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1.
West Afr J Med ; 36(3): 246-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622487

RESUMO

BACKGROUND AND OBJECTIVE: Disclosure of human immuno-deficiency virus (HIV) sero-status is a difficult process that involves communication of information about a potentially stigmatizing and transmissible illness. Despite this, it is important for preventing HIV infection and mitigating its impacts. This study aimed to assess the rate and determinants of self-disclosure of HIV sero-status among people living with HIV/AIDS (PLHIV) attending an Antiretroviral Therapy (ART) Clinic in North Central Nigeria with a view to promoting self- disclosure as an intervention for secondary prevention of HIV/AIDS. METHODS: It was a cross-sectional study involving 325 consenting adults aged 18 to 65 years PLHIV attending ART clinic who were recruited using systematic random sampling method. Data collected from the participants include socio-demographic data and medical history. The rate and factors affecting self-disclosure of HIV sero-status were obtained by using a structured interviewer-administered questionnaire. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 Results: Most of the participants (66.2%) were females. 96% of the participants had disclosed their HIV sero-status. Self-disclosure of HIV sero-status had statistically significant association with age (c2 = 12.614; p = 0.027) and gender (c2 = 4.638; p = 0.031). CONCLUSION: Self-disclosure of HIV sero-status was high among the participants. Being female and within 15-44 year age group were statistically significant factors associated with disclosure of HIV sero-status. Multiple counselling sessions are needed to improve disclosure particularly in males and older PLHIV as self-disclosure of HIV sero-status is a process that requires ongoing support and encouragement.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Soropositividade para HIV/psicologia , Revelação da Verdade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Idoso , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Soropositividade para HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Parceiros Sexuais , Centros de Atenção Terciária , Adulto Jovem
2.
Am Surg ; 85(10): 1166-1170, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657317

RESUMO

Youth and young adult interpersonal violence (IPV) is a unique clinical challenge which merits study. This study defined the demographics and clinical outcomes of youth and young adult victims of IPV presenting to our hospital while examining violent injury recidivism. We reviewed patients aged 10 to 30 years admitted to our trauma bay as a victim of gunshot wound (GSW), stabbing wound, or blunt assault from 1998 to 2015 (n = 12,549). Logistic regression analysis was conducted to compare patient mortality across demographic characteristics, and Cox proportional hazards regression was used to determine risk factors for recidivism. Male (92%) and Hispanic patients (75%) constituted the majority of admissions. We observed differences in the mortality rate by gender (9% in males vs 5% in females, P < 0.001), race/ethnicity (5% non-Hispanic white vs 9% Hispanic, P = 0.001), insurance status (3% insured vs 10% uninsured, P < 0.001), and mechanism of injury (13% GSW, 2% stabbing wound, and 0.3% blunt assault, P < 0.001). Male gender, younger age, GSW, and amphetamine placed patients at higher risk for IPV recidivism (P < 0.05). This study demonstrates the need to better understand how demographics and economics are associated with youth and young adult IPV. In addition, future IPV prevention and intervention initiatives can be tailored to suit the unique needs of our population.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Reincidência/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/mortalidade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Violência com Arma de Fogo/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Razão de Chances , Reincidência/etnologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/etnologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/etnologia , Adulto Jovem
3.
BMC Infect Dis ; 19(1): 775, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488063

