Social Environment As A Determinant Of Coping Self-Efficacy In Men And Women Living With HIV Under The Auspice Of A Large Healthcare Provider In Kenya

Kenya faces a severe, generalized HIV epidemic that continues to have a devastating impact on men and women living with HIV and, generally, all sectors of the population. HIV-related stress based on living with HIV, fear of progression of HIV to AIDS or to death, stigma, and discrimination among others are constant stressors afflicting people living with HIV. There are two ways to help people face these stressors - changing the internal characteristics of a person or changing the social environment. A major healthcare provider engages a therapeutic coping model based on stress, appraisal, and coping theory that aims not only directly at changing internal dynamics of the person, but also changing these dynamics by altering the environment of men and women living with HIV. The interplay of a person’s effort with a socially supportive environment is believed to foster coping self-efficacy (CSE). However, the efficacy of this therapeutic model has not been assessed and documented. The purpose of this study was to determine the role of the social environment in shaping CSE among men and women living with HIV enrolled in the treatment and care program under the auspices of a large healthcare provider in Kenya. Three types of social support are: 1) emotional, which reduces anxiety and promotes self-esteem; 2) informational, which provides needed knowledge and skills useful in solving problems; and 3) belonging, which helps to distract a distressed person from disturbing thoughts significantly predicted CSE. The results support interventions that strengthen a person’s character while encouraging family members, friends, and other social ties to act and react favorably, thereby creating a supportive environment. Implications, limitations, and future directions are discussed.

Translation Of Interpersonal Support Evaluation List (ISEL) And Coping Self-Efficacy (CSE) From English Into Kiswahili For Use In Kenya

There is a growing body of international research focusing on social factors and their impact on mental health of people living in developing countries. Because of the novelty of these studies and high cost associated with developing survey tools, researchers may choose to translate pre-existing survey tools instead. Research findings are only reliable if a translated instrument is equivalent in content, semantics, and concept to the original instrument. The objective of this study was to translate the Interpersonal Support Evaluation List (ISEL) and the Coping Self-Efficacy (CSE) from English into Kiswahili. The original version of each instrument was translated from English into Kiswahili (forward translation) and then the Kiswahili version was translated back into English (back-translation). The Kiswahili version was reviewed against the original version by a committee of experts. The committee corrected and modified the translated version to create the final Kiswahili version. The final versions were pre-tested by ten bilingual individuals living in New York to determine the instrument’s face-validity. The raters accepted the Kiswahili version as equivalent to the original English version. The Kiswahili versions were then administered to a sample of 212 people living with HIV in Kenya. Cronbach’s alpha reliability coefficients for the composite measures of ISEL and CSE were 0.905 and 0.860, respectively. The step-wise process of creating an equivalent translated version of a proven survey instrument may require adjustments specific to the cultural background of each target population of interest. Based upon the scientific rigor with which the translations took place, the authors support that both translated versions of the ISEL and CSE questionnaires are valid and reliable instruments to measure the social support and beliefs of Kiswahili-speaking people in Kenya

Comparative effectiveness of natalizumab versus ocrelizumab in multiple sclerosis: a real-world propensity score–matched study

Background: For treatment of relapsing-remitting multiple sclerosis (RRMS), a broad range of disease-modifying therapies (DMT) is available. However, few comparative effectiveness studies between different drugs have been performed. Objectives: This study aimed to compare the efficacy and treatment continuation of natalizumab and ocrelizumab in a real-world cohort of patients with relapsing-remitting multiple sclerosis (RRMS) from two German university hospitals. Methods: We performed a retrospective analysis of RRMS patients who initiated treatment with natalizumab or ocrelizumab between January 2016 and April 2019 at the German university hospitals of Mainz and Düsseldorf. Bayesian propensity score matching was conducted to correct for differences in baseline characteristics. Our primary outcome was no evidence of disease activity [NEDA-3: no relapses, no confirmed disability progression, and no magnetic resonance imaging (MRI) activity] and its subcomponents. Secondary outcomes included measurement of neurofilament light chain (NfL) in serum, analysis of premature discontinuation, and evidence of rebound activity in patients switching from natalizumab to ocrelizumab. Results: We identified 63 patients starting treatment with natalizumab and 76 patients starting with ocrelizumab. Binary logistic regression showed that treatment with natalizumab or a higher number of relapses in the previous year were independently associated with a higher risk for relapses. Patients receiving natalizumab had a higher probability of premature discontinuation of therapy (p = 0.002). After propensity score matching of the two treatment arms, 55 patients remained per group. NEDA-3 after 30 months of follow-up was reached by 53.1% in the ocrelizumab group and 36.1% in the natalizumab group (p = 0.177). Ocrelizumab was superior to natalizumab concerning the occurrence of relapses in log-rank test (p = 0.019). NfL levels in serum were low under both treatments. Patients who switched from natalizumab to ocrelizumab showed no increased rebound activity. Discussion: This study provides class IV evidence that treatment of RRMS patients with ocrelizumab and natalizumab show comparable effectiveness in combined endpoints, while ocrelizumab might be more effective in preventing the occurrence of relapses

