Unmasking Individual and Institutional HIV Stigma in Hospitals: Perspectives of Dutch Healthcare Providers.

People with HIV continue to experience HIV stigma. Quantitative data on HIV stigma perpetrated by healthcare providers of hospitals providing HIV care in high-income countries are limited. The aim of this study is to investigate factors associated with HIV stigma in Dutch healthcare settings from the healthcare providers' perspective. We conducted a cross-sectional study using the questionnaire 'Measuring HIV Stigma and Discrimination Among Health Facility Staff - Monitoring Tool for Global Indicators' to assess HIV stigma among healthcare providers (n = 405) in two academic hospitals. Healthcare providers licensed to provide medical care were eligible for inclusion. The primary outcome was the self-reported prevalence of at least one manifestation of HIV stigma measured by six stigma indicators (four individual, two institutional). Secondary outcomes were the prevalence of HIV stigma per indicator, per occupation, per department, and factors associated with individual stigma indicators. HIV stigma was prevalent among 88.1% (95%CI 84.5% - 91.2%) of participants. Stigma was mostly driven by negative attitudes towards people with HIV and worry to acquire HIV. Multivariate analysis showed that several factors were associated with HIV stigma, including younger age, male sex, working at one of the surgical departments, and working as a nurse. Having received any training on HIV stigma and/or discrimination was associated with less HIV stigma among all indicators. In conclusion, HIV stigma is highly prevalent among Dutch healthcare providers. Targeted approaches, including training on HIV stigma and discrimination, are needed to reduce HIV stigma in healthcare and should, among others, focus on younger healthcare providers.

Development and feasibility of a telemedicine tool for patients with recurrent urinary tract infection: myRUTIcoach.

INTRODUCTION AND HYPOTHESIS: Patients with recurrent urinary tract infection (rUTI) have limited knowledge of preventive strategies to lower the risk of UTI. We aimed to develop and test the feasibility of an eHealth system for women with rUTI, named myRUTIcoach, and explored the facilitators and barriers related to its adoption. METHODS: We developed myRUTIcoach in a structured iterative process and tested its feasibility among 25 women with rUTI over 2 months. Subsequent questionnaires covered satisfaction, accessibility, and experiences with myRUTIcoach. A random selection of participants and relevant stakeholders took part in semi-structured interviews to explore adoption. Data were analyzed and elaborated using inductive and deductive approaches using the Non-adoption, Abandonment, Spread, Scale-up, and Sustainability (NASSS) framework. RESULTS: MyRUTIcoach was not only widely accepted but also facilitated communication with health care professionals (HCPs) and contributed to greater knowledge of rUTI. Women graded the system a mean of 8.0 (±0.6) out of 10, with 89% stating that they would recommend it to others. Patients indicated that self-management skills were the major facilitators and barriers related to adoption, whereas HCPs stated that the disconnect between myRUTIcoach and electronic health care records (EHRs) was the major barrier. CONCLUSIONS: This research describes the development and testing of myRUTIcoach for women with rUTI. Patients and HCPs reported high satisfaction and compliance with myRUTIcoach. However, adoption by the intended users is complex and influenced by all examined domains of the NASSS framework. We have already improved linkage to EHRs, but further optimization to meet patient needs may improve the effectiveness of this self-management tool for rUTI.

Strong magnetic anisotropy in PrRu2Ga8and PrCo2Al8single crystals.

Single crystals ofLnRu2Ga8andLnCo2Al8(Ln= La and Pr) were grown using a Ga/Al self-flux method. An orthorhombic CaCo2Al8-type structure with space groupPbam(No.55) of them was identified by x-ray diffraction. LaRu2Ga8and LaCo2Al8are Pauli paramagnetic down to 2 K, while PrRu2Ga8and PrCo2Al8show antiferromagnetic (AFM) order at 2.5 and 5 K, respectively. Strong magnetic anisotropy in PrRu2Ga8and PrCo2Al8single crystals was found by an anisotropic magnetic measurement. The field-induced FM state was observed in both PrRu2Ga8and PrCo2Al8forH||c. However, in the case of H⊥c, the AFM state is robust. The strong magnetic anisotropy in PrRu2Ga8FM and PrCo2Al8is due to their anisotropic magnetic interactions that FM interactions are dominant in the case ofH||cwhile AFM interactions forH⊥c.

The effects of autonomous sensory meridian response (ASMR) on mood, attention, heart rate, skin conductance and EEG in healthy young adults.