RESUMO

BACKGROUND: South Africa has the highest HIV prevalence and supports the largest antiretroviral therapy (ART) programme globally. With the introduction of a test and treat policy, ensuring long term optimal adherence to ART (≥95%) is essential for successful patient and public health outcomes. The aim of this study was to assess long-term ART adherence to inform best practices for chronic HIV care. METHOD: Long-term ART adherence was retrospectively analysed over a median duration of 5 years (interquartile range [IQR]: 5.3-6.5) in patients initially enrolled in a randomised controlled trial assessing tuberculosis and HIV treatment integration and subsequently followed post-trial in an observational cohort study in Durban, South Africa. The association between baseline patient characteristics and adherence over time was estimated using generalized estimating equations (GEE). Adherence was assessed using pharmacy pill counts conducted at each study visit and compared to 6 monthly viral load measurements. A Kaplan Meier survival analysis was used to estimate time to treatment failure. The McNemar test (with exact p-values) was used to determine the effect of pill burden and concurrent ART and tuberculosis treatment on adherence. RESULTS: Of the 270 patients included in the analysis; 54.8% were female, median age was 34 years (IQR:29-40) and median time on ART was 70 months (IQR = 64-78). Mean adherence was ≥95% for each year on ART. Stable patients provided with an extended 3-month ART supply maintained adherence > 99%. At study end, 96 and 94% of patients were optimally adherent and virologically suppressed, respectively. Time since ART initiation, female gender and primary breadwinner status were significantly associated with ≥95% adherence to ART. The cumulative probability of treatment failure was 10.7% at 5 years after ART initiation. Concurrent ART and tuberculosis treatment, or switching to a second line ART regimen with higher pill burden, did not impair ART adherence. CONCLUSION: Optimal long-term adherence with successful treatment outcomes are possible within a structured ART programme with close adherence monitoring. This adherence support approach is relevant to a resource limited setting adopting a test and treat strategy.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Contagem de Linfócito CD4 , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , África do Sul/epidemiologia , Fatores de Tempo , Resultado do Tratamento
4.
Psychiatr Danub ; 31(Suppl 3): 249-251, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488735

RESUMO

The prevalence of personality disorders (PDs) in black people has consistently been reported as significantly lower than in their white equivalents. If this result is accurate, then it may reveal important clues as to the aetiology of personality disorders, which could provide invaluable insights as to how we should support these patients. However, if this result does not reflect the truth, then important questions must be answered as to why black people with personality disorders are under- represented. There has been limited investigations into what may cause a discrepancy in the PD prevalence between ethnicities. This review aims to determine whether the lower prevalence of PDs in black people is likely to be accurate, and if it isn't, explore some of the potential causes for the difference. This is an important issue to address as may reveal pertinent inequalities in healthcare.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Transtornos da Personalidade/epidemiologia , Grupos Étnicos/psicologia , Grupos Étnicos/estatística & dados numéricos , Humanos , Prevalência
5.
Gynecol Oncol ; 155(1): 98-104, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378375

RESUMO

OBJECTIVE: To evaluate associations between US region of residence and urbanization and the place of death among women with gynecologic malignancies in the United States. METHODS: A retrospective cross-sectional study was performed using publicly available death certificate data from the National Center for Health Statistics. All gynecologic cancer deaths were included from 2006 to 2016. Comparisons among categories were performed with a two-tailed chi-square test, with p-values <0.05 considered significant. RESULTS: From 2006 to 2016, 328,026 women died from gynecologic malignancies in the US. Of these deaths, 40.1% (n = 134,333) occurred in the patient's home, 24.9%(n = 81,823) in the hospital, and 11.3% (37,188) in an inpatient hospice facility. Place of death varied by geographic region. The Northeast had the largest percentage of gynecologic cancer patients (31.3%) die as a hospital inpatient. The West had the highest percentage of deaths (49.3%) at home. Deaths in a hospice facility were the highest (14.1%) in the South. Place of death varied by urbanization; patients residing in large central metro or rural counties were the most likely to die during hospital admission (28.7% and 27.1%, respectively). Patients living in medium-sized metro areas were the least likely to die in hospitals (21.8%) and most likely to die in a hospice facility (14.3%). All comparisons were significant by study definition. CONCLUSION: The place of death for patients with gynecologic malignancies varies by US region and urbanization. These disparities are multifactorial in nature, likely influenced by both sociodemographic factors and regional resource availability. In this study, however, rural and central metro areas are identified as regions that may benefit from further hospice development and advocacy.


