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The Influence of Self-efficacy on The Relationship Between Depression and HIV-related Stigma with ART Adherence Among The Youth in Malawi

 Depression and HIV-related stigma, among other factors, have been inversely linked independently with adherence to antiretroviral therapy (ART) among the youth. However, the processes through which the various factors influence this relationship is not fully known. Guided by Social Action Theory, we examined the interactive mechanisms through which depression, HIV-related stigma, and self-efficacy influenced ART adherence and whether or not these relationships are moderated by gender. A total of 450 HIV-positive youth (13–24 years) in Malawi receiving ART participated in this cross-sectional study. Moderated mediation analyses were conducted using Hayes’ PROCESS macro 2.11 in SPSS. ART adherence was measured by pill count. Findings showed that self-efficacy mediated the effects of depression and stigma on ART adherence. The analyses also revealed that gender moderated both the direct and indirect influence of depression and stigma (via self-efficacy) on ART adherence. Furthermore, self-efficacy simultaneously mediated and moderated the relationship between stigma and ART adherence. The interactive mechanisms through which various factors influence ART nonadherence must be considered to design effective interventions. To reduce the impact of depression and stigma on ART adherence, medication self-efficacy should be bolstered while taking gender in consideration. Keywords: Adolescent, Antiretroviral adherence, Malawi, Moderated mediation, Social action theory, Youth Abstrak Pengaruh Efikasi Diri Terhadap Hubungan antara Depresi dan Stigma HIV dengan Kepatuhan Terapi ART pada Remaja di Malawi. Depresi dan stigma HIV, di antara faktor-faktor lain, berhubungan terbalik secara independen dengan kepatuhan terapi antiretroviral (ART) pada remaja. Akan tetapi, dalam prosesnya faktor yang memengaruhi hubungan ini belum sepenuhnya diketahui. Berdasarkan Teori Perilaku Sosial, penelitian ini dilakukan bertujuan untuk mengkaji mekanisme interaktif depresi, stigma HIV, dan efikasi diri yang memengaruhi kepatuhan ART, dan untuk mengetahui apakah hubungan ini dimoderasi oleh gender atau tidak. Sebanyak 450 remaja dengan HIV-positif (13–24 tahun) di Malawi yang menerima ART ikut berpartisipasi dalam penelitian potong lintang ini. Analisis mediasi moderated dilakukan dengan menggunakan Hayes 'PROCESS macro 2.11 pada SPSS. Kepatuhan ART diukur menggunakan jumlah pil. Hasil penelitian menunjukkan bahwa efikasi diri memediasi efek depresi dan stigma pada kepatuhan ART. Hasil analisis juga mengungkapkan bahwa jenis kelamin memoderasi pengaruh langsung dan tidak langsung dari depresi dan stigma (melalui efikasi diri) terhadap kepatuhan ART. Lebih lanjut,efikasi diri secara bersamaan mediasi dan moderasi hubungan antara stigma dan kepatuhan ART. Mekanisme interaktif dengan berbagai faktor yang memengaruhi ketidakpatuhan ART harus dipertimbangkan untuk merancang intervensi yang efektif. Untuk mengurangi dampak depresi dan stigma terhadap kepatuhan ART, efikasi diri pengobatan harus didukung saat mempertimbangkan jenis kelamin. Kata kunci: Kepatuhan antiretroviral, Malawi, Mediasi tingkat menengah, Teori Perilaku Sosial, Remaj

Papier-mach(in)e: Thinking with “sticky” paper in the cloud

There is nothing less about paper and its use when it comes to academic study as we experience increasingly converging media spaces and functionalities of online applications within the screens of our laptops, mobile phones and tablet devices. The paper persists, and the paperless office, classroom and pedagogy become nothing but pure rhetoric. Hence, it is most pertinent to focus on paper and its “stickiness” in maintaining educational structures and practices. Usually hidden from view or neglected in educational technology studies is a consideration on how we think and interact not only with our mind but also with our heads and limbs. This paper will argue that paper has a composite place or bearing, a kind of stickiness to our technologised bodies, digital mobilities and hybrid practices in what I have coined here as papier-mach(in)e. This claim will be supported by evidence that demonstrates how we simply think both practically and pathically and that our mobilities in media and physical spaces are in one form or another meshed with paper. In fact, a drive towards a paperless classroom or pedagogy is without much foundation when it comes to mobilising a sustainable agenda for technology-enhanced learning

Evaluating 'Prefer not to say' Around Sensitive Disclosures

As people's offline and online lives become increasingly entwined, the sensitivity of personal information disclosed online is increasing. Disclosures often occur through structured disclosure fields (e.g., drop-down lists). Prior research suggests these fields may limit privacy, with non-disclosing users being presumed to be hiding undesirable information. We investigated this around HIV status disclosure in online dating apps used by men who have sex with men. Our online study asked participants (N=183) to rate profiles where HIV status was either disclosed or undisclosed. We tested three designs for displaying undisclosed fields. Visibility of undisclosed fields had a significant effect on the way profiles were rated, and other profile information (e.g., ethnicity) could affect inferences that develop around undisclosed information. Our research highlights complexities around designing for non-disclosure and questions the voluntary nature of these fields. Further work is outlined to ensure disclosure control is appropriately implemented around online sensitive information disclosures