Toward An Identity for the Field of Doctoral Education in Health Sciences

The Association of Doctoral Programs in Health Sciences (ADPHS) was informally established in November 2019, officially incorporated in August 2021, and is currently a 501(c)(3) non-profit organization comprised of the directors of member doctoral programs of health sciences. The ADPHS grew from informal discussions among program directors who agreed that a major problem in the field of doctoral education in health sciences was the lack of a clearly defined and easily articulable identity. The discussions led to the drafting of an informal and nonscientific survey used to help clarify the current health sciences education environment, relevant emerging trends, and the educational philosophies adopted by the directors of health sciences doctoral programs nationally. The results of the survey and follow-up discussions revealed a strong consensus among program directors that the field of doctorate education in health sciences is uniformly characterized by its interdisciplinary nature. In this position paper, we provide the rationale for the formal position of the ADPHS that the identity of the field of doctoral education in health sciences is based on its interdisciplinary approach to education

Increased cortical curvature reflects white matter atrophy in individual patients with early multiple sclerosis

AbstractObjectiveWhite matter atrophy occurs independently of lesions in multiple sclerosis. In contrast to lesion detection, the quantitative assessment of white matter atrophy in individual patients has been regarded as a major challenge. We therefore tested the hypothesis that white matter atrophy (WMA) is present at the very beginning of multiple sclerosis (MS) and in virtually each individual patient. To find a new sensitive and robust marker for WMA we investigated the relationship between cortical surface area, white matter volume (WMV), and whole-brain-surface-averaged rectified cortical extrinsic curvature. Based on geometrical considerations we hypothesized that cortical curvature increases if WMV decreases and the cortical surface area remains constant.MethodsIn total, 95 participants were enrolled: 30 patients with early and advanced relapsing–remitting MS; 30 age-matched control subjects; 30 patients with Alzheimer's disease (AD) and 5 patients with clinically isolated syndrome (CIS).Results29/30 MS and 5/5 CIS patients showed lower WMV than expected from their intracranial volume (average reduction 13.0%, P<10−10), while the cortical surface area showed no significant differences compared with controls. The estimated WMV reductions were correlated with an increase in cortical curvature (R=0.62, P=0.000001). Discriminant analysis revealed that the curvature increase was highly specific for the MS and CIS groups (96.7% correct assignments between MS and control groups) and was significantly correlated with reduction of white matter fractional anisotropy, as determined by diffusion tensor imaging and the Expanded Disability Status Scale. As expected by the predominant gray and WM degeneration in AD, no systematic curvature increase was observed in AD.ConclusionWhole-brain-averaged cortical extrinsic curvature appears to be a specific and quantitative marker for a WMV–cortex disproportionality and allows us to assess “pure” WMA without being confounded by intracranial volume. WMA seems to be a characteristic symptom in early MS and can already occur in patients with CIS and should thus be considered in future MS research and clinical studies

Covarying patterns of white matter lesions and cortical atrophy predict progression in early MS

Objective We applied longitudinal 3T MRI and advanced computational models in 2 independent cohorts of patients with early MS to investigate how white matter (WM) lesion distribution and cortical atrophy topographically interrelate and affect functional disability. Methods Clinical disability was measured using the Expanded Disability Status Scale Score at baseline and at 1-year follow-up in a cohort of 119 patients with early relapsing-remitting MS and in a replication cohort of 81 patients. Covarying patterns of cortical atrophy and baseline lesion distribution were extracted by parallel independent component analysis. Predictive power of covarying patterns for disability progression was tested by receiver operating characteristic analysis at the group level and support vector machine for individual patient outcome. Results In the study cohort, we identified 3 distinct distribution types of WM lesions (cerebellar, bihemispheric, and left lateralized) that were associated with characteristic cortical atrophy distributions. The cerebellar and left-lateralized patterns were reproducibly detected in the second cohort. Each of the patterns predicted to different extents, short-term disability progression, whereas the cerebellar pattern was associated with the highest risk of clinical worsening, predicting individual disability progression with an accuracy of 88% (study cohort) and 89% (replication cohort), respectively. Conclusion These findings highlight the role of distinct spatial distribution of cortical atrophy and WM lesions predicting disability. The cerebellar involvement is shown as a key determinant of rapid clinical deterioration

Serum neurofilament levels reflect outer retinal layer changes in multiple sclerosis

