Health Insurance Type and Control of Hypertension Among US Women Living With and Without HIV Infection in the Women’s Interagency HIV Study

BACKGROUND: Health care access is an important determinant of health. We assessed the effect of health insurance status and type on blood pressure control among US women living with (WLWH) and without HIV. METHODS: We used longitudinal cohort data from the Women's Interagency HIV Study (WIHS). WIHS participants were included at their first study visit since 2001 with incident uncontrolled blood pressure (BP) (i.e., BP ≥140/90 and at which BP at the prior visit was controlled (i.e., <135/85). We assessed time to regained BP control using inverse Kaplan-Meier curves and Cox proportional hazard models. Confounding and selection bias were accounted for using inverse probability-of-exposure-and-censoring weights. RESULTS: Most of the 1,130 WLWH and 422 HIV-uninfected WIHS participants who had an elevated systolic or diastolic measurement were insured via Medicaid, were African-American, and had a yearly income ≤$12,000. Among participants living with HIV, comparing the uninsured to those with Medicaid yielded an 18-month BP control risk difference of 0.16 (95% CI: 0.10, 0.23). This translates into a number-needed-to-treat (or insure) of 6; to reduce the caseload of WLWH with uncontrolled BP by one case, five individuals without insurance would need to be insured via Medicaid. Blood pressure control was similar among WLWH with private insurance and Medicaid. There were no differences observed by health insurance status on 18-month risk of BP control among the HIV-uninfected participants. CONCLUSIONS: These results underscore the importance of health insurance for hypertension control-especially for people living with HIV

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

<p>Abstract</p> <p>Background</p> <p>In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh.</p> <p>Methods</p> <p>A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home.</p> <p>Results</p> <p>Overall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = < 0.001). Depression status were significantly associated with women reporting negative life changes such as worse relationships with their husband (adjusted OR = 3.89, 95% CI: 1.37-11.04) and feeling guilty (adjusted OR = 2.61, 95% CI: 1.22-5.63) following the results of their last pregnancy outcome after 6 months of childbirth.</p> <p>Conclusions</p> <p>This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.</p

Spoken language interaction with robots: Recommendations for future research

With robotics rapidly advancing, more effective human–robot interaction is increasingly needed to realize the full potential of robots for society. While spoken language must be part of the solution, our ability to provide spoken language interaction capabilities is still very limited. In this article, based on the report of an interdisciplinary workshop convened by the National Science Foundation, we identify key scientific and engineering advances needed to enable effective spoken language interaction with robotics. We make 25 recommendations, involving eight general themes: putting human needs first, better modeling the social and interactive aspects of language, improving robustness, creating new methods for rapid adaptation, better integrating speech and language with other communication modalities, giving speech and language components access to rich representations of the robot’s current knowledge and state, making all components operate in real time, and improving research infrastructure and resources. Research and development that prioritizes these topics will, we believe, provide a solid foundation for the creation of speech-capable robots that are easy and effective for humans to work with

Prevención en fonoaudiólogos de la Universidad del Valle en Cali, Colombia Prevention and performance role of speech-hearing therapist from University of Valley in Cali, Colombia

