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People with epilepsy frequently experience problems in marriage including reduced marital prospects, poor marital outcomes and diminished quality of married life. Conversely, marriage might impact epilepsy self-management and quality of life in people with epilepsy. There is little in published literature on marriage and epilepsy, so there is a need for psycho-behavioral research. Here, we focus on arranged marriages which, although now rare in western cultures, are widely prevalent in South Asian communities. Arranged marriages, in which families rather than individuals choose marital partners, are particularly problematic because epilepsy is frequently hidden during marital negotiations as well as later. From the psycho-behavioral perspective, marital prospects, outcomes and satisfaction should be examined in relation to the type of marriage (arranged vs. love) and whether or not epilepsy is hidden. Additionally, culturally-relevant tools to appraise marital quality and epilepsy self-management within marriage should be developed. The main objective should be to develop a multi-sectorial action plan with interventions at several different levels involving different stakeholders to mitigate stigma associated with epilepsy in matrimony.
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Investigación Conductal , Epilepsia/psicología , Matrimonio/psicología , Humanos , Estado Civil , Calidad de VidaRESUMEN
Rural women living with HIV/AIDS (WLA) in India face multifarious challenges which affect access to antiretroviral regimens and management of HIV/AIDS. The purpose of this pilot study, using cluster randomization, is to compare the effectiveness of the Asha-Life (AL) intervention, delivered by HIV-trained village women, Asha (Accredited Social Health Activists), with a usual care group on reduction of internalized stigma and avoidant coping among 68 WLA in rural India over a 6-month period. The findings demonstrated that participation in the AL intervention was associated with significant reductions in internalized stigma and the use of avoidant coping strategies at follow-up. The findings of our study are promising in terms of the role rural village women (Asha) may play in reducing internalized stigma and avoidant coping in the lives of rural WLA in India.
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Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/psicología , Población Rural , Estereotipo , Adaptación Psicológica , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Adulto JovenRESUMEN
Body composition in HIV-infected individuals is subject to many influences. We conducted a pilot 6-month randomized trial of 68 women living with AIDS (WLA) from rural India. High protein intervention combined with education and supportive care delivered by HIV-trained village women (activated social health activist [Asha] life [AL]) was compared to standard protein with usual care delivered by village community assistants (usual care [UC]). Measurements included CD4 counts, ART adherence, socio-demographics, disease characteristics (questionnaires); and anthropometry (bioimpedance analyzer). Repeated measures analysis of variance modeled associations. AL significantly gained in BMI, muscle mass, fat mass, ART adherence, and CD4 counts compared to UC, with higher weight and muscle mass gains among ART adherent (≥66%) participants who had healthier immunity (CD4 ≥450). BMI of WLA improved through high protein supplementation combined with education and supportive care. Future research is needed to determine which intervention aspect was most responsible.
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Recuento de Linfocito CD4 , Proteínas en la Dieta/uso terapéutico , Infecciones por VIH/terapia , Adulto , Fármacos Anti-VIH/uso terapéutico , Composición Corporal/efectos de los fármacos , Composición Corporal/inmunología , Depresión/etiología , Proteínas en la Dieta/administración & dosificación , Suplementos Dietéticos , Femenino , Abastecimiento de Alimentos , Infecciones por VIH/tratamiento farmacológico , Humanos , India , Cumplimiento de la Medicación , Educación del Paciente como Asunto , Proyectos Piloto , Población Rural , Resultado del TratamientoRESUMEN
The purpose of this descriptive study is to highlight the physical and mental health symptoms of 68 rural women living with AIDS (WLA) in India, their compliance to antiretroviral therapy (ART) medication, and barriers to accessing health care within the past 6 months. Physical and mental health status was obtained by self-report, administered by questionnaire and physician-determined clinical assessment, as well as selected objective parameters. Findings revealed that while rural WLA had been on antiretroviral therapy for just under 2 years, they self-reported a high prevalence of physical symptoms, and more than half reported high levels of depressive symptoms and major barriers to accessing health care. CD4 levels, body weight, and basal metabolic rate were also low. While the rural and urban WLA faced similar health care challenges, the demographic characteristics of the rural women may make them more vulnerable, as they are less adherent to ART and slimmer than their urban counterparts.
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Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Humanos , India , Cumplimiento de la Medicación , Población Rural , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This cross-sectional study (N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for antiretroviral therapy (ART) adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural Indian WLA.