Autonomous sensory meridian response (ASMR) is a warm tingling sensation which is often accompanied by feelings of calmness and relaxation. The present study examined the effects of an ASMR video on mood, attention, heart rate (HR), electrodermal activity (EDA), electroencephalography (EEG) and the interaction with personality factors in 38 young adults (33 females and 5 males). Based on the ASMR-checklist responses of having tingles during watching the ASMR video 15 participants out of 38 were classified as ASMR-experiencers. Mood, attention and personality characteristics were measured by the Profile of Mood States, the Flanker task and HEXACO. EEG, HR and EDA were recorded during the ASMR and control videos. Depressive feelings decreased after watching the ASMR video in individuals experiencing tingles relative to those not experiencing tingles. Furthermore, in all participants, irrespective of experiencing tingles, a decrease of HR during watching the ASMR video was found. In ASMR-experiencers scoring low on Conscientiousness EDA tended to increase and HR tended-relatively to the group not experiencing tingles-to decrease during watching the ASMR video. EEG recordings indicated that watching the ASMR video was associated with decreased alpha power in ASMR-sensitive participants and decreased theta as well as increased beta power in the whole group of participants. The observed ASMR-induced decrease of alpha and theta power and increase of beta power and (only in low conscientious participants) EDA may reflect that, apart from relaxation, ASMR is related to arousal and focused attention.

O enviado do céu: defesas contra a desidealização / Heaven's envoy: defenses against deidealization / El enviado del cielo: defensas contra la desidealización

O artigo se dedica a investigar certos fenômenos defensivos contra a desidealização da imagem de um filho neuroatípico, em especial à negação do patologizar pela transcendência. Ao longo do tempo, a manutenção dessas defesas se mostra insustentável e interessa a esse estudo entender suas consequências, bem como imaginar os caminhos clamados pela psique rumo à elaboração criativa do conflito na qual se encontra.

The article is dedicated to investigate certain phenomena that emerges against the de-idealization of the image of a neuroatypical child. The maintenance of such defenses proves to be unsustainable and this study is interested in understanding the consequences of this forced maintenance, as well as imagining the paths claimed by the psyche towards the creative elaboration of the conflict in which it finds itself.

El artículo está dedicado a investigar ciertos fenómenos defensivos frente a la desidealización de la imagen del niño neuroatípico. El mantenimiento de estas defensas se muestra insostenible y este estudio se interesa en comprender las consecuencias de ese mantenimiento forzado, así como imaginar los caminos reivindicados por la psique hacia la elaboración creativa del conflicto en el que se encuentra.

Hermes nos campos de Apolo: desidealização e excentricidade na paternidade neurodivergente / Hermes in the fields of Apolo: Deidealization and eccentricity in neurodivergent pattern / Hermes en los campos de Apolo: desidealización y excentricidad en la paternidad neurodivergente

O artigo apresenta o início de uma investigação a respeito da neurodiversidade numa perspectiva arquetípica, especificamente sobre certos aspectos da chegada de um filho neurodivergente em uma família, buscando levantar reflexões vivenciais a respeito da diversidade no mundo, lares, escolas e consultórios. Essa investigação parte de experiências tanto pessoais quanto clínicas e elabora, sob uma lente arquetípica, relações entre a imaginação do trickster e dois fenômenos psíquicos presentes na ocorrência da neurodivergência em uma família: a desidealização e a excentricidade.

The article presents the beginning of an investigation about neurodiversity, specifically about certain aspects of the arrival of a neurodivergent child in a family, and it seeks to raise experiential reflections about neurodiversity in the world, homes, schools, and medical offices. This investigation starts from both personal and clinical experiences to elaborate, under an archetypal lens, relationships between the imagination of the trickster and two psychic phenomena present in the occurrence of neurodivergence in a family: deidealization and eccentricity.

El artículo presenta el inicio de una investigación sobre la neurodiversidad desde una perspectiva arquetípica, específicamente sobre ciertos aspectos de la llegada de un niño neurodivergente a una familia, buscando plantear reflexiones experienciales sobre la diversidad en el mundo, los hogares, las escuelas y los consultorios. Esta investigación parte de experiencias tanto personales como clínicas y elabora, bajo una lente arquetípica, las relaciones entre la imaginación del trickster y dos fenómenos psíquicos presentes en la ocurrencia de la neurodivergencia en una familia: la desidealización y la excentricidad.

Adherence to surveillance guidelines for colorectal adenomatous polyps in the elderly.

