Social Support and Coping of Indonesian Family Caregivers Caring for Persons with Schizophrenia

Purpose: The aim of the study was to examine the relationship between social support and coping of family caregivers caring for persons with schizophrenia in West Java Province, Indonesia. Methods: This study used the correlational design. Eighty eight family caregivers who cared for persons with schizophrenia were recruited from the Outpatient Department of West Java Province Mental Hospital, West Java, Indonesia through purposive sampling technique. Data were collected by self-report questionnaires using the Perceived Social Support Questionnaire (PSSQ) and the Jalowiec Coping Scale (JCS). Then, data was analyzed by descriptive and Pearson\u27s product-moment correlation statistic.Results: Overall social support was perceived at a moderate level. The most often coping methods used was optimistic optimistic, followed by self-reliant coping, confrontative coping, and supportant coping. There were significant positive correlation between social support and confrontative coping (r = .68, p < .01), optimistic coping (r = .42, p < .01), and supportant coping (r = .46, p < .01). Social support was significantly and negatively correlate with evasive coping (r = -.52, p < .01) and fatalistic coping (r = -.41, p < .05).Conclusion: For nurses, providing social support including emotional, informational, instrumental, and appraisal support were to be important for caregiver to determine effective coping strategies

Defining the True Sensitivity of Culture for the Diagnosis of Melioidosis Using Bayesian Latent Class Models

BACKGROUND: Culture remains the diagnostic gold standard for many bacterial infections, and the method against which other tests are often evaluated. Specificity of culture is 100% if the pathogenic organism is not found in healthy subjects, but the sensitivity of culture is more difficult to determine and may be low. Here, we apply Bayesian latent class models (LCMs) to data from patients with a single Gram-negative bacterial infection and define the true sensitivity of culture together with the impact of misclassification by culture on the reported accuracy of alternative diagnostic tests. METHODS/PRINCIPAL FINDINGS: Data from published studies describing the application of five diagnostic tests (culture and four serological tests) to a patient cohort with suspected melioidosis were re-analysed using several Bayesian LCMs. Sensitivities, specificities, and positive and negative predictive values (PPVs and NPVs) were calculated. Of 320 patients with suspected melioidosis, 119 (37%) had culture confirmed melioidosis. Using the final model (Bayesian LCM with conditional dependence between serological tests), the sensitivity of culture was estimated to be 60.2%. Prediction accuracy of the final model was assessed using a classification tool to grade patients according to the likelihood of melioidosis, which indicated that an estimated disease prevalence of 61.6% was credible. Estimates of sensitivities, specificities, PPVs and NPVs of four serological tests were significantly different from previously published values in which culture was used as the gold standard. CONCLUSIONS/SIGNIFICANCE: Culture has low sensitivity and low NPV for the diagnosis of melioidosis and is an imperfect gold standard against which to evaluate alternative tests. Models should be used to support the evaluation of diagnostic tests with an imperfect gold standard. It is likely that the poor sensitivity/specificity of culture is not specific for melioidosis, but rather a generic problem for many bacterial and fungal infections

The Response of Lemna minor to Mixtures of Pesticides That Are Commonly Used in Thailand

In the field, aquatic organisms are exposed to multiple contaminants rather than to single compounds. It is therefore important to understand the toxic interactions of co-occurring substances in the environment. The aim of the study was to assess the effects of individual herbicides (atrazine, 2,4-D, alachlor and paraquat) that are commonly used in Thailand and their mixtures on Lemna minor. Plants were exposed to individual and binary mixtures for 7 days and the effects on plant growth rate were assesed based on frond area measurements. Experimental observations of mixture toxicity were compared with predictions based on single herbicide exposure data using concentration addition and independent action models. The single compound studies showed that paraquat and alachlor were most toxic to L. minor, followed by atrazine and then 2,4-D. For the mixtures, atrazine with 2,4-D appeared to act antagonistically, whereas alachlor and paraquat showed synergism

The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis

Background Antimicrobial resistance (AMR) is an urgent global health challenge and a critical threat to modern health care. Quantifying its burden in the WHO Region of the Americas has been elusive—despite the region’s long history of resistance surveillance. This study provides comprehensive estimates of AMR burden in the Americas to assess this growing health threat. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen–drug combinations for countries in the WHO Region of the Americas in 2019. We obtained data from mortality registries, surveillance systems, hospital systems, systematic literature reviews, and other sources, and applied predictive statistical modelling to produce estimates of AMR burden for all countries in the Americas. Five broad components were the backbone of our approach: the number of deaths where infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of pathogens resistant to an antibiotic class, and the excess risk of mortality (or duration of an infection) associated with this resistance. We then used these components to estimate the disease burden by applying two counterfactual scenarios: deaths attributable to AMR (compared to an alternative scenario where resistant infections are replaced with susceptible ones), and deaths associated with AMR (compared to an alternative scenario where resistant infections would not occur at all). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Findings We estimated 569,000 deaths (95% UI 406,000–771,000) associated with bacterial AMR and 141,000 deaths (99,900–196,000) attributable to bacterial AMR among the 35 countries in the WHO Region of the Americas in 2019. Lower respiratory and thorax infections, as a syndrome, were responsible for the largest fatal burden of AMR in the region, with 189,000 deaths (149,000–241,000) associated with resistance, followed by bloodstream infections (169,000 deaths [94,200–278,000]) and peritoneal/intra-abdominal infections (118,000 deaths [78,600–168,000]). The six leading pathogens (by order of number of deaths associated with resistance) were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Together, these pathogens were responsible for 452,000 deaths (326,000–608,000) associated with AMR. Methicillin-resistant S. aureus predominated as the leading pathogen–drug combination in 34 countries for deaths attributable to AMR, while aminopenicillin-resistant E. coli was the leading pathogen–drug combination in 15 countries for deaths associated with AMR. Interpretation Given the burden across different countries, infectious syndromes, and pathogen–drug combinations, AMR represents a substantial health threat in the Americas. Countries with low access to antibiotics and basic health-care services often face the largest age-standardised mortality rates associated with and attributable to AMR in the region, implicating specific policy interventions. Evidence from this study can guide mitigation efforts that are tailored to the needs of each country in the region while informing decisions regarding funding and resource allocation. Multisectoral and joint cooperative efforts among countries will be a key to success in tackling AMR in the Americas. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund