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Adaptación Psicológica , Infecciones por VIH/psicología , Población Rural/estadística & datos numéricos , Aislamiento Social , Estigma Social , Adolescente , Adulto , Actitud del Personal de Salud , Estudios Transversales , Depresión/etiología , Depresión/psicología , Femenino , Infecciones por VIH/etnología , Conocimientos, Actitudes y Práctica en Salud , Humanos , India/epidemiología , Modelos Estadísticos , Análisis de Regresión , Autorrevelación , Apoyo Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Despite the increased prevalence of HIV in the rural female population of India, adherence to antiretroviral therapy continues to be low because of several barriers that discourage rural women. OBJECTIVES: This study aims to assess the effectiveness of an intervention (Asha-Life) delivered by Accredited Social Health Activists (Asha) to improve antiretroviral therapy adherence of rural women living with AIDS in India compared with that of a usual care group. METHODS: Sixty-eight rural women living with AIDS, aged 18-45 years, participated in a prospective, randomized pilot clinical trial and were assessed for several factors affecting adherence, such as sociodemographic characteristics, health history, CD4 cell count, enacted stigma, depressive symptomology, help getting antiretroviral therapy, and perceived therapy benefits. RESULTS: Findings at 6 months revealed that, although both groups improved their adherence to antiretroviral therapy, there was greater improvement in the Asha-Life group (p < .001), who reported a greater reduction in barriers to antiretroviral therapy than those in the usual care group. DISCUSSION: Antiretroviral therapy adherence showed significant increase in the Asha-Life cohort in which basic education on HIV/AIDS, counseling on antiretroviral therapy, support from Ashas, financial assistance, and better nutrition, was provided. The Asha-Life intervention may have great potential in improving antiretroviral therapy adherence and decreasing barriers among rural women living with AIDS in India.
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Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Promoción de la Salud/métodos , Cumplimiento de la Medicación/estadística & datos numéricos , Población Rural , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , India , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Adulto JovenRESUMEN
The purpose of this randomized pilot study is to conduct an intervention with 68 rural women living with AIDS to compare the effectiveness of two different programs on depressive symptoms. The trial was designed to assess the impact of the Asha-Life intervention engaging with an HIV-trained village woman, Asha (Accredited Social Health Activist), to participate in the care of women living with AIDS (WLA), along with other health care providers compared to a Usual Care group. Two high prevalence HIV/AIDS villages in rural Andhra Pradesh, which were demographically alike and served by distinct Public Health Centers, were selected randomly from a total of 16 villages. The findings of this study demonstrated that the Asha-Life participants significantly reduced their depressive symptom scores compared to the Usual Care participants. Moreover, women living with AIDS who demonstrated higher depressive symptom scores at baseline had greater reduction in their depressive symptoms than women with lower scores.
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Síndrome de Inmunodeficiencia Adquirida/psicología , Depresión/terapia , Población Rural , Apoyo Social , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adaptación Psicológica , Adulto , Culinaria , Depresión/complicaciones , Femenino , Humanos , India , Estado Nutricional , Ocupaciones , Responsabilidad Parental , Proyectos Piloto , Resultado del TratamientoRESUMEN
In this prospective, randomized clinical trial, correlates of adherence to antiretroviral therapy (ART) were assessed using a baseline questionnaire among 68 rural women living with AIDS (WLA) in India. Unadjusted analyses revealed positive relationships of ART adherence with Hindu religion, and support from spouses and parents, whereas negative associations were found with depression, poor quality of life, and having ten or more HIV symptoms. Multiple linear regression analysis also revealed that WLA who were Hindu, not depressed, had ART support from spouses and parents, and perceived some benefit from ART were more adherent to ART than their respective counterparts. This study reveals the unique challenges which rural WLA experience and the need to mitigate these challenges early in ART treatment. Further, the findings enable the refinement of an intervention program which will focus on strengthening ART adherence among rural WLA.
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Although depression may be commonly experienced by persons living with AIDS, it may be challenging for health care providers to identify persons who are suffering from depression symptoms, particularly if they are living in the more isolated rural areas of India. The purpose of this study is to assess correlates of depression among women living with AIDS in rural Andhra Pradesh, India. A total of 68 rural women living with AIDS (WLA) completed baseline data and were assessed by means of structured instruments. Regression modeling revealed that disclosure avoidance and making at least six health care visits in the last six months were all associated with depression. Further, living with a spouse was associated with lower depressive symptom scores. Stigma was not found to be associated with depression. Understanding correlates of depression can lead the way toward designing culturally-tailored interventions that can mitigate disclosure avoidance and improve the health of women. A more comprehensive health focus may be needed to empower the women to seek quality care for both physical health, as well as mental health, symptomatology.
