Barriers to hepatitis C treatment in the era of direct-acting anti-viral agents.

BACKGROUND: Direct-acting anti-virals (DAA) are safe, effective treatment of hepatitis C virus (HCV). Suboptimal linkage to specialists and access to DAAs are the leading barriers to treatment; however, data are limited. AIM: To determine predictors of follow-up, receipt of DAAs, and reasons for the lack thereof. METHODS: We used clinical data from retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow-up in HCV clinics and DAA treatment (during 12/1/2013-4/30/2015). We then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment. RESULTS: We identified 84 221 veterans who were previously seen in HCV clinics during the pre-DAA era. Of these, 47 165 (56.0%) followed-up in HCV specialty clinics, 13 532 (28.7%) of whom received DAAs. Older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection and psychiatric illness were predictors of follow-up. Alcohol/drug abuse and medical co-morbidity were predictors of lack of treatment. Of the 905 prospectively recruited patients, 56.2% patients had a specialist visit and 28% received DAAs. Common reasons for lack of follow-up were relocation (n = 148, 37.4%) and missed/cancelled appointments (n = 63, 15.9%). Reasons for lack of treatment included waiting for newer therapy (n = 99, 38.8%), co-morbidities (n = 66, 25.9%) and alcohol/drug abuse (n = 63, 24.7%). CONCLUSIONS: Half of patients with established HCV care were followed-up in the DAA era and only 29% received DAAs. Targeted efforts focusing on patient and system-levels may improve the reach of treatment with the new DAAs.

Posttraumatic stress disorder diagnostic criteria and suicidal ideation in a South African Police sample.

OBJECTIVE: Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with suicidal ideation in a sample of police officers. While the psychometric measures of PTSD often mirror the DSM-IV-TR criteria, focusing on exposure, symptom, and duration criteria, suicidal ideation measures often focus on concepts quite different from that. In this report the focus was on investigating how PTSD symptom criteria correlate with the suicidal ideation. METHOD: A group of South African police officers (N = 217) were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and hierarchical regressions were used to determine which PTSD symptom criteria best predict suicidal ideation. RESULTS: Hyperarousal was the primary predictor of suicidal ideation (R(2) [adjusted] = 0.249). Intrusive thoughts added only marginally to the model, contributing a further 2.5% to the declared variance. The contributions of the other two symptom types were negligible. CONCLUSION: In this study hyperarousal correlated significantly with suicidal ideation. It is suggested that practitioners be alert to these symptoms as possible indicators of suicidal ideation. Implications for suicide risk assessment and prevention measures are discussed.

The relationship between body mass index and self-concept among adolescent black female university students.

The study investigated the relationship between body mass index and self-concept among adolescent black female university students. The study used a mixed research design (quantitative and qualitative methods). Media images of handsome faces and beautiful bodies are used to sell almost everything, from clothes and cosmetic to luncheon, meats, and so on. These images reinforce the western cultural stereotype that women should be thin and shapely to be attractive. Thus, as some girls go through puberty they may become dissatisfied with their weight, and to a lesser extent, with their shape, thus, developing low self-concept or imae of themselves. It is in this context that the study was conceptualised. First year female students from three different Schools and Faculties at the University of Limpopo, Turfloop Campus, South Africa, participated in the study. Using the availability and convenient sampling method, 75 students were selected for this study. For the quantitative aspect of the study, the Rosenberg Self-esteem Measure was used to measure self-esteem. For the qualitative part, a topic guide was used for the focus group discussions. Analysis of Variance (ANOVA) and the Pearson's Product Moment Correlation were used to analyse the quantitative data, while the phenomenological principle of open coding used for the thematic analysis. Results showed that there is a relationship between body mass and self-concept and that overweight participants tend to have a low self-esteem. Low self-esteem was perceived to be aggravated by a number of factors, like the attitude of the media and the society. Participants who are overweight also indicated that they are limited in certain activities of daily living (e.g., sports) as a result of their body mass. They expressed mixed feelings and frustration when it comes to such activities. The above results did not differ from those reported from western cultures. Support groups, life-skills programmes and psychotherapy should be made available and attainable for overweight female adolescent students.

Growth failure after recurrent fever in young guinea pigs.

