Search

Posttraumatic stress disorder (PTSD) and stressful life events are frequent and distressing problems for women living with HIV (WLWH). Studies have independently focused on the impact of these problems, but little work has examined the relationship between PTSD and stressful life events. Our cross-sectional study examined relationships between PTSD and recent stressful life events in WLWH. A sample of 60 women recruited through HIV community agencies in southeastern North Carolina completed the Stressful Life Events Questionnaire and the PTSD Checklist-Civilian Version (PCL-C). PTSD prevalence was high (43.2%). Two-thirds (66%) reported three or more recent life stressors. Women who experienced a higher number of recent life stressors scored higher on the PCL-C than those with fewer life stressors (p .001). Recent stressful life events may accelerate PTSD symptoms. Findings underscore the importance of addressing mental health issues in HIV treatment settings. Implications for nursing practice are provided.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n=135) and providers (n=71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Background In 2016 the Care Quality Commission published a review of end of life care which heard from people who may be less likely to receive good care – whether because of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances – and found that this may be because their specific needs are not always understood or fully considered by providers and commissioners. Later in 2016 the Government announced six commitments to end variation in end of life care in England by 2020 (Department of Health, 2016). Aim/s This project explored what the six point commitment on end of life care means for three groups identified by the CQC’s review; Gypsies and Travellers, LGBT people and people experiencing homelessness. It sought to understand the particular needs of these groups in making the commitments a reality and to share evidence and personalised end of life care examples. Methods The project was guided by an advisory steering group and informed by a literature review plus focus group and stakeholder consultation. Case studies of emerging practice and innovation were sought through the group’s networks and wider communication channels. Results Five principles for delivering personalised end of life care for children, young people and adults were identified; including enabling strategic level partnership working; good communication to support informed decision making; workforce training and support. A practical guide has been produced for commissioners, service providers and care professionals. Conclusions In identifying work to improve personalised end of life care for the three groups, the project also found a need for more evidence and research. Equitable end of life care needs to be a local priority and better data about needs and access to services is required. This project was funded as part of the national Voluntary Community and Social Enterprise Health and Wellbeing Alliance.

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

This analysis examined the relationships between HIV-related stigma, depression, and anxiety in rural and urban sites. Participants were HIV-positive urban (n = 100) and rural (n = 100) adult residents of a US southern state, drawn from a sample for a larger international study of self-esteem and self-compassion. Measures included demographic and health information, the HIV Stigma Scale, the Center for Epidemiology Studies Depression Scale (CES-D), and the Symptom Checklist 90 Revised (SCL-R-90) anxiety scale. Independent sample t-tests showed no significant differences between urban/rural groups on measures of HIV-related stigma, anxiety, or depression, except that rural participants reported greater disclosure concerns (t = 2.11, df = 196, p = .036). Both groups indicated high levels of depression and anxiety relative to published norms and clinically relevant cut-off scores. Hierarchical regression analyses were conducted for the HIV Stigma Scale including its four subscales and total stigma scores. Block 1 (control) contained health and demographic variables known to predict HIV-related stigma. Block 2 included the CES-D and the SCL-R-90, and Block 3 was urban/rural location. Mental health symptom scores contributed a significant amount to explained variance in total stigma scores (5.5%, FΔ = 6.020, p

Health literacy, including people's abilities to access, process, and comprehend health-related information, has become an important component in the management of complex and chronic diseases such as HIV infection. Clinical measures of health literacy that focus on patients' abilities to follow plans of care ignore the multidimensionality of health literacy. Our thematic analysis of 28 focus groups from a qualitative, multisite, multinational study exploring information practices of people living with HIV (PLWH) demonstrated the importance of location as a dimension of health literacy. Clinical care and conceptual/virtual locations (media/Internet and research studies) were used by PLWH to learn about HIV and how to live successfully with HIV. Nonclinical spaces where PLWH could safely discuss issues such as disclosure and life problems were noted. Expanding clinical perspectives of health literacy to include location, assessing the what and where of learning, and trusted purveyors of knowledge could help providers improve patient engagement in care.

Globally, people living with HIV (PLWH) are at remarkably high risk for developing chronic comorbidities. While exercise and healthy eating reduce and mitigate chronic comorbidites, PLWH like many others, often fail to engage in recommended levels. We qualitatively examined the perspectives and contextual drivers of diet and exercise reported by PLWH and their health care providers. Two hundred and six participants across eight sites in the United States, Puerto Rico and Botswana described one overarching theme, Arranging Priorities, and four subthemes Defining Health, Perceived Importance of Diet and Exercise, Competing Needs, and Provider Influence. People living with HIV and their health care providers recognize the importance of eating a healthy diet and engaging in regular exercise. Yet there are HIV-specific factors limiting these behaviors that should be addressed. Health care providers have an important, and often underutilized opportunity to support PLWH to make improvements to their exercise and diet behavior.