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Síndrome de Inmunodeficiencia Adquirida/enfermería , Síndrome de Inmunodeficiencia Adquirida/psicología , Trastorno Depresivo/enfermería , Trastorno Depresivo/psicología , Países en Desarrollo , Población Rural , Aislamiento Social , Adolescente , Adulto , Costo de Enfermedad , Estudios Transversales , Mecanismos de Defensa , Femenino , Humanos , India , Aceptación de la Atención de Salud/psicología , Autorrevelación , Estigma Social , Esposos/psicología , Estadística como Asunto , Adulto JovenRESUMEN
Researchers explored the barriers to AIDS care for rural women living with AIDS, and they investigated alternative delivery models to increase the women's adherence to antiretroviral therapy (ART). Community-based participatory research focus groups were conducted by the researchers with a convenience sample of 39 women living with AIDS from a primary health center (PHC) near Chennai, India, and with nurses, physicians, and Accredited Social Health Activists (Ashas), who are lay health care workers. The most prevalent barriers expressed by the women were sickness-related, psychological, financial issues with childcare, and distance, or transportation to the site. Women living with AIDS reviewed Ashas favorably.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH , Accesibilidad a los Servicios de Salud , Cooperación del Paciente/psicología , Población Rural/estadística & datos numéricos , Adulto , Fármacos Anti-VIH/economía , Investigación Participativa Basada en la Comunidad , Atención a la Salud/organización & administración , Femenino , Grupos Focales , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , India , Entrevistas como Asunto , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , Privacidad , Investigación Cualitativa , Apoyo Social , Factores Socioeconómicos , Estereotipo , Adulto JovenRESUMEN
A community-based participatory research study was conducted using focus groups with 39 women living with AIDS (WLA) in the rural setting of Andhra Pradesh, India. In addition, three nurses, two physicians, and five reproductive health accredited social health activists (ASHAs) took part in focus groups. The WLA offered insight into the benefits of HIV-trained ASHAs including emotional support, assistance with travel to health care providers and antiretroviral therapy medication adherence. Health care providers also identified benefits of using HIV-trained ASHAs and suggested modalities for how to train these individuals. These findings will contribute to the design of a future program of care involving HIV-trained ASHAs.
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OBJECTIVE: To gain an insight into the phenomenon of social resistance and rumors against pulse polio campaign. DESIGN: Qualitative, community-based investigation, mapping perceptions of various stakeholders through in-depth interviews (IDIs), focus group discussions (FGDs), non-formal interactions and observations. SETTING: Moradabad and JP Nagar districts of Uttar Pradesh. SUBJECTS: IDIs (providers 33, mothers 33, community leaders 10); FGDs (providers 4, mothers 8) and non-formal interactions (156) with community leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS: A distinct machination of social resistance and rumors against oral polio vaccine during supplementary immunization activities (SIA) was observed in some minority dominated areas. The pattern can be understood through a model that emerged through qualitative evidence. Inspite of all this, most parents in minority areas supported the SIAs. Only a few clusters from extremely marginalized sections continued to evade SIAs, with an endemic pattern. Through social osmosis, these rumors reached majority community as well and some parents were affected. However, in such cases, the resistance was sporadic and transient. CONCLUSION: While the programs focus was on microbiological issues, the obstacles to polio eradication lie in the endemicity of social (and/or cultural) resistance in some pockets, leading to clustering of perpetually unimmunized children - inspite of good coverage of SIAs at macro level. This may sustain low levels of wild poliovirus transmission, and there can be exceptions to the robustness of the pulse approach. A micro level involvement of volunteers from marginalized pockets of minorities might be able to minimize or eliminate this resistance.
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Poliomielitis/prevención & control , Poliomielitis/psicología , Vacuna Antipolio Oral/administración & dosificación , Vacunación/psicología , Actitud Frente a la Salud , Niño , Servicios de Salud Comunitaria , Investigación Participativa Basada en la Comunidad , Femenino , Salud Global , Humanos , India , Madres , Poliomielitis/etnología , Confianza/psicologíaRESUMEN
OBJECTIVES: To understand the perceptions and likely determinants that facilitate or act as barriers in implementing additional strategies for polio eradication: (a) accelerated delivery of mOPV1 (monovalent polio vaccine type 1); (b) use of IPV (inactivated polio vaccine); and (c) provision of incentives. DESIGN: QUALITATIVE. Rapid appraisal procedures (RAP) were adopted to derive the reality by synthesizing multiple sources of information; search for opinions, motivations, behaviors and attitudes of key stakeholders within their organizational and socio-cultural matrix. SETTING: Two districts of Uttar Pradesh - Moradabad and J P Nagar. SUBJECTS: Total 244 interactions were conducted; 33 interviews and 4 focussed group discussions (FGD) conducted with providers; 33 mothers (<5 years) and 10 leaders were interviewed; 8 FGD were conducted with mothers of under-fives. Informal interactions (156) were also conducted with village pradhans, religious leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS: Providers expressed reservation regarding accelerated rounds of OPV; scientific rationale of accelerated rounds is not clear to parents and leaders. Although technical advantages of introducing IPV exist, issues of logistical difficulties and injection safety emerged strongly. Providers and communities indicated a clear 'no' to the cash incentives but argued for developmental issues. Resistance to the program has declined over time but still the program is perceived as the "government's need, not ours". CONCLUSION: The polio eradication program is critically poised, an opportunity to intensify efforts for reducing inequities in health services and improve access of all children to the PHC services. Ongoing dialogue with local communities and strong political commitment would be essential to translate the technological innovations into a sustainable program.
