'I believe that the staff have reduced their closeness to patients': an exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda

<p>Abstract</p> <p>Background</p> <p>Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff.</p> <p>Methods</p> <p>A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews.</p> <p>Results</p> <p>HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences.</p> <p>Conclusion</p> <p>HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process.</p

Neutrophil Paralysis in Plasmodium vivax Malaria

Plasmodium vivax is responsible for approximately 60–80% of the malaria cases in the world, and contributes to significant social and economic instability in the developing countries of Latin America and Asia. The pathogenesis of P. vivax malaria is a consequence of host derived inflammatory mediators. Hence, a better understanding of the mechanisms involved in induction of systemic inflammation during P. vivax malaria is critical for the clinical management and prevention of severe disease. The innate immune receptors recognize Plasmodium sp. and initiate a broad spectrum of host defense mechanisms that mediate resistance to infection. However, the innate immune response is the classic “two-edged sword”, and clinical malaria is associated with high levels of circulating pro-inflammatory cytokines. Our findings show that both monocytes and neutrophils are highly activated during malaria. Monocytes produced high levels of IL-1β, IL-6 and TNF-α during acute malaria. On the other hand, neutrophils were a poor source of cytokines, but displayed an enhanced phagocytic activity and superoxide production. Unexpectedly, we noticed an impaired chemotaxis of neutrophils towards an IL-8 (CXCL8) gradient. We proposed that neutrophil paralysis is in part responsible for the enhanced susceptibility to bacterial infection observed in malaria patients

Adesão ao tratamento e hospitalizações entre pacientes que realizam aplicações de Flufenazina Depot Adhesión al tratamiento y hospitalización entre pacientes que realizan aplicaciones de Flufenazina Depot Compliance with treatment and hospitalization among patients using Flufenazine Depot

OBJETIVOS: Os autores revisam a bibliografia sobre medicação depot e apresentam dados referentes à adesão ao tratamento e hospitalizações entre os pacientes que realizam aplicações de enantato de flufenazina em regime ambulatorial no Hospital Espírita de Pelotas. MÉTODO: Analisaram-se os prontuários de pacientes que foram incluídos no regime depot anteriormente a maio de 2001 e que realizaram pelo menos uma aplicação entre maio de 2001 e junho de 2002, quanto à adesão ao tratamento e eventuais hospitalizações. RESULTADOS: De um total de 100 pacientes, 66 permaneciam em regime depot ao término do período estudado. Destes, 40 (61%) apresentavam boa adesão ao tratamento, enquanto 26 (39%) apresentavam má adesão. Houve um total de 25 pacientes que sofreram hospitalizações, entre os quais a maioria não estava em tratamento no término do estudo ou apresentava má adesão. Entre os pacientes procedentes do mesmo bairro em que se situa o hospital, 10 (67%) apresentavam boa adesão em comparação com 30 pacientes (59%) procedentes de bairros distintos. DISCUSSÃO: O número de hospitalizações variou visivelmente, conforme a permanência ou não em tratamento e a adesão ao mesmo. Pacientes provenientes de bairros distantes do hospital tenderam a apresentar pior adesão ao tratamento. CONCLUSÕES: É possível que pacientes em regime de aplicação depot residentes próximos ao local de aplicação beneficiem-se mais do tratamento que aqueles residentes em locais distantes. São necessários mais estudos comparando administrações depot com VO em termos de adesão e investigando fatores preditores de boa adesão ao tratamento.<br>OBJETIVOS: Los autores revisan la bibliografía sobre medicación depot y presentan datos referentes a la adhesión al tratamiento y hospitalizaciones entre los pacientes que realizan aplicaciones de enantato de flufenazina en régimen ambulatorio en el Hospital Espiritista de Pelotas. MÉTODO: Fueron analizados los informes de pacientes incluidos en el régimen depot antes de mayo de 2001 y que realizaron por lo menos una aplicación entre mayo de 2001 y junio de 2002, con respecto a la adhesión al tratamiento y eventuales hospitalizaciones. RESULTADOS: De un total de 100 pacientes, 66 permanecían en régimen depot al final del período estudiado. De estos, 40 (61%) respondieron bien al tratamiento, mientras que 26 (39%) no respondieron adecuadamente. Hubo un total de 25 pacientes que sufrió hospitalizaciones, de los cuales, la mayoría no estaba en tratamiento a la finalización del estudio o no respondieron bien al tratamiento. Entre los pacientes que procedían del mismo barrio en que se encuentra el hospital, 10 (67%) respondieron bien al tratamiento, mientras que 30 pacientes (59%) procedentes de otros barrios no respondieron bien al tratamiento. DISCUSIÓN: El número de hospitalizaciones varió visiblemente de acuerdo con la permanencia o no en tratamiento y la respuesta al mismo. Pacientes provenientes de barrios distantes del hospital tendieron a presentar peor adhesión al tratamiento. CONCLUSIONES: Es posible que pacientes en régimen de aplicación depot residentes en las cercanías al local de aplicación se beneficien mas del tratamiento que aquellos residentes en locales distantes. Son necesarios mas estudios comparando administraciones depot con VO en términos de adhesión e investigando factores predecibles de buena respuesta al tratamiento.<br>OBJECTIVES: The authors review literature on depot medication and present data referring to compliance with treatment and hospitalizations of patients who are medicated with flufenazine enantate as outpatients at Hospital Espírita de Pelotas. Methods: The patients in the study were included in the depot regime before May 2001 and had at least one application between May 2001 and June 2002. They were analyzed for the variables compliance with treatment and possible hospitalizations RESULTS: Out of a total of 100 patients, 66 continued to receive deposit applications until the end of the period studied. Of these, 40 (61%) presented good compliance with the treatment, while in 26 (39%) patients compliance was poor. Twenty-five patients in all underwent hospitalizations, most of whom were not in treatment by the end of the study or presented poor compliance. Among patients from the neighborhood in which the hospital is located 10 (67%) presented good compliance with treatment as compared to 30 patients (59%) from different neighborhoods. DISCUSSION: The number of hospitalizations clearly varied according to remaining or not in treatment and compliance with the latter. Patients coming from distant neighborhoods tended to be less compliant with treatment. CONCLUSIONS: It is possible that patients on a depot medication regime who live close to the application site benefit more from the treatment that those who live far away. Further studies are required comparing depot administration with PO in terms of adhesion and investigating predictive factors of good compliance with treatment