OBJECTIVE: Determining adherence to recommended surveillance intervals after polypectomy in elderly patients. DESIGN: A retrospective cohort study including 531 patients aged above 70 years undergoing polypectomy between 2009-2011 in a large Dutch teaching hospital, identified using the hospital's pathology registry. Outcomes of the index colonoscopy were reviewed. The interval until the next colonoscopy was assessed and compared both to the advised interval according to the Dutch guidelines and the gastroenterologist's recommendation. Reasons for deviating from the guideline were assessed. RESULTS: The initial recommendation of the gastroenterologist for the surveillance interval was in accordance to the guideline in 59.1% of the patients. In 21.8% the gastroenterologist's advice was not documented. In 15.8% of the patients the gastroenterologist recommended to perform surveillance endoscopy earlier than the guideline, mainly based on polyp characteristics. The gastroenterologist advised endoscopy when the guideline advised no surveillance at all in 1.0%, later than the guideline recommendation in 1.2%, or did not recommend surveillance when the guideline advised to continue in 1.0%. Actual surveillance intervals were in accordance to the guideline in 54.4% and in accordance to the initial advice of the gastroenterologist in 58.4% of the patients. CONCLUSION: Only in 41% of patients was the gastroenterologist's recommendation regarding surveillance after polypectomy either absent (21.8%) or not in accordance to the guideline (19.2%). Future research should focus on developing an evidence-based decision algorithm for elderly patients to support gastroenterologists and patients in the choices regarding cessation of surveillance at a certain level of frailty, comorbidity or remaining life-expectancy.

Administration of adjuvant chemotherapy in older patients with Stage III colon cancer: an observational study.

AIM: According to established guidelines, patients with Stage III colon cancer should receive adjuvant chemotherapy. However, a significant proportion do not. This study assessed factors associated with the administration of adjuvant chemotherapy and causes of death. METHODS: Patients with Stage III colon cancer who underwent surgery between 2000 and 2009 were selected from two hospitals in the Netherlands. Patient characteristics including comorbidities and treatment preferences, tumour characteristics and follow-up were extracted from the medical records. The patient and tumour characteristics of patients who did receive chemotherapy were compared with those who did not using chi-squared analysis. Differences between the groups in causes of death were recorded together with the duration of follow-up. RESULTS: A total of 348 patients were included. The median age was 73 years (range 33-93). Over half of the patients received adjuvant chemotherapy (50.6%). Patients who did not receive adjuvant chemotherapy were significantly older (P < 0.001), had more comorbidities (P < 0.001) and were more often living alone (P < 0.001). Patients who received no adjuvant chemotherapy had a reduced overall survival, and the cause of death was more often attributed to other causes (60%) than colon cancer (40%). For patients who received chemotherapy, the cause of death was usually attributed to colon cancer (71%). CONCLUSION: Patients who did not receive adjuvant chemotherapy had a worse overall survival and the majority died due to other causes than colon cancer. In our aging society it will become even more important to develop tools to estimate remaining life expectancy in order to improve the selection of older patients for adjuvant treatments.

Effects of adding minimally refined cottonseed oil or crude glycerol to diets containing 40% corn distiller's dried grains with solubles on growth performance, carcass characteristics, and pork fat firmness of growing-finishing pigs.

Diets containing more than 20% distiller's dried grains with solubles (DDGS) reduce fat firmness in pork, but supplementation of cottonseed oil or crude glycerol may improve fat firmness. The objective of this study was to assess the effect of feeding minimally refined cottonseed oil or crude glycerol on growth performance, carcass composition, and fat quality of growing-finishing pigs. Mixed sex pigs ( = 216; 24 ± 4 kg initial BW) were blocked by BW and allotted to 1 of 3 dietary treatments: 1) a basal corn-soybean meal diet with 40% DDGS (CON), 2) CON diet plus 5% minimally refined cottonseed oil added throughout the experiment (COT), or 3) CON fed during the first 8 wk and CON + 8% crude glycerol fed during the last 6 wk of the experiment (GLY). Although diets were not isocaloric, total AA-to-ME ratios were calculated to be equal among diets. Carcass composition was estimated using real-time ultrasound 2 d before harvest. Gilts (16/treatment) closest to the mean BW of each pen were harvested (115 ± 8 kg BW), and bellies were retrieved for in-depth analysis of fat quality. Belly fat was sampled and analyzed for fatty acid composition. Overall, ADFI of pigs fed COT (2.30 kg/d) was less ( < 0.01) than that of pigs fed CON or GLY (2.47 and 2.49 kg/d, respectively). Pigs fed COT (0.93 kg/d) had greater ( < 0.01) ADG compared with pigs fed CON or GLY (0.88 and 0.87 kg/d, respectively). Greater ( < 0.01) G:F was observed for pigs fed COT (0.41) than for pigs fed CON or GLY diets (0.36 and 0.35, respectively). Final BW of pigs fed COT (124.3 kg) was greater ( < 0.01) than that of pigs fed CON or GLY (118.9 and 118.6 kg, respectively). Pigs fed COT had greater ( < 0.01) HCW (94.9 kg) compared with pigs fed CON or GLY (89.9 and 89.2 kg, respectively). No differences were observed for dressing percentage (75.7, 76.3, and 75.3%), fat-free carcass lean percentage (50.5, 49.7, and 50.0%), and belly flop angle (6.21, 8.57, and 6.06°) for CON, COT, and GLY, respectively. Pigs assigned to COT had higher ( < 0.01) melting point of belly fat compared with pigs assigned to CON or GLY (30.4 vs. 26.3 and 25.3°C, respectively). Pigs fed COT had increased ( < 0.05) SFA, PUFA, and iodine value (IV) compared with CON-fed pigs. Glycerol supplementation had no influence on SFA, MUFA, and PUFA concentrations or IV of belly, jowl, and back fat compared with CON. In conclusion, COT diets improved growth performance due to greater energy density, but carcass composition was not affected by treatments. In this experiment, feeding neither COT nor GLY improved fat firmness of pigs fed diets containing 40% DDGS.