Background:Serum neurofilament light chain (sNfL) and distinct intra-retinal layers are both promising biomarkers of neuro-axonal injury in multiple sclerosis (MS). We aimed to unravel the association of both markers in early MS, having identified that neurofilament has a distinct immunohistochemical expression pattern among intra-retinal layers. Methods:Three-dimensional (3D) spectral domain macular optical coherence tomography scans and sNfL levels were investigated in 156 early MS patients (female/male: 109/47, mean age: 33.3 ± 9.5 years, mean disease duration: 2.0 ± 3.3 years). Out of the whole cohort, 110 patients had no history of optic neuritis (NHON) and 46 patients had a previous history of optic neuritis (HON). In addition, a subgroup of patients (n = 38) was studied longitudinally over 2 years. Support vector machine analysis was applied to test a regression model for significant changes. Results:In our cohort, HON patients had a thinner outer plexiform layer (OPL) volume compared to NHON patients (B = −0.016, SE = 0.006, p = 0.013). Higher sNfL levels were significantly associated with thinner OPL volumes in HON patients (B = −6.734, SE = 2.514, p = 0.011). This finding was corroborated in the longitudinal subanalysis by the association of higher sNfL levels with OPL atrophy (B = 5.974, SE = 2.420, p = 0.019). sNfL levels were 75.7% accurate at predicting OPL volume in the supervised machine learning. Conclusions:In summary, sNfL levels were a good predictor of future outer retinal thinning in MS. Changes within the neurofilament-rich OPL could be considered as an additional retinal marker linked to MS neurodegeneration

Increased cerebrospinal fluid albumin and immunoglobulin a fractions forecast cortical atrophy and longitudinal functional deterioration in relapsing-remitting multiple sclerosis

Background Currently, no unequivocal predictors of disease evolution exist in patients with multiple sclerosis (MS). Cortical atrophy measurements are, however, closely associated with cumulative disability. Objective Here, we aim to forecast longitudinal magnetic resonance imaging (MRI)-driven cortical atrophy and clinical disability from cerebrospinal fluid (CSF) markers. Methods We analyzed CSF fractions of albumin and immunoglobulins (Ig) A, G, and M and their CSF to serum quotients. Results Widespread atrophy was highly associated with increased baseline CSF concentrations and quotients of albumin and IgA. Patients with increased CSFIgA and CSFIgM showed higher functional disability at follow-up. Conclusion CSF markers of blood–brain barrier integrity and specific immune response forecast emerging gray matter pathology and disease progression in MS

Interrater reliability of the mind map assessment rubric in a cohort of medical students

<p>Abstract</p> <p>Background</p> <p>Learning strategies are thinking tools that students can use to actively acquire information. Examples of learning strategies include mnemonics, charts, and maps. One strategy that may help students master the tsunami of information presented in medical school is the mind map learning strategy. Currently, there is no valid and reliable rubric to grade mind maps and this may contribute to their underutilization in medicine. Because concept maps and mind maps engage learners similarly at a metacognitive level, a valid and reliable concept map assessment scoring system was adapted to form the mind map assessment rubric (MMAR). The MMAR can assess mind map depth based upon concept-links, cross-links, hierarchies, examples, pictures, and colors. The purpose of this study was to examine interrater reliability of the MMAR.</p> <p>Methods</p> <p>This exploratory study was conducted at a US medical school as part of a larger investigation on learning strategies. Sixty-six (<it>N </it>= 66) first-year medical students were given a 394-word text passage followed by a 30-minute presentation on mind mapping. After the presentation, subjects were again given the text passage and instructed to create mind maps based upon the passage. The mind maps were collected and independently scored using the MMAR by 3 examiners. Interrater reliability was measured using the intraclass correlation coefficient (<it>ICC</it>) statistic. Statistics were calculated using SPSS version 12.0 (Chicago, IL).</p> <p>Results</p> <p>Analysis of the mind maps revealed the following: concept-links <it>ICC </it>= .05 (95% CI, -.42 to .38), cross-links <it>ICC </it>= .58 (95% CI, .37 to .73), hierarchies <it>ICC </it>= .23 (95% CI, -.15 to .50), examples <it>ICC </it>= .53 (95% CI, .29 to .69), pictures <it>ICC </it>= .86 (95% CI, .79 to .91), colors <it>ICC </it>= .73 (95% CI, .59 to .82), and total score <it>ICC </it>= .86 (95% CI, .79 to .91).</p> <p>Conclusion</p> <p>The high <it>ICC </it>value for total mind map score indicates strong MMAR interrater reliability. Pictures and colors demonstrated moderate to strong interrater reliability. We conclude that the MMAR may be a valid and reliable tool to assess mind maps in medicine. However, further research on the validity and reliability of the MMAR is necessary.</p