23.5 ka), and investigated the spatial structure of 230Th-normalized mass fluxes. On a global scale, sedimentary mass fluxes were significantly higher during the Last Glacial Maximum (1.79–2.17 g/cm2kyr, 95% confidence) relative to the Holocene (1.48–1.68 g/cm2kyr, 95% confidence). We then examined the potential confounding influences of boundary scavenging, nepheloid layers, hydrothermal scavenging, size-dependent sediment fractionation, and carbonate dissolution on the efficacy of 230Th as a constant flux proxy. Anomalous 230Th behavior is sometimes observed proximal to hydrothermal ridges and in continental margins where high particle fluxes and steep continental slopes can lead to the combined effects of boundary scavenging and nepheloid interference. Notwithstanding these limitations, we found that 230Th normalization is a robust tool for determining sediment mass accumulation rates in the majority of pelagic marine settings (\u3e1,000 m water depth)

Epilepsy in Onchocerciasis Endemic Areas: Systematic Review and Meta-analysis of Population-Based Surveys

Epilepsy is particularly common in tropical areas. One main reason is that many endemic infections have neurological consequences. In addition, the medical, social and demographic burden of epilepsy remains substantial in these countries where it is often seen as a contagious condition and where the aetiology is often undetermined. For several decades, field researchers had reported some overlapping between the geographical distributions of epilepsy and onchocerciasis, a parasitic disease caused by the filarial worm Onchocerca volvulus which afflicts some 40 million persons worldwide. Here, we conducted a statistical analysis of all the data available on the relationship between the two conditions to determine whether the proportion of people suffering from epilepsy in a community could be related to the frequency of onchocerciasis. The combined results of the eight studies carried out in west, central and east Africa indicate a close epidemiological association between the two diseases. Should a causative relationship be demonstrated, onchocerciasis, which is known as “river blindness” because of its most serious sequela and the distribution of its vectors, could thus also be called “river epilepsy”. More research is needed to determine the mechanisms explaining this association and to assess the burden of onchocerciasis-associated epilepsy