Risk of developing psoriasis in patients with schizophrenia: a nationwide retrospective cohort study.

BACKGROUND: Schizophrenia is a complex disease which proceeds from an interaction between genetic background and environmental factors. Recent studies showed T helper 17 (Th17) signalling, which is the main downstream immune response of psoriasis, is activated in schizophrenia. OBJECTIVE: To investigate whether patients with schizophrenia have higher risk of psoriasis. METHODS: In this nationwide retrospective cohort study, we analysed the 1 million enrollees' cohort from Taiwan's National Health Insurance Research Database. Psoriasis and schizophrenia were ascertained by International Classification of Diseases, 9th revision, Clinical Modification coding. The study cohort was comprised of enrollees diagnosed with schizophrenia during the period from 1 January 1996 through 31 December 2010, while the comparison population consisted of enrollees who had not been diagnosed with schizophrenia during the study period. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the risk of psoriasis associated with schizophrenia using Cox proportional hazard regression. RESULTS: The adjusted HR of psoriasis associated with schizophrenia was 2.32 (95% CI = 1.81-2.98). After 15 years, the cumulative incidence of psoriasis in patients with schizophrenia and comparison population was 2.82% and 1.17%, respectively. The Kaplan-Meier curves for the cumulative incidence of psoriasis in individuals with and without schizophrenia differed significantly (P < 0.0001, log-rank test). CONCLUSIONS: Patients with schizophrenia have higher risk of psoriasis, which may be due to common genetic susceptibilities and/or immunologic mechanisms in both diseases. Th17 signalling and pro-inflammatory cytokines may act as a link between these two diseases and are potential therapeutic targets for schizophrenia.

Tacrolimus abrogates TGF-ß1-induced type I collagen production in normal human fibroblasts through suppressing p38MAPK signalling pathway: implications on treatment of chronic atopic dermatitis lesions.

BACKGROUND: Atopic dermatitis (AD) is a commonly encountered inflammatory skin disease. Although acute lesions of acute AD are characterized by intense inflammation, the hallmarks of chronic AD lesions include lichenified fibrosis and thickening of the upper dermis. The increased expression of transforming growth factor beta 1 (TGF-ß1), a well-known fibrogenic cytokine, is observed in chronic AD lesions. Tacrolimus (FK506) ointment has been reported to be effective for treating AD as well as some TGF-ß1-induced fibrotic diseases. OBJECTIVES: To evaluate the effect of tacrolimus on TGF-ß1-stimulated cultured normal human dermal fibroblasts and explore the potential signalling pathways involved. METHODS: Fibroblasts cultured from healthy adult human foreskins were treated with TGF-ß1 with or without tacrolimus. The impact on cell viability and proliferation were assessed by [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay and BrdU incorporation assay respectively. Reverse transcription-polymerase chain reaction (RT-PCR), quantitative real-time PCR, enzyme-linked immunosorbent assay (ELISA) and western blotting were performed to evaluate the relevant expressions of mRNA or proteins in fibroblasts. RESULTS: Our results revealed that the increased expressions of transforming growth factor-ß receptor I (TGF-ßRI) and TGF-ßRII in TGF-ß1-treated fibroblasts were suppressed by tacrolimus treatment. In addition, tacrolimus significantly inhibited fibroblast proliferation enhanced by TGF-ß1. TGF-ß1 increased type I collagen production, and this enhancing effect was suppressed by tacrolimus. The down-regulation of MMP-1 and up-regulation of TIMP-1 induced by TGF-ß1 were reversed by tacrolimus. The increase in phosphorylated p38 mitogen-activated protein kinase (p38MAPK) expression stimulated by TGF-ß1 was down-regulated by tacrolimus. Moreover, the fibroblasts treated with p38MAPK inhibitor significantly reduced type I collagen expression induced by TGF-ß1. CONCLUSIONS: The present results demonstrated that tacrolimus significantly inhibited physiological functions of fibroblasts enhanced by TGF-ß1 in vitro. Clinically, we propose that topical tacrolimus may not only reduce AD recurrence but also ameliorate dermal fibrosis often seen in chronic AD lesions.