Aim This research aimed to explore the lived experiences of extended-period expeditionary adventurers to understand why these individuals adventure, and what they perceive gaining from such experience. Most work in this area thus far has focused on exploring pre-determined elements of adventuring such as risk, stressors, and personality traits. However, rarely the aim has been to understand the overall why of this specific participant pool; the meaning and perceived benefits of going on an enduring adventure or expedition. Design Seven participants were purposefully selected for their serial and extensive adventure involvement to explore their lived experiences and in-depth insights. Method: This study utilised a qualitative approach, using semi-structured interview techniques and an Interpretative Phenomenological Analysis (IPA). Results Three intercorrelated master themes were revealed: pre-, during- and post-adventure, all with subordinate themes: to go knowingly into the unknown; autonomy, the real outdoors and liberation; resilience and growth. Conclusion The results suggest that enduring expeditionary adventures have the potential to accelerate and magnify individuals’ growth and facilitate psychological well-being.

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.

The purposes of this study were to (a) review original research in the United States on the intersection of HIV risk and intimate partner violence (IPV) in women, and (b) identify trends that promote nursing and public health prevention and intervention strategies. Twenty-three original, peer-reviewed articles in the medical literature from 2008 to April 2012 were reviewed. Articles were eligible for inclusion if they addressed both HIV and IPV in women. Studies identified relationships between intimate partner victimization and HIV risk behaviors. Other factors compounding the complex relationship between IPV and increased HIV risk in women included sexual decision-making, male behavior, and substance use. A promising trend was found in the publication of studies addressing interventions. Prospective studies are needed to determine causality and temporal associations. Nursing interventions should focus on identifying women at risk for IPV, assessing HIV exposure risks, and providing culturally sensitive interventions and preventive measures.

© 2016 John Wiley & Sons Ltd Aim: Sexual risk behaviour was explored and described using Social Action Theory. Background: The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. Design: Cross-sectional survey. Methods: Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. Findings: Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. Conclusion: Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.

The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

Purpose: Over a decade ago, the U.S. Public Health Service recommended routine human immunodeficiency virus (HIV) testing for pregnant women. Despite this recommendation, nearly 30% of pregnant women report not being tested. The purpose of this qualitative study was to describe personal experiences of women in obtaining HIV testing and healthcare services in east Texas. Data sources: A secondary data analysis was conducted using audiotapes and transcriptions from structured group interview data obtained from HIV-positive and high-risk negative women residing in east Texas (n = 64). Conclusions: Content analysis revealed three patterns: living with stigma; struggling to be healthy; and getting along, day by day. Additional findings indicated that women are more likely to access HIV testing if they are assured of confidentiality and women living with HIV are more likely to remain in the healthcare system if healthcare professionals are supportive, knowledgeable, and nonjudgmental. Implications for practice: Healthcare professionals must engage in self-reflection to conscientiously uncover their true feelings related to caring for women with or at risk for HIV disease. Once providers acknowledge that their beliefs and values differ from their clients, they will be able to minimize personal biases that interfere with HIV testing and healthcare services.

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

Diabetes affects 22.3 million people in the United States.1 It is a major cause of heart disease and stroke and is the seventh leading cause of death.2 Patients with diabetes are at two to four times greater risk of myocardial infarction (MI) than those without diabetes, and diabetes is the primary reason for renal failure, blindness, and nontraumatic limb amputations.3 Preventive care practices can reduce the development of severe vision loss by 50–60%, reduce foot amputations by 45–85%, and lower blood pressure to reduce proteinuria, a risk factor for developing kidney disease, by ~ 35%.2 Despite evidence that complications related to diabetes are preventable,4,5 only 52% of individuals with diabetes meet guidelines targeting an A1C of < 7.0%, and only 18% meet combined glycemic, lipid, and blood pressure goals.6 In addition to significant morbidity, diabetes has a substantial financial impact. Medical expenses for people with diabetes are more than two times higher than for those without diabetes.2 Total national health care and related costs for the treatment of all people with diabetes total ~ $245 billion.1 Complications from diabetes, such as chronic kidney disease, can cost health care organizations $33 billion per year.2 Most diabetes care is provided in the community in the primary care setting,3 and diabetes is the fourth most frequent reason for ambulatory physician visits.7 A gap exists between optimal and actual care, constituting a wide “quality chasm,”8 which underscores the need for innovative approaches to change the current practice of diabetes care. Clinical decision support systems (CDSSs) have been suggested as a viable solution to these pressing issues.9 CDSSs have been defined as systems providing an automated process for comparing patient-specific characteristics against a computerized knowledge base, with resulting recommendations or …

OBJECTIVE To explore the relationships among contextual, environmental, and regulatory factors with antiretroviral (ARV) medication adherence to assist care providers in improving care for women living with HIV. DESIGN Descriptive, multicenter study. SETTING Sixteen HIV clinics and service organizations in North America. PARTICIPANTS This convenience sample was drawn from a larger study of 2,182 persons living with HIV recruited from clinics and service from September 2009 to January 2011. We included 383 women living with HIV who were taking ARV medications. METHODS We assessed the relationship of contextual, environmental, and psychological factors specific to women living with HIV in relation to adherence to ARV medication. Descriptive and multivariate statistics were used to examine the effects of these factors on self-reported ARV drug adherence. RESULTS Age, depression symptoms, stigma, engagement with health care provider, and four psychological factors were correlated with self-reported ARV medication adherence (p = .01). Regression analysis indicated that adherence self-efficacy and depression symptoms accounted for 19% for 3-day and 22% for 30-day self-reported medication adherence. CONCLUSIONS Adherence self-efficacy and depression symptoms predict ARV medication adherence in women and should be evaluated by nurses. Future research is needed to identify antecedents to and interventions that support adherence self-efficacy and decrease depression symptoms.