A three-component hydrograph separation based on geochemical tracers in a tropical mountainous headwater catchment in northern Thailand

Land-use change in the mountainous parts of northern Thailand is reflected by an increased application of agrochemicals, which may be lost to surface and groundwater. The close relation between flow paths and contaminant transport within hydrological systems requires recognizing and understanding the dominant hydrological processes. To date, the vast majority of studies on runoff generation have been conducted in temperate regions. Tropical regions suffer from a general lack of data, and little is known about runoff generation processes. To fill this knowledge gap, a three-component hydrograph separation based on geochemical tracers was carried out in a steep, remote and monsoon-dominated study site (7 km2) in northern Thailand. Silica and electrical conductivity (EC) were identified as useful tracers and were applied to calculate the fractions of groundwater (similar to pre-event water), shallow subsurface flow and surface runoff on stormflow. K+ was a useful indicator for surface runoff dynamics, and Ca2+ provided insights into groundwater behaviour. Nevertheless, neither measure was applicable for the quantification of runoff components. Cl- and further parameters (e.g. Na+, K+, and Mg2+) were also not helpful for flow path identification, nor were their concentrations distinguishable among the components. Groundwater contributed the largest fractions to stormflow (62–80%) throughout all events, followed by shallow subsurface flow (17–36%) and surface runoff (2–13%). Our results provide important insights into the dynamics of the runoff processes in the study area and may be used to assess the transport pattern of contaminants (i.e. agrochemicals) here

A three-component hydrograph separation based on geochemical tracers in a tropical mountainous headwater catchment in northern Thailand

Land-use change in the mountainous parts of northern Thailand is reflected by an increased application of agrochemicals, which may be lost to surface and groundwater. The close relation between flow paths and contaminant transport within hydrological systems requires recognizing and understanding the dominant hydrological processes. To date, the vast majority of studies on runoff generation have been conducted in temperate regions. Tropical regions suffer from a general lack of data, and little is known about runoff generation processes. To fill this knowledge gap, a three-component hydrograph separation based on geochemical tracers was carried out in a steep, remote and monsoon-dominated study site (7 km2) in northern Thailand. Silica and electrical conductivity (EC) were identified as useful tracers and were applied to calculate the fractions of groundwater (similar to pre-event water), shallow subsurface flow and surface runoff on stormflow. K+ was a useful indicator for surface runoff dynamics, and Ca2+ provided insights into groundwater behaviour. Nevertheless, neither measure was applicable for the quantification of runoff components. Cl- and further parameters (e.g. Na+, K+, and Mg2+) were also not helpful for flow path identification, nor were their concentrations distinguishable among the components. Groundwater contributed the largest fractions to stormflow (62–80%) throughout all events, followed by shallow subsurface flow (17–36%) and surface runoff (2–13%). Our results provide important insights into the dynamics of the runoff processes in the study area and may be used to assess the transport pattern of contaminants (i.e. agrochemicals) here.Water ManagementCivil Engineering and Geoscience

IS LEGITIMACY CONTAGIOUS? THE COLLECTIVE LEGITIMATION OF ALTERNATIVE THERAPIES IN THE U.S. HOSPITAL INDUSTRY

Committee members: Pamela Tolbert (Chair) David Strang Wesley SineThis dissertation research examines the rise and spread of alternative medicine in the U.S. health care field. Alternative medicine includes a variety of treatment therapies (e.g., acupuncture, therapeutic touch, acupressure, etc.) whose underlying principles rest uneasily with those of dominant mainstream medicine. Although their efficacy is still subject to challenge by the medical establishment, these therapies have enjoyed increasing public acceptance in the last two decades, and recently a number of hospitals have begun to incorporate them into their formal structure. In this context, I explore an under-theorized process, the contagion of legitimacy among practices--how the adoption of one or more therapies by a given hospital affects the adoption of other alternative therapies by other hospitals. I suggest that the spread of one practice can be regarded as an informational cue on which potential adopters rely in deciding whether to adopt other associated practices. As long as the informational cue enhances the familiarity and acceptability of new practices, this type of influence may be understood as the process in which the legitimacy of some practices is transferred to other associated practices. As an underpinning process of such association, I focus on categorization which lumps similar practices into a common category and thus creates a common identity for the grouped practices. I argue that a categorical scheme serves as a cognitive basis for association between practices that would otherwise be viewed as disconnected. I empirically examine if the adoption of members of one group of alternative therapies accounts for variation in adoption rates of other therapies which are also in the same group. The findings of analyses strongly support my argument that prior adoptions of alternative therapies by hospitals enhance diffusion rates of other therapies, especially when the therapies present a coherent categorical identity. This study concludes with theoretical implications of the empirical findings and directions for future research