Benefits and drawbacks of short-course preoperative radiotherapy in rectal cancer patients aged 75 years and older.

PURPOSE: To study incidence of local recurrences, postoperative complications and survival, in patients with rectal carcinoma aged 75 years and older, treated with either surgery and pre-operative 5 × 5 Gy radiotherapy or surgery alone. PATIENTS AND METHODS: A random sample of patients aged over 75 years with pT2-T3, N0-2, M0 rectal carcinoma diagnosed between 2002 and 2004 in the Netherlands was included, treated with surgery alone (N = 296) or surgery in combination with pre-operative radiotherapy (N = 346). Information on local recurrent disease, postoperative complications, ECOG-performance score and comorbidity was gathered from the medical files. RESULTS: Local recurrences developed less frequently in patients treated with pre-operative radiotherapy compared to surgery alone (2% vs 6%, p = 0.002). Postoperative complications developed more frequently in irradiated patients (58% vs 42%, p < 0.0001). Especially deep infections (anastomotic leakage, pelvic abscess) were significantly increased in this group (16% vs 10%, p = 0.02). 30-day mortality was equal in both groups (8%). A significant increase in postoperative complication rate and 30-day mortality was only seen in those with "severe comorbidity" compared to patients without comorbidity (respectively 58% and 10% vs 43% and 3%), COPD (59% and 12%), diabetes (60% and 11%) and cerebrovascular disease (62% and 14%). In multivariable analysis, postoperative complications predicted 5-year survival. CONCLUSION: Elderly patients receiving pre-operative radiotherapy show a lower local recurrence rate. However, as incidence rates of local recurrent disease are low and incidence of postoperative complications is increased in irradiated patients, omitting preoperative RT may be suitable in elderly patients with additional risks for complications or early death.

Psoriasis as initiator or amplifier of the systemic inflammatory march: impact on development of severe vascular events and implications for treatment strategy.

BACKGROUND: Psoriasis is a systemic disease associated with metabolic disorders and vascular complications. Both psoriasis and metabolic disorders are associated with systemic inflammation. We hypothesized that the sequence of events between the onset of psoriasis and metabolic disorder may affect the risk for subsequent development of vascular complications. METHODS: Nested case-control study was performed using the Taiwan National Health Insurance database. Accordingly, a total of 8180 psoriatic patients and 163,600 controls were included. Psoriasis was considered as the initiator of inflammatory march if metabolic disorder, including hypertension, diabetes mellitus and dyslipidemia, developed after onset of psoriasis. In patients with pre-existing metabolic disorder, psoriasis was considered as the amplifier of inflammatory march. RESULTS: In patients whose psoriasis served as the disease initiator, a lower risk for developing vascular disease (HR = 1.49; 95% CI = 1.11-2.00 and HR = 1.64; 95% CI = 1.31-2.05 for cerebrovascular and cardiovascular events, respectively) was found compared with patients whose psoriasis served as the disease amplifier (HR = 2.26; 95% CI = 1.72-2.97 and HR = 2.78; 95% CI = 2.26-3.42 for cerebrovascular and cardiovascular events, respectively) after adjusting for age and gender. In terms of treatment implications, methotrexate was associated with reduced risk for developing cerebrovascular event (HR = 0.22; 95% CI = 0.05-0.88) only in patients with psoriasis serving as the disease amplifier. CONCLUSIONS: Our results suggested that two scenarios of systemic inflammatory marches are present among psoriatic patients with metabolic disorder and judicious use of methotrexate may reduce the risk of cerebrovascular event, especially when psoriasis served as the disease amplifier of the systemic inflammatory march.