Assuntos
Neoplasias dos Genitais Femininos/mortalidade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Neoplasias dos Genitais Femininos/etnologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
6.
AIDS Behav ; 23(9): 2588-2599, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31263998

RESUMO

Black and Latina transgender women (BLTW) are disproportionately impacted by HIV but remain underrepresented in HIV and health services research. Between March 2016 and May 2017, BLTW (N = 201) were recruited in Baltimore, Maryland and Washington, DC through convenience sampling for a survey assessing multilevel determinants of HIV risk and treatment outcomes. Interviews concluded with a rapid oral HIV test. Bivariate and multivariable logistic regression modeling was performed to identify gender affirmation-related correlates of self-reported HIV treatment interruptions (HIVTIs) among BLTW living with HIV who had initiated antiretroviral therapy (ART) (n = 96). Among them, 57.3% (n = 55) reported at least one HIVTI. Unmet surgical needs (aOR = 1.6), past-year marijuana use (aOR = 14.6), and no current hormone use (aOR = 24.9) were significantly (p < 0.05) associated with HIVTIs in multivariable analysis. Unmet need for gender affirmation may inhibit ART adherence, highlighting opportunities to mitigate care interruptions in alignment with community needs and goals.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Hispano-Americanos/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoas Transgênero/psicologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Baltimore/epidemiologia , District of Columbia/epidemiologia , Feminino , Infecções por HIV/etnologia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Adesão à Medicação/etnologia , Adesão à Medicação/psicologia , Estigma Social , Pessoas Transgênero/estatística & dados numéricos , Transexualismo
7.
J Urol ; 202(6): 1209-1216, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31246547

RESUMO

PURPOSE: There is a differential in prostate cancer mortality between black and white men. Advances in precision medicine have shifted the research focus toward underlying genetic differences. However, nonbiological factors may have a large role in these observed disparities. Therefore, we sought to measure the relative importance of race compared to health care and social factors on prostate cancer specific mortality. MATERIALS AND METHODS: Using the SEER (Surveillance, Epidemiology, and End Results) database we identified 514,878 men diagnosed with prostate cancer at age 40 years or greater between 2004 and 2012. We also selected a subset of black and white men matched by age, stage and birth year. We stratified patients by age 40 to 54, 55 to 69 and 70 years or older and disease stage, resulting in 18 groups. By applying random forest methods with variable importance measures we analyzed 15 variables and interactions across 4 categories of factors (tumor characteristics, race, and health care and social factors) and the relative importance for prostate cancer specific mortality. RESULTS: Tumor characteristics at diagnosis were the most important factors for prostate cancer mortality. Across all groups race was less than 5% as important as tumor characteristics and only more important than health care and social factors in 2 of the 18 groups. Although race had a significant impact, health care and social factors known to be associated with racial disparities had greater or similarly important effects across all ages and stages. CONCLUSIONS: Eradicating disparities in prostate cancer survival will require a multipronged approach, including advances in precision medicine. Disparities will persist unless health care access and social equality are achieved among all populations.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias da Próstata/mortalidade , Adulto , Idoso , Estudos de Coortes , Interpretação Estatística de Dados , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Programa de SEER/estatística & dados numéricos , Fatores Socioeconômicos , Aprendizado de Máquina Supervisionado , Estados Unidos/epidemiologia
8.
J Frailty Aging ; 8(3): 131-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31237313