INTRODUCCIÓN: Un curriculo de formación en fonoaudiología, idealmente, contempla fundamentación teórica-prática para el abordaje preventivo de desordenes de comunicación humana presentes en usuarios de serviços profesionales. Para explorar la coherencia de lo propuesto por un plan de estudios y las prácticas preventivas en el ejercicio profesional, se vinculó a los graduados del programa de estudios en fonoaudiologia de la Universidad del Valle con sede en la ciudad de Cali - Colombia. METODOLOGÍA: Se formuló un estudio descriptivo; 45 profisionales que cumplieron criterios de graduación, residencia y con ejercicio comprobado en la ciudad al momento del estudio, respondieron entre enero y abril de 1995 a un cuestionario autoadministrado de 13 items, formulados y validados según objetivos del estudio; referidos a variable laborales, ocupacionales y profesionales para describir y analizar la distribución del grupo según campo de ocupación, lugar de trabajo, tipo de institución a la que estam vinculados, grupo etáreo y área de comunicación humana en la que ejercían su prática professional; abordar el origen intra o extracurricular de sus conocimientos en prevención y la utilización-frequencia de estrategias y acciones específicas de prevención en las áreas de voz-habla, audición, lenguaje y aprendizaje. RESULTADOS: El 67% reconoció el plan de estudios como fuente relevante de sus conocimientos preventivos. Un 47% de profesionales usaba solo una entre nueve estrategias preventivas viables; un 29% afirmó haber usado maximo dos de tales alternativas de intervencíon. Para todas las areas de comunicación, en media, cerca del 60% de fonoaudiólogos nunca incorporó acciones preventivas de ninguna categoría. CONCLUSIÓN: La mayoría del grupo estudiado no incorpora en su ejercicio profesional estrategias ni acciones preventivas de desordenes de comunicación del modo propuesto en el perfil curricular, como es socialmente esperado, a pesar de reconocer los aportes teorico-praticos preventivos recibidos durante su formación académica. Se sugiere que determinantes del mercado laboral y de la demanda de servicios fonoaudiológicos impiden la incorporación de práticas preventivas habituales.<br>INTRODUÇÃO: Visando a explorar a coerência do currículo de formação com a realidade do exercício, tendo como fato relevante a prática preventiva, foram inqueridos os graduados de um programa universitário em fonoaudiologia, que oferece fundamentação teórico-prática aos seus estudantes para a abordagem preventiva das desordens da comunicação humana nos usuários dos seus serviços profissionais. METODOLOGIA: Formulou-se um estudo descritivo das ações e estratégias da prevenção de desordens no exercício profissional dos formados na Universidade do Vale, em Cali, Colômbia; 45 sujeitos que cumpriram critérios de inclusão responderam, de janeiro a abril de 1995 um questionário autoministrado, com 13 perguntas formuladas e validadas segundo objetivos da pesquisa para: descrever e analisar a distribuição do grupo por campo de acupação, local de trabalho, tipo de instituição do vínculo, grupo etário e área de comunicação em que ocorre seu desempenho; abordar a origem intra ou extracurricular dos seus conhecimentos em prevenção, e a utilização-freqüência das estratégias e ações específicas da prevenção nas áreas da voz, fala, audição, linguagem e aprendizagem. RESULTADOS: Sessenta e sete por cento reconheceram o plano de estudos como fonte dos seus conhecimentos preventivos. Quarenta e sete por cento faziam uso de só uma entre nove estratégias preventivas; 29% afirmaram ter usado no máximo duas dessas estratégias opcionais de intervenção. Para o conjunto de áreas da comunicação, em média, quase o 60% de fonoaudiólogos participantes nunca incorporaram na sua prática ações preventivas. CONCLUSÃO: Revelou-se que proporção majoritária do grupo estudado não incorpora sistematicamente estratégias nem ações preventivas de desordens de comunicação da forma proposta no seu perfil de formação, nem tal como é socialmente esperado, apesar de reconhecer o role do currículo na sua fundamentação teórico-prática quanto à prevenção comunicativa. É sugerida a presença de determinantes laborais e da demanda de serviços que impedem práticas preventivas habituais.<br>INTRODUCTION: Preventive activities in communication disorders treated by speech-hearing therapists of the Universidad del Valle in Cali Colombia, between January and April, 1995, are described. METHODOLOGY: Forty-five professionals to whom a self administered questionnaire with 13 questions was applied, were included in the study. RESULTS: For 67% the program of graduation is basic as source of their preventive knowledge. 47% used only one of nine strategic options and 29% report the use of only two of these preventive interventions. For all communication areas, on average nearly 60% of speech-hearing therapists never use preventive actions. CONCLUSION: The alumni of the Universidad del Valle do not exercise the practice of prevention in a sistematic way it has been claimed by the curriculum of the school. Some determinants of social context and demand of professional services are suspected to induce a great reduction in the proportion and frecuency of preventive practice in the professional role