Background Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations.

The engagement of patients with their health care providers (HCP) improves patients' quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client's choices, and management of client concerns. This study compares country-level differences in patients' engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR -7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = -5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = -3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.

Over a decade ago, the U.S. Public Health Service recommended routine human immunodeficiency virus (HIV) testing for pregnant women. Despite this recommendation, nearly 30% of pregnant women report not being tested. The purpose of this qualitative study was to describe personal experiences of women in obtaining HIV testing and healthcare services in east Texas.A secondary data analysis was conducted using audiotapes and transcriptions from structured group interview data obtained from HIV-positive and high-risk negative women residing in east Texas (n = 64).Content analysis revealed three patterns: living with stigma; struggling to be healthy; and getting along, day by day. Additional findings indicated that women are more likely to access HIV testing if they are assured of confidentiality and women living with HIV are more likely to remain in the healthcare system if healthcare professionals are supportive, knowledgeable, and nonjudgmental.Healthcare professionals must engage in self-reflection to conscientiously uncover their true feelings related to caring for women with or at risk for HIV disease. Once providers acknowledge that their beliefs and values differ from their clients, they will be able to minimize personal biases that interfere with HIV testing and healthcare services.

These pages offer you the chance to open topics for debate, discuss the latest issues, or even offer advice to fellow readers. One letter in this issue offers PCDs a way into a full dental degree programme. Send us your views on this or anything to do with working in the dental profession. We look forward to hearing from you.

Within a 53-year-old Douglas-fir (Pseudotsugamenziesii (Mirb.) Franco) plantation, replicated thinning and fertilization plots were examined for responses in stem growth, leaf area, and stem growth per unit leaf area. Although measurements occurred 20–30 years after plot installation, substantial effects from the various treatment levels were still present. Thinning reduced leaf area of the stands but increased stem growth per unit of leaf area, resulting in little difference in stem growth per hectare over the 5-year measurement period (1977–1981). Fertilization increased both stand leaf area and stem growth per unit leaf area, and more than doubled 5-year stem growth per hectare. Consideration of the role of leaf area and stem growth per unit leaf area in determining stand treatment responses may account for much of the variation found among replicates of treatments or between studies on different sites.

Male and female mice that had been genetically selected for blood pressure extremes were tested for both general activity level and preference for stimulation and novelty. Male and female hypertensive mice appeared to be more active than the hypotensive male and female mice, while male hyper- and hypotensive mice exhibited greater preference for stimulation and novelty. The method of testing appeared to separate the components of general arousal from preference for stimulation and is an alternative to other activity measures. Although animals were genetically selected for blood pressure extremes, no genetic hypotheses per se were tested.

The levels of several androgen responsive enzymes including beta-glucuronidase, alcohol dehydrogenase, D-amino acid oxidase and arginase, were compared in kidneys of normal and hypophysectomized female mice after treatment with testosterone. While hypophysectomy did not alter the basal level of glucuronidase, the androgen-mediated accumulation of kidney beta-glucuronidase was greatly decreased in hypophysectomized mice. Measurements of the rate of synthesis of glucuronidase showed that after androgen treatment the enzyme was synthesized in kidney of hypophysectomized mice at only 5% the normal rate. Glucuronidase activity in seven other organs was not appreciably affected by treatment with androgens or by hypophysectomy. Unlike the effect of hypophysectomy on kidney glucuronidase, there was no reduction in the accumulation of alcohol dehydrogenase or D-amino acid oxidase in kidney of hypophysectomized mice after androgen treatment. Hypophysectomy caused a large reduction in kidney arginase activity. However, subsequent administration of testosterone restored much of this activity. It is concluded that there are at least two mechanisms by which androgens increase enzyme activity in kidney. The normal increase in activity or rate of synthesis of beta-glucuronidase following androgen administration requires pituitary hormones and/or products of these hormones, while the increase in activity of enzymes like alcohol dehydrogenase and D-amino acid oxidase does not require pituitary hormones.

Most Douglas-fir stands respond to nitrogen fertilization by increasing stem growth for less than 8 years, but one plantation at the United States Forest Service Wind River Experimental Forest has responded for over 15 years. The nitrogen concentration of foliage and fresh litter were higher in the fertilized (applied at 470 kg N/ha) plots 18 years after fertilization. Retranslocation of N from senescent needles was not affected and stem growth per unit N in the canopy was similar between unfertilized and fertilized plots. An index of soil N availability in the fertilized plots was twice that of unfertilized plots. The higher stem growth, leaf area, and stem growth per unit leaf area appeared related to a sustained increase in soil N availability rather than increased N-use efficiency. Soil N transformation processes need to be examined to complete the explanation of the unusually prolonged fertilizer response in these plots.