Infection causes fever and suppression of appetite, a combination of effects which threatens normal growth in infected children. We have used an animal model to study the effects on growth of recurrent simulated Gram-positive bacterial infection. After weaning, 10 guinea pig pups underwent surgery under general anaesthesia for the implantation of temperature-sensitive radiotelemeters and thereafter were assigned to receive intramuscular injections of either 50 microg/kg muramyl dipeptide (MDP), or sterile saline. During a 30-day period corresponding to their rapid growth phase, the pups were given eight injections. MDP resulted in fevers of about 1.5 degrees C on each occasion, but no significant change in body temperature occurred after saline injections. Food intake was suppressed during each febrile episode such that 24-h intake was significantly lower on days of injections of MDP, compared to days between MDP injections in the same animals, and compared to that of animals injected with saline. The rate of weight gain of the MDP-injected guinea pigs was significantly lower than that of the control group and failed even to achieve a rate similar to the saline-injected group in their more adult-like growth phase. Plasma zinc concentration was significantly lower in MDP-compared to saline-injected animals sampled 8 days after the last injection. Our results show that recurrent fever during the growth phase of young guinea pigs results in irreversible growth failure, and that reduced food intake on days when the animals were febrile was at least partly responsible for this reduced rate of growth.

How long does it take a static speaking individual to contaminate the immediate environment?

Developments in forensic genetic profiling mean that only a very little DNA is required to generate an identifying profile. However, as this sensitivity increases so does the risk of contamination with non-offender DNA, potentially leading to the conviction of innocents, or release of the guilty. The work of Rutty et al. showed that a static and talking person deposited DNA in front of them within a 15-minute period. This work expands on that of Rutty et al. by determining the time period required for an individual to deposit sufficient DNA for a positive identification to be made, and the distance that this contamination can be detected from the speaking individual. To simulate a scene of crime, sheets of Benchkote(®) were used to represent an area of interest and an unprotected subject talked over them for a variety of times, in a variety of positions (standing, kneeling, and sitting at a desk). Results show that contamination by talking in both kneeling and sitting positions occurred almost immediately (<30 seconds, but not from just one sentence) up to 69 cm from the subject. When standing, contamination could be observed up to a maximum 115 cm from the subject, and was only present in one of three repeats when talking for only 30 seconds. This article illustrates how rapidly a static person can potentially contaminate an area in front of him or herself within a laboratory or scene environment, just by talking.

Correlations for perceived family environmental factors with substance use among adolescents in South Africa.

Perceived family environmental factors were used to predict self-reported use of substances (drugs or alcohol) among adolescents in South Africa. 435 high school students (ages 15 to 19 years, M=17.2 yr., SD=1.34) answered a questionnaire which included questions on demographic variables, the Family Environmental Scale, and questions on substances used (drugs or alcohol). Logistic regression analysis indicated that scores on family conflict and low family moral-religious emphasis were significantly associated with drug use (57.9% of the variance was accounted for) and use of alcohol (62.3% of the variance was accounted for). Programmes for the reduction of substance use among adolescents should include activities designed to reduce family conflict and strengthen family moral-religious emphasis.

Changing stress levels through gaining information on stress.

OBJECTIVE: The aim of this research was to find out the effect of the Information Phase of a Stress Management Program (SMP) on the perceptions of participants about their stress levels. METHOD: A total sample of 100 workers (nursing staff, private business men and women, laboratory assistants, the protective services [foreman and security staff], as well as people in human resources departments) took part in this study. All the participants were from the Northern and Gauteng Provinces in South Africa. The Combined Hassles and Uplifts Scale (Folkman & Lazarus, 1989) was used as an instrument to measure the perceived stress level of participants in a SMP. RESULT: A significant reduction in stress levels was achieved among those who received the Information Phase of the SMP only, as well as those who received the whole stress management techniques. There was no significant difference between the amount of reduction in perceived stress-levels achieved among those that received the Information Phase of the SMP only, compared to that of those who received the whole techniques. CONCLUSION: The authors conclude that where the resources are limited, only the information phase of a SMP may be given to desiring clients. That should help to save time and money spent on participating in SMPs. This should however not discourage the use of the whole SPM, where affordable.

Prevalence and patterns of child sexual abuse and victim-perpetrator relationship among secondary school students in the northern province (South Africa).