RESUMO

BACKGROUND: Prospective studies examining the potential association of vitamin D with age-related muscle loss have shown inconsistent results. OBJECTIVE: To examine the association between baseline serum 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and prospective change in lean mass with aging in African ancestry population. We also determined if associations were modulated by age and diabetes mellitus (DM). DESIGN: Prospective observational cohort study. SETTING: Data were collected from a random sub-sample of 574 men, participants of the Tobago Bone Health Study (TBHS). PARTICIPANTS: 574 Afro-Caribbean men, aged 43+ years (mean age: 59.1 ± 10.5), who were randomly selected as the participants in both the baseline and the follow-up visits. MEASUREMENTS: Baseline fasting serum 25(OH)D was measured using liquid chromatography mass spectrometry (LC-MS/MS), and and 1,25(OH)2D was measured using radioimmunosassay (RIA). Changes in dual-energy X-ray absorptiometry (DXA)-measured appendicular lean mass (ALM), and total body lean mass (TBLM) were measured over an average of 6.0 ± 0.5 years. The associations of 25(OH)D and 1,25(OH)2D with ALM and TBLM were assessed by multiple linear regression model after adjusting for potential confounders. RESULTS: When stratifying all men into two groups by age, greater baseline 25(OH)D and 1,25(OH)2D levels were associated with smaller losses of ALM and TBLM in older (age 60+ years) but not in younger (age 43 - 59 years) men. When stratifying by DM status, the associations of 25(OH)D and 1,25(OH)2D with declines in ALM and TBLM were statistically significant only in prediabetic, but not among normal glycemic or diabetic men. CONCLUSION: Higher endogenous vitamin D concentrations are associated with less lean mass loss with aging among older and prediabetic Afro-Caribbean men independent of potential confounders. Our findings raise a possibility that maintaining high serum vitamin D level might be important for musculoskeletal health in elderly and prediabetic African ancestry men.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Envelhecimento/etnologia , Atrofia Muscular/etnologia , Vitamina D/sangue , Adulto , Distribuição por Idade , Idoso , Envelhecimento/patologia , Diabetes Mellitus/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
J Exp Psychol Gen ; 148(6): 1022-1040, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180716

RESUMO

Large-scale data collection has enabled social scientists to examine psychological constructs at broad, regional levels. However, because constructs and their measures initially operationalized at the individual level may have qualitatively and quantitatively different properties at other levels of analysis, the validity of constructs must be established when they are operationalized at new levels. To this end, the current research presents evidence of construct validity for explicit and implicit racial bias at region levels. Following classic measurement theory, we examine the substantive, structural, and external evidence of construct validity for regional biases. We do so with responses from ∼2 million Black and White North Americans collected over 13 years. Though implicit measures typically demonstrate low retest reliability at the individual level, our analyses reveal conventionally acceptable levels of retest reliability at the highest levels of regional aggregation. Additionally, whereas previous meta-analyses find relatively low explicit-implicit correlations at the individual level, the present research uncovered strong explicit-implicit correlations at regional levels. The findings have implications for how we interpret measures of racial bias at regional levels. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Racismo/estatística & dados numéricos , Projetos de Pesquisa , Grupo com Ancestrais do Continente Africano/psicologia , Interpretação Estatística de Dados , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Masculino , Racismo/psicologia , Reprodutibilidade dos Testes , Estados Unidos
10.
Public Health ; 171: 66-75, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31103615

RESUMO

OBJECTIVES: Over a quarter of UK births are to women who were born outside of the UK. Black and Minority Ethnic (BME) women are disproportionately affected by poor mental health and inequitable access to mental health care in the perinatal period, yet the influence of the migrant status (mothers' UK vs. non-UK birth) is poorly understood. This study aimed to explore the relationship between ethnicity, migration and mental health indicators among mothers participating in a large nationally representative cohort study. STUDY DESIGN: This is a secondary analysis of data from the Millennium Cohort Study. METHODS: Logistic regression quantified the crude and adjusted effects of self-reported ethnicity and migrant status on prevalence of psychological distress and treatment for anxiety/depression at 9-month and 5-year postpartum. RESULTS: We found substantial variation in the prevalence of distress according to ethnicity and migrant status, with Indian and Pakistani women at greatest risk. Despite equal or greater risk, BME and migrant women were less likely to report treatment for anxiety/depression. Mutually adjusted analyses showed ethnicity to be a stronger predictor of both outcomes than migrant status; however, at 5 years, being a migrant independently predicted lower odds of treatment, for a statistically similar level of distress. CONCLUSIONS: Migrant women are likely to be at high risk of poor mental health in the perinatal period and beyond, yet may face significant barriers to accessing mental health care. A better understanding of ethnicity and migration as interrelated risk factors for perinatal mental ill-health is needed to help National Health Service organisations develop policy and practice that is flexible and responsive to diversity.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Grupos Étnicos/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Grupos Minoritários/psicologia , Mães/psicologia , Migrantes/psicologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Ansiedade/epidemiologia , Ansiedade/etnologia , Ansiedade/terapia , Estudos de Coortes , Depressão/epidemiologia , Depressão/etnologia , Depressão/terapia , Grupos Étnicos/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/etnologia , Serviços de Saúde Mental , Grupos Minoritários/estatística & dados numéricos , Mães/estatística & dados numéricos , Período Pós-Parto , Gravidez , Prevalência , Fatores de Risco , Autorrelato , Migrantes/estatística & dados numéricos , Reino Unido/epidemiologia
11.
BMC Public Health ; 19(1): 629, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122239