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Actitud Frente a la Salud , Participación de la Comunidad , Programas de Inmunización/organización & administración , Poliomielitis/prevención & control , Mercadeo Social , Preescolar , Femenino , Humanos , India , Lactante , Recién Nacido , Madres , Motivación , Poliomielitis/psicología , Vacuna Antipolio de Virus Inactivados , Vacuna Antipolio Oral , Política , Investigación CualitativaRESUMEN
INTRODUCTION: Caregivers of patients of schizophrenia and bipolar affective disorder (BAD) experience considerable burden while caring their patients. They develop different coping strategies to deal with this burden. Longitudinal studies are required to assess the relationship between caregiver burden and coping. AIM: The present study was conducted to assess relationship between burden and coping in caregivers of clinically stable patients with schizophrenia and BAD. METHOD: One hundred patients each of schizophrenia and BAD attending a psychiatric outpatient setting and their caregivers were followed up for a period of 6 months. Burden and coping strategies were assessed in the caregivers at baseline, and after 3 and 6 months using the Burden Assessment Schedule (BAS) and Ways of Coping Checklist - Hindi Adaptation (WCC - HA). RESULTS: Burden remained stable over 6 months and was comparable in the two groups of caregivers. Caregivers from both the groups were found to use problem focused coping strategies more often than seek social support and avoidance strategies. Scores on avoidance type of coping showed a positive correlation with the total burden scores and a number of burden factors. CONCLUSION: Caregivers of patients of schizophrenia and BAD face similar levels of burden and use similar types of coping methods to deal with it. Relationship between caregiver burden and coping is quite complex.
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Adaptación Psicológica , Trastorno Bipolar/terapia , Cuidadores/psicología , Costo de Enfermedad , Esquizofrenia/terapia , Adolescente , Adulto , Femenino , Estado de Salud , Hinduismo , Atención Domiciliaria de Salud/psicología , Hospitales Psiquiátricos , Humanos , India , Masculino , Salud Mental , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Estudios Prospectivos , Estrés PsicológicoRESUMEN
OBJECTIVES: Recently, the Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling pathway was found to be prominently associated with activation of the autocrine loop of the heart tissue-localized renin angiotensin system (RAS). We investigated if the JAK-STAT pathway is activated in the post-myocardial infarction (MI) non-ischemic myocardium (NIM), destined to undergo remodeling and whether blockade of the pathway in vivo can modify early post-MI remodeling. METHODS: We investigated the time course of tyrosine phosphorylation of JAK-STAT and gp130 proteins in the NIM of post-MI rat heart as well as the binding activity of STAT proteins to the St-domain of the angiotensinogen gene promoter. We further compared the effects of in vivo blockade of RAS by the AT(1) receptor (AT(1)R) blocker losartan with the in vivo blockade of JAK-STAT pathway by the specific JAK2 blocker tyrphostin AG490 on certain aspects of early post-MI remodeling. RESULTS: We showed that JAK2, STATs 1, 3, 5a and 6 and gp130 proteins are tyrosine phosphorylated as early as 5-30 min post-MI and that STATs 1, 3, and 5a remain activated up to 7 days post-MI. Gel mobility shift assay showed a strong binding activity of STAT proteins to the St-domain of angiotensinogen gene promoter in 1-day post-MI NIM. The binding was significantly reduced in rat hearts previously treated with losartan or tyrphostin AG490. Supershift experiments identified STATs 3 and 5a as specifically interacting with the St-domain. Both AT(1)R and JAK2 blockade resulted in significant amelioration of the increase of protein phosphatase 1 activity and decrease in basal level of p16-phospholamban that may underlie early diastolic dysfunction, as well as partial amelioration of early downregulation of Kv4.2 gene expression that may underlie increased arrhythmogenicity of 3-day post-MI heart. On the other hand, while blockade of AT(1)R significantly ameliorated apoptotic changes in 1-day post-MI border zone, blockade of JAK2 increased apoptosis. CONCLUSIONS: The study provides compelling evidence in favor of the linkage of the JAK-STAT pathway with the angiotensin II autocrine loop and uncovers a mechanism by which selective activation of a set of STAT proteins underlies mobilization of the gene activation program intrinsic to post-MI remodeling. It also suggests that drugs that inhibit JAK-STAT phosphorylation may provide a new approach to modify post-MI remodeling. This needs to be confirmed in long term in vivo studies in the post-MI heart.