An investigation into the prevalence and characteristics of child sexual abuse in the Northern Province (South Africa) was conducted. A total of 414 secondary school students in standard 9 and 10 in three representative secondary schools completed a retrospective self-rating questionnaire in a classroom setting. The questionnaire asked about childhood sexual abuse and the victim-perpetrator relationship. Results shows an overall (N = 414) child sexual abuse prevalence rate of 54.2%, 60% for males (N = 193), 53.2% for females (N = 216). Among them, 86.7% were kissed sexually, 60.9% were touched sexually, 28.9% were victims of oral/anal/vaginal intercourse. "Friend" was the highest indicated perpetrator in all patterns of sexual abuse. Many victims (86.7%) perceived themselves as not sexually abused as a child, and many (50.2%) rated their childhood as "very happy." A call is made for more research, publicity, and campaigns in the area of child sexual abuse in the Province.

Prevalence of child psychological, physical, emotional, and ritualistic abuse among high school students in Mpumalanga Province, South Africa.

Based on self-reports the prevalence during childhood of psychological, physical, emotional, and ritualistic abuse among 559 high school students in Standards 7, 8, 9, and 10 of three high schools in the Mpumalanga Province of South Africa was examined. The questionnaire asked for the demographic information and experiences of psychological, physical, and emotional abuse by their parents or adult caretakers as well as ritualistic abusive experiences before they were 17 years of age plus an estimate of self-perceived abuse during childhood and an overall rating of their own childhood. Analysis showed the self-reported prevalence rates to be as follows: 70.7% psychologically abused (but 14.4% for extreme cases), 27.0% physically abused, 35.3% emotionally abused, and 10.0% ritualistically abused. 13.4% of those who reported themselves as psychologically abused, 20.7% of the physically abused, 19.3% of the emotionally abused, and 35.8% of the ritualistically abused perceive themselves as not abused in any form during childhood. Yet, of the psychologically abused 23.4%, of the physically abused 18.2%, of the emotionally abused 22.0%, and of the ritualistically abused 28.3% rated their childhood as 'very unhappy'. It appears these various forms of abuse are experienced by the participants as widespread, suggesting that a much more serious problem may exist than has been recognised. More research into those forms of child abuse in this Province and elsewhere is needed for a clear appreciation of the problems and the effects of such abuse in children's behavior.

Concepts and treatment for diabetes among traditional and faith healers in the northern province, South Africa.

The purpose of the study was to assess the concepts and treatment modalities for diabetes among traditional and faith healers in the Northern Province in South Africa. The sample consisted of 50 traditional healers (13 females and 37 males) and 50 faith healers (12 females and 38 males). They were interviewed on local terminology, clinical manifestations, causes, curability, and treatment for diabetes, help-seeking behaviour of diabetes patients, and the healers' sources of information about diabetes. Results indicate that all healers were familiar with "diabetes", however, not all of them had seen patients suffering from diabetes. The perceived causes of diabetes by both traditional and faith healers could be divided into (1) diet (especially too much of sugar), (2) heredity, (3) supernatural, and (4) psychological causes. Most traditional healers (92%) and faith healers (90%) indicated that diabetes is curable. Treatments used by the healers in this study included the use of prayer, diet, and herbs. The authors conclude that the concepts and treatment modalities for diabetes among traditional and faith healers should be taken note of by health workers while developing health education programmes in the Province.

Risk factors and child sexual abuse among secondary school students in the Northern Province (South Africa).

OBJECTIVE: This is an investigation into the risk factors that could discriminate childhood sexual abuse (CSA) from non-abuse in the Northern Province (South Africa). METHOD: 414 students in standard 9 and 10 in three secondary schools in the province filled-in a retrospective self-rating questionnaire in a classroom setting. Questionnaires included modified and adapted questions from the Finkelhor's (1979) Risk Factor Checklist, and asked for physical contact forms of sexual abusive experiences of participants before the age of 17 years with an adult or a person at least 5 years older or a person in a position of power. RESULT: It shows an overall (N = 414) CSA prevalence rate of 54.2%. Only four factors (from eight)-ethnicity not Northern Sotho, mother employed and not as laborer, a stepparent present in the family during childhood, and violence at home not seldom-significantly discriminated CSA from non-abuse. Increase in the number of combination of the four significant factors also increases the probability of the discrimination in a linear manner. CONCLUSION: With some caution, we recommend the four significant risk factors for use while planning preventive strategies against childhood sexual abuse, and a massive campaign against child sexual abuse in the province. More job opportunities should be created in the province.