RESUMO

BACKGROUND: Older people living in deprived areas, from black and minority ethnic groups (BME) or aged over 85 years (oldest old) are recognised as 'hard to reach'. Engaging these groups in health promotion is of particular importance when seeking to target those who may benefit the most and to reduce health inequalities. This study aimed to explore what influences them practicing health promotion and elicit the views of cross-sector professionals with experiences of working with 'hard to reach' older people, to help inform best practice on engagement. METHODS: 'Hard to reach' older people were recruited through primary care by approaching those not attending for preventative healthcare, and via day centres. Nineteen participated in an interview (n = 15) or focus group (n = 4); including some overlaps: 17 were from a deprived area, 12 from BME groups, and five were oldest old. Cross-sector health promotion professionals across England with experience of health promotion with older people were identified through online searches and snowball sampling. A total of 31 of these 44 professionals completed an online survey including open questions on barriers and facilitators to uptake in these groups. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team. RESULTS: Older people's motivation to stay healthy and independent reflected their everyday behaviour including practicing activities to feel or stay well, level of social engagement, and enthusiasm for and belief in health promotion. All of the oldest old reported trying to live healthily, often facilitated by others, yet sometimes being restricted due to poor health. Most older people from BME groups reported a strong wish to remain independent which was often positively influenced by their social network. Older people living in deprived areas reported reluctance to undertake health promotion activities, conveyed apathy and reported little social interaction. Cross-sector health professionals consistently reported similar themes as the older people, reinforcing the views of the older people through examples. CONCLUSIONS: The study shows some shared themes across the three 'hard-to-reach' groups but also some distinct differences, suggesting that a carefully outlined strategy should be considered to reach successfully the group targeted.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Atitude do Pessoal de Saúde , Grupos Étnicos/psicologia , Promoção da Saúde/organização & administração , Grupos Minoritários/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Grupos Étnicos/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Masculino , Grupos Minoritários/estatística & dados numéricos , Áreas de Pobreza , Atenção Primária à Saúde , Pesquisa Qualitativa
12.
Soc Psychiatry Psychiatr Epidemiol ; 54(7): 883-886, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30989256

RESUMO

PURPOSE: To investigate to what extent mental health treatment needs are met in white and black and minority ethnic (BME) prisoners. METHODS: Treatment needs of a random sample of male (n = 197) and female (n = 171) prisoners were assessed with standardised instruments. Interventions provided were confirmed through face-to-face interviews and case note review. RESULTS: BME prisoners comprised 44% of participants. Treatment for depression, personality disorder and alcohol abuse was more often needed by White than BME prisoners. Needs were more frequently met in White than BME prisoners (48.5% vs 38.2%; p < 0.05), largely due to the delivery of psychological treatments. CONCLUSIONS: BME prisoners had fewer of their mental health needs met.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Grupos Étnicos/psicologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Masculino , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Prisioneiros/psicologia , Psicoterapia/estatística & dados numéricos
13.
Health Qual Life Outcomes ; 17(1): 65, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992020

