Comparison of Social Valdidity Ratings with the Effects of a Video-feedback Intervention for Communication Partners of Individuals with Deafblindness

The parents, teachers, and professional caregivers of individuals with disabilities may benefit from interventions to enhance their educational skills. In previous studies, positive effects were observed of a video-feedback intervention for caregivers (i.e. parents, teachers, and professional caregivers) on their communication with an individual with congenital deafblindness. The intervention they received, was the High-Quality Communication (HQC) intervention. The aim of the current study was to gain insight into the perceived relevance, feasibility, and effectiveness (i.e., social validity) of the HQC-intervention according to these caregivers, and the correspondence between the social validity ratings and the observational effects of the HQC-intervention. Responses on the Social Validity Scale from 25 caregivers who participated in the High-Quality Communication (HQC) intervention revealed that they considered the HQC intervention to be a relevant, feasible, and effective intervention. Comparing the caregiver ratings with observational effects of the HQC intervention at the individual case level, we found no association between the observed effectiveness of this intervention and caregivers’ opinions about its relevance, feasibility and effectiveness. There was however, an association between the rated feasibility and effectiveness, which suggests that the perceived success of the intervention was influenced by caregivers’ experienced competency in supporting the communication of individuals with CDB. The combination of observational and social validity data enabled a critical analysis of the clinical value of the HQC intervention. We recommend that future studies use multiple data source for social validity assessment

Applying Erikson’s theory of psychosocial development to understand autonomy development in children and youths with deafblindness:a systematic literature review

This systematic review revealed how children and youths with congenital deafblindness (CDB) exhibit autonomy characteristics and how caregivers perform autonomy support, which Erikson described as part of the first three stages of psychosocial development. This review comprises 22 studies that explicitly addressed one or more autonomy characteristics or autonomy support tasks. The results demonstrated that children and youths with CDB exhibited most characteristics of Erikson’s first stage (e.g., explorative behavior in their nearby environment and with objects within reach) and caregivers predominantly fulfilled autonomy tasks in the first stage (e.g., being present and near the child). In addition, children and youths with CDB exhibited independent acts at the second stage, although these were often limited to asking for or refusing concrete objects in the here-and-now situation. The limited degree to which the children with CDB exhibited autonomy characteristics from the second and third stages seems to co-occur with their struggle to develop symbolic communication. Additionally, the review revealed that caregivers supported autonomy by remaining present and nearby, even when autonomy support tasks from the second and third stages might be more appropriate in supporting the autonomy of children and youths with CDB (e.g., the second stage’s autonomy support task to balance between offering the child protection and encouragement, and the third stage’s task to support the child in taking initiative and setting goals). We recommend the use of a longitudinal video-feedback intervention that both supports the children’s and youths symbolic communication skills and supports caregivers in finding a balance between being present and nearby and fostering the autonomy characteristics of children and youths with CDB

Multiparty conversations with people with congenital deafblindness:Operationalization, significance, and requirements

Typically developing children are exposed to multiparty communication on a daily basis from birth. This facilitates both group belonging and observational learning. However, involvement in multiparty conversations is not self-evident for people with congenital deafblindness due to their dual sensory impairment. This study explored the added value of multiparty conversations for people with congenital deafblindness by analyzing communication partners' narrations of their experiences. Three focus group sessions were conducted with professionals and relatives (n = 24) of people with congenital deafblindness. These sessions were audiotaped, transcribed, and coded using thematic analysis. Participants described the following defining characteristics of multiparty conversations in relation to congenital deafblindness: a minimum of three people involved, with at least one who has congenital deafblindness; awareness of the presence of the other communication partners; attention for the communicative setting; and the use of communication means that are familiar to all communication partners. In their experience, multiparty conversations supported social, emotional, and communication development. Furthermore, focus group participants indicated that spontaneous multiparty conversations with people with congenital deafblindness were scarce and, therefore, needed to be encouraged by communication partners. The participants considered positive beliefs, preparation of the multiparty conversation, repetitions, and a low communication speed as important partner competencies to support the involvement of individuals with congenital deafblindness in multiparty conversations. Accordingly, we recommend the development of an intervention protocol for communication partners to initiate and foster multiparty conversations with people with congenital deafblindness. Another recommendation is to test the effects of MPC on the observational learning of people with congenital deafblindness

Diabetes alone should not be a reason for withholding adjuvant chemotherapy for stage III colon cancer