Diagnosis of X-linked adrenal hypoplasia congenita by mutation analysis of the DAX1 gene.

OBJECTIVE: To develop a rapid diagnostic approach to individuals with the X-linked cytomegalic form of adrenal hypoplasia congenita (AHC) and hypogonadotropic hypogonadism (HH) due to mutations in DAX1, a new member of the nuclear hormone receptor gene superfamily. DESIGN: Molecular genetic diagnostic investigations of individuals with AHC and their relatives included polymerase chain reaction amplification of DAX1 for identification of intragenic mutations and fluorescence in situ hybridization with a cosmid containing the DAX1 gene for evaluation of larger deletions. PARTICIPANTS: Families that had males affected with AHC were evaluated for mutations involving the DAX1 gene. RESULTS: DAX1 mutations were identified in four families that had males affected with AHC. Two apparently independent pedigrees had an identical frame-shift mutation due to a single base pair deletion, and a third had a larger deletion involving the entire DAX1 locus. The fourth family was evaluated by fluorescence in situ hybridization for prenatal diagnosis, and both the DAX1 locus and the contiguous glycerol kinase region were deleted. CONCLUSIONS: Molecular genetic and molecular cytogenetic techniques represent rapid and complementary approaches to the diagnosis of mutations in the DAX1 gene responsible for AHC and the associated HH. Specific diagnosis of the cause of adrenal insufficiency in these boys permits anticipatory management of the HH and prenatal counseling for parents of the affected child and other members of their families.

Communication of patients' worries in a psychiatric unit in Nigeria: a comparative study of patient-patient and patient-nurse communication.

The main question examined by this study is: do psychiatric patients communicate their worries more accurately to nurses than to other patients? The study also looked into the relationship between sex and diagnosis of patients' illness on the one hand, and the number of worries reported on the other. Subjects interviewed were in-patients who had stabilised in the ward. The patients, as well as nurses and colleague patients they nominated, used the "Hospital Patients Worry Inventory" to describe the things patients worry about while in hospital. The results showed that in terms of overall accuracy, other patients were more accurate than nurses in reporting a patient's worries. Males and patients diagnosed as schizophrenic and manic reported a higher number of worries than females and patients diagnosed as depressed. Nurses in this study under-estimated the number of worries experienced by patients. The findings were discussed in the light of the importance of informal medium of communication in the assessment and treatment of psychiatric patients.

Genomic scanning for expressed sequences in Xp21 identifies the glycerol kinase gene.

Rapid genomic scanning methods are required to identify expressed sequences and we report an efficient, sensitive and specific approach which relies upon hybridization of an amplified, labeled cDNA library to digested cosmid DNA. We identified expressed sequences within a cosmid in the glycerol kinase (GK) "critical region" of Xp21 that had impressive similarity to prokaryotic GKs. We used this genomic sequence information to clone the human hepatic GK cDNA. Independent confirmation of the identity of this gene was obtained by functional complementation of GK deficient E. coli mutants with a construct containing the complete human X-linked GK coding sequence.

The traditional healer's approach to the treatment of obsessional neurosis. A case study at Ibadan.

This paper presents a case study of a Nigerian traditional healer's methods of treating obsessional thinking. Under supervision, two psychology students of the University of Ibadan watched several sessions during the treatment of a woman suffering from obsessional thoughts in a traditional healer's home. The mental state of the woman was assessed by a clinical interview at the beginning and end of the course of treatment, and the traditional healer was interviewed after each session. The healer used psychological and physical methods of treatment. Supernatural forces were implicated as being aetiological to this disorder. Elements of Western psychological medical methods (such as environmental manipulation, enquiry into the unconscious motivation of behaviour, and suggestion through incantation) were evident in this practice, although applied without the systematic coherence of clinical medicine. Physical methods included the oral administration of a variety of roots and leaves and bathing with a local soap. The paper calls for some form of cooperation with these native healers in health care delivery.