RESUMO

BACKGROUND: Systemic lupus erythematosus (SLE) often has a profound negative impact on health-related quality of life (HRQoL). In the absence of any qualitative studies in sub-Saharan Africa, we undertook a study to explore living experiences, perceptions and unmet needs of South African patients with SLE. METHODS: Twenty-five women with SLE consented to participate in the study. They underwent individual in-depth interviews exploring their physical concerns, emotional health, sexual well-being and fertility. NVivo software was used for analysis. RESULTS: Participants were either of black ancestry or mixed racial ancestry, mainly indigent with only a quarter gainfully employed. Living with pain was the most common complaint, negatively impacting on activities of daily living (ADL), family expectations, social life, sleep and intimacy. Most participants expressed challenges of living with fatigue, and many felt their fatigue was misconstrued as being 'simply lazy'. This pernicious fatigue had negative consequences on many facets of ADL, including caring for dependants, job sustainability and sexual well-being. All participants experienced low emotional states, often associated with suicidal ideations. Many experienced difficulties with fertility and childbearing and these were exacerbated in many instances by the pessimism of health care providers, resulting in confusion and depression. Physical disfigurements resulting from lupus-associated alopecia and rashes and corticosteroid-induced weight fluctuations were a major concern. These changes often affected self-image and libido, leading to strained personal relationships. Coping mechanisms that participants adopted included intense spiritual beliefs, 'pushing through the difficult times' and use of alternative therapies to relief symptoms was common. A poor understanding of SLE on the part of participant's family and the community, coupled with the unpredictable course of the disease, exacerbated frustration and social exclusion. For most, limited income, lack of basic services, family dependencies, and comorbid diseases, such as human immune deficiency virus (HIV), exacerbated the daily negative SLE experiences. CONCLUSION: In this study of mainly indigent South African women, SLE is associated with complex, chronic and challenging life experiences. The chronic relapsing and unpredictable nature of the disease, poor understanding and acceptance of SLE, compounded by a background of poverty, inadequate social support structures, negatively impact on a range of personal, social and vocational daily life experiences. Improved access to psychosocial services and SLE education might result in better outcomes. TRIAL REGISTRATION: (Ethics Project identification code: 275/2016 and M160633 registered 10 & 29 August 2016).


Assuntos
Adaptação Psicológica , Lúpus Eritematoso Sistêmico/psicologia , Qualidade de Vida , Atividades Cotidianas , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Depressão/etiologia , Depressão/psicologia , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/psicologia , Pesquisa Qualitativa , Fatores Socioeconômicos , África do Sul , Adulto Jovem
16.
Public Health ; 170: 122-128, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31029834

RESUMO

OBJECTIVES: Mediation analyses were conducted to explore the contribution of lifestyle behaviours in the ethnic pattern of poor health outcomes in Leicester, England. STUDY DESIGN: Cross-sectional study. METHODS: The study used data on 1959 participants from the Leicester Health and Well-being Survey (2015). Lifestyle behaviours were physical activity, diet, smoking and alcohol drinking. Poor health outcomes were the presence of long-term illness and poor self-reported health. RESULTS: Poor health outcomes were less common in Black and Minority Ethnic groups (BMEs) than Whites. Smoking was less common in BMEs than Whites. Poor health outcomes were more common in ex-smokers and current smokers than never smokers. Health outcomes were associated with smoking even after adjusting for ethnicity. The association of ethnicity and health outcomes reduced after adjusting for smoking, suggesting that the effect was mediated by smoking. CONCLUSIONS: In Leicester, Whites had poorer health outcomes than BMEs, which were not mediated by physical activity, diet and alcohol drinking but were mediated by smoking.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Disparidades nos Níveis de Saúde , Estilo de Vida/etnologia , Grupos Minoritários/psicologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/etnologia , Estudos Transversais , Dieta/etnologia , Inglaterra/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Exercício/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Fumar/etnologia
17.
JAMA Netw Open ; 2(3): e190864, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901043