Background: With increasing prevalence of diabetes mellitus and colon cancer, the number of patients suffering from both diseases is growing, and physicians are being faced with complicated treatment decisions. Objective: To investigate the association between diabetes and treatment/course of stage III colon cancer and the association between colon cancer and course of diabetes. Materials and Methods: Additional information was collected from the medical records of all patients with both stage III colon cancer and diabetes (n=201) and a random sample of stage III colon cancer patients without diabetes (n=206) in the area of the population-based Eindhoven Cancer Registry (1998–2007). Results: Colon cancer patients without diabetes were more likely to receive adjuvant chemotherapy compared with diabetic colon cancer patients (OR 1.8; 95% CI 1.2–2.7). After adjustment for age, this difference was borderline significant (OR 1.6; 95% CI 1.0–2.6). Diabetic patients did not have: significantly more side-effects from surgery or adjuvant chemotherapy; more recurrence from colon cancer; significantly shorter time interval until recurrence; or a poorer disease-free survival or overall survival. Age and withholding of adjuvant chemotherapy were most predictive of all-cause mortality. After colon cancer diagnosis, the dose of antiglycaemic medications was increased in 22% of diabetic patients, resulting in significantly lower glycaemic indexes than before colon cancer diagnosis. Conclusions: Since diabetic patients did not have more side-effects of adjuvant chemotherapy, and adjuvant chemotherapy had a positive effect on survival for both patients with and without diabetes, diabetes alone should not be a reason for withholding adjuvant chemotherapy.Journal of Comorbidity 2011;1(1):19–2

The detection and modeling of direct effects in latent class analysis

Several approaches have been proposed for latent class modeling with external variables, including one-step, two-step and three-step estimators. However, very little is known yet about the performance of these approaches when direct effects of the external variable to the indicators of latent class membership are present. In the current article, we compare those approaches and investigate the consequences of not modeling these direct effects when present, as well as the power of residual and fir statistics to identify such effects. The results of the simulations show that not modeling direct effect can lead to severe parameter bias, especially with a weak measurement model. Both residual and fit statistics can be used to identify such effects, as long as the number and strength of these effects is low and the measurement model is sufficiently strong

Impact of Anti-Retroviral Treatment and Cotrimoxazole Prophylaxis on Helminth Infections in HIV-Infected Patients in Lambar�n�, Gabon

Background: Foci of the HIV epidemic and helminthic infections largely overlap geographically. Treatment options for helminth infections are limited, and there is a paucity of drug-development research in this area. Limited evidence suggests that antiretroviral therapy (ART) reduces prevalence of helminth infections in HIV-infected individuals. We investigated whether ART exposure and cotrimoxazole preventive therapy (CTX-P) is associated with a reduced prevalence of helminth infections. Methodology and Principal Findings: This cross-sectional study was conducted at a primary HIV-clinic in Lambaréné, Gabon. HIV-infected adults who were ART-naïve or exposed to ART for at least 3 months submitted one blood sample and stool and urine samples on 3 consecutive days. Outcome was helminth infection with intestinal helminths, Schistosoma haematobium, Loa loa or Mansonella perstans. Multivariable logistic regression was used to assess associations between ART or CTX-P and helminth infection. In total, 408 patients were enrolled. Helminth infection was common (77/252 [30.5%]). Filarial infections were most prevalent (55/310 [17.7%]), followed by infection with intestinal helminths (35/296 [11.8%]) and S. haematobium (19/323 [5.9%]). Patients on CTX-P had a reduced risk of Loa loa microfilaremia (adjusted odds ratio (aOR) 0.47, 95% CI 0.23-0.97, P = 0.04), also in the subgroup of patients on ART (aOR 0.36, 95% CI 0.13-0.96, P = 0.04). There was no effect of ART exposure on helminth infection prevalence. Conclusions/Significance: CTX-P use was associated with a decreased risk of Loa loa infection, suggesting an anthelminthic effect of antifolate drugs. No relation between ART use and helminth infections was established

Factors associated with retention to care in an HIV clinic in Gabon, Central Africa

BACKGROUND: Retention to HIV care is vital for patients' survival, to prevent onward transmission and emergence of drug resistance. Travelling to receive care might influence adherence. Data on the functioning of and retention to HIV care in the Central African region are limited. METHODS: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon. Adult patients who presented to this clinic between January 2010 and January 2012 were included. Outcomes were retention in care (defined as documented show-up for clinical visits, regardless of delay) or LTFU (defined as a patient not retained in care; on ART or ART naïve, not returning to care during the study period with a patient delay for scheduled visits of more than 6 months), and mortality. Cox regression analysis was used to assess factors associated with respective outcomes. Qualitative data on reasons for LTFU were obtained from focus-group discussions. RESULTS: Of 223 patients included, 67.3% were female. The mean age was 40.5 (standard deviation 11.4) years and the median CD4 count 275 (interquartile range 100.5-449.5) cells/μL. In total, 34.1% were lost to follow up and 8.1% died. Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data. CONCLUSIONS: Retention to HIV care in a primary clinic in Gabon is relatively poor and interventions to address this should be prioritized in the HIV program. Early initiation of ART might improve retention in care

Molecular epidemiology of apparent outbreak of invasive aspergillosis in ahematology ward

During a 2-month period, five patients suffering from invasive infections caused by Aspergillus flavus or Aspergillus fumigatus were identif