Characteristics of intensive care units in Michigan: Not an open and closed case

OBJECTIVE: Delivery of critical care by intensivists has been recommended by several groups. Our objective was to understand the delivery of critical care physician services in Michigan and the role of intensivists and nonintensivist providers in providing care. DESIGN: Descriptive questionnaire. PARTICIPANTS AND SETTING: Intensive care unit (ICU) directors and nurse managers at 96 sites, representing 115 ICUs from 72 hospitals in Michigan. MEASUREMENTS AND RESULTS: The primary outcome measure was the percentage of sites utilizing a closed vs. an open model of ICU care. Secondary outcome measures included the percentage of ICUs utilizing a high-intensity service model, hospital size, ICU size, type of clinician providing care, and clinical activities performed. Twenty-four (25%) sites used a closed model of intensive care, while 72 (75%) had an open model of care. Hospitals with closed ICUs were larger and had larger ICUs than sites with open ICUs ( P < 0.05). Hospitalists serving as attending physicians were strongly associated with an open ICU (odds ratio [OR] = 12.2; 95% confidence interval [CI] = 2.5-60.2), as was the absence of intensivists in the group (OR = 12.2; 95%CI = 1.4-105.8), while ICU and hospital size were not associated. At 18 sites (20%) all attendings were board certified in Critical Care. Sixty sites had less than 50% board-certified attending physicians. CONCLUSIONS: The closed intensivist-led model of intensive care delivery is not in widespread use in Michigan. In the absence of intensivists, alternate models of care, including the hospitalist model, are frequently used. Journal of Hospital Medicine 2010;5:4–9. © 2010 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64903/1/567_ftp.pd

Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people

The efficacy of orthographic rime, grapheme-phoneme correspondence, and implicit phonics approaches to teaching decoding skills

This study compared the efficacy of two decoding skill-based programs, one based on explicit orthographic rime and one on grapheme–phoneme correspondences, to a control group exposed to an implicit phonics program. Children in both explicit decoding programs performed consistently better than the control group in the accuracy with which they read and spelled words covered in the program. Only children in the grapheme–phoneme correspondence program consistently spelled transfer words better than children in the control group. In addition, children in the grapheme–phoneme correspondence group consistently read words more quickly than children in the control group. Children in both explicit decoding programs scored higher than the children in the control group on measures of reading comprehension and oral reading at posttest

The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada

BACKGROUND: Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. METHODS: Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 1980 and follow-up was complete to March 2000. Analyses evaluated the rate and timing of all-cause and cardiovascular hospitalizations within discrete periods in the five years following the index stroke. Cardiovascular hospitalizations included patients with a primary diagnosis of ischemic stroke, transient ischemic attack, myocardial infarction, stable or unstable angina, heart failure or peripheral arterial disease. RESULTS: One-third (36%) of patients were identified by a hospitalized stroke. Mean age was 70.5 years, 48.0% were male, half had a history of stroke or a transient ischemic attack at the time of their index stroke. Three-quarters of the patients (72.7%) were hospitalized at least once during a mean follow-up of 4.6 years, accruing CAD $24 million in the first year alone. Of all hospitalizations, 20.4% were related to cardiovascular disease and 1.6% to bleeds. In the month following index stroke, 12.5% were admitted, an average of 1.04 times per patient hospitalized. Strokes accounted for 33% of all hospitalizations in the first month. The rate diminished steadily throughout the year and stabilized in the second year when approximately one-third of patients required hospitalization, at a rate of about one hospitalization for every two patient-years. Mean lengths of stay ranged from nine days to nearly 40 days. Close-fitting Weibull functions allow highly specific probability estimates. Other cardiovascular risk factors significantly increased hospitalization rates. CONCLUSION: After stroke, there are frequent hospitalizations accounting for substantial additional costs. Though these rates drop after one year, they remain high over time. The number of other cardiovascular causes of hospitalization confirms that stroke is a manifestation of disseminated atherothrombotic disease

Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania

BACKGROUND: Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania. METHODS AND FINDINGS: A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold. CONCLUSIONS: Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis

pp32 (ANP32A) Expression Inhibits Pancreatic Cancer Cell Growth and Induces Gemcitabine Resistance by Disrupting HuR Binding to mRNAs

The expression of protein phosphatase 32 (PP32, ANP32A) is low in poorly differentiated pancreatic cancers and is linked to the levels of HuR (ELAV1), a predictive marker for gemcitabine response. In pancreatic cancer cells, exogenous overexpression of pp32 inhibited cell growth, supporting its long-recognized role as a tumor suppressor in pancreatic cancer. In chemotherapeutic sensitivity screening assays, cells overexpressing pp32 were selectively resistant to the nucleoside analogs gemcitabine and cytarabine (ARA-C), but were sensitized to 5-fluorouracil; conversely, silencing pp32 in pancreatic cancer cells enhanced gemcitabine sensitivity. The cytoplasmic levels of pp32 increased after cancer cells are treated with certain stressors, including gemcitabine. pp32 overexpression reduced the association of HuR with the mRNA encoding the gemcitabine-metabolizing enzyme deoxycytidine kinase (dCK), causing a significant reduction in dCK protein levels. Similarly, ectopic pp32 expression caused a reduction in HuR binding of mRNAs encoding tumor-promoting proteins (e.g., VEGF and HuR), while silencing pp32 dramatically enhanced the binding of these mRNA targets. Low pp32 nuclear expression correlated with high-grade tumors and the presence of lymph node metastasis, as compared to patients' tumors with high nuclear pp32 expression. Although pp32 expression levels did not enhance the predictive power of cytoplasmic HuR status, nuclear pp32 levels and cytoplasmic HuR levels associated significantly in patient samples. Thus, we provide novel evidence that the tumor suppressor function of pp32 can be attributed to its ability to disrupt HuR binding to target mRNAs encoding key proteins for cancer cell survival and drug efficacy