RESUMO

Importance: Black African adults are disproportionately affected by HIV in the United Kingdom. Many within this population acquire HIV after migration or are diagnosed late. Data are needed to inform targeted interventions to increase HIV testing and prevention in this population. Objective: To inform future HIV prevention strategies by estimating diagnosed and undiagnosed HIV infection and measuring changes in HIV testing rates in black African adults in London, United Kingdom. Design, Setting, and Participants: This cross-sectional study used a self-completed survey conducted from September 20 to December 3, 2016. Questionnaires were linked to an optional, anonymous oral fluid HIV test and compared with data from a previous survey (2004). Respondents were recruited from social and commercial venues frequented by black African adults in London. Of 2531 individuals approached in 63 venues, 752 agreed to participate. Data were analyzed initially in March 2017 (as part of internal reporting) and again in August 2018. Main Outcomes and Measures: Self-reported HIV testing within the past 5 years; diagnosed and undiagnosed HIV prevalence. Logistic regression examined factors associated with HIV testing by sex. Results: In total, 292 women (median [interquartile range] age, 31 [25.0-41.5] years) and 312 men (median [interquartile range] age, 35 [25.0-41.5] years) were included in the analysis. More than half of men (159 [51.0%]) and women (154 [52.7%]) had been tested for HIV in the past 5 years. In multivariable analysis, HIV testing was associated with a range of factors in both sexes, including health service attendance, time in the United Kingdom, and sexually transmitted infection diagnosis. Increases in HIV testing in the past 5 years were observed between 2004 and 2016 for both sexes. In the 2016 sample, 219 of 235 women (93.2%) and 206 of 228 men (90.4%) tested HIV negative. Among those testing positive, 56.3% of women (9 of 16) and 40.9% of men (9 of 22) self-reported as HIV negative or untested, indicating they were living with undiagnosed HIV. A fifth of women (20.7%) and 25.0% of men reported condomless last sex with a partner of different or unknown HIV status in the past year. Conclusions and Relevance: Despite efforts to increase HIV testing, uptake in black African communities in London remains modest. This study identified a large fraction of undiagnosed infection-greater than other at-risk populations-suggesting that the prevention and care needs of this group are not adequately met.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Infecções por HIV/epidemiologia , Saúde Sexual/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Humanos , Londres/epidemiologia , Masculino , Comportamento Sexual/estatística & dados numéricos
18.
Drug Alcohol Depend ; 198: 112-115, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30903985

RESUMO

BACKGROUND: Marijuana is a commonly used recreational substance with purported analgesic and mood enhancing properties. Many people living with HIV identify marijuana as a palliative substance. However, through its main psychoactive component, tetrahydrocannabinol (THC), is known to influence the immune system. The effects of marijuana use in people with HIV are still controversial, with very scant literature in Black adults. METHODS: The current study determined the differences in the lymphocyte count, specifically the number cluster differentiation 4 and 8 (CD4+ and CD8+), among patients who urine drug tested negative for THC (n = 70) and those who tested positive for THC (n = 25). The sample included 95 Black people living with HIV, 51% female, with a mean age of 46 ± 11 years. Participants provided a urine sample for substance use testing and a trained researcher extracted clinical data from clinical charts on the day of appointment. RESULTS: After adjusting for demographic and HIV-related covariates, THC-positive patients had significantly higher CD4+ and CD8+ counts than their THC-negative counterparts. CONCLUSION: These results extend previous HIV-related immunity findings in an underrepresented group, and suggest that THC use does not reduce immune function as measured by CD count. Further research is warranted on the overall effects of THC on immune function in HIV positive patients.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Infecções por HIV/sangue , Abuso de Maconha/sangue , Uso da Maconha/sangue , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Dronabinol/urina , Feminino , HIV , Infecções por HIV/psicologia , Infecções por HIV/urina , Infecções por HIV/virologia , Humanos , Contagem de Linfócitos , Masculino , Abuso de Maconha/urina , Abuso de Maconha/virologia , Uso da Maconha/urina , Pessoa de Meia-Idade
19.
AIDS Behav ; 23(10): 2706-2709, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30874995

RESUMO

Racial and ethnic disparities exist in HIV pre-exposure prophylaxis (PrEP) awareness and care. We evaluated how racial and ethnic disparities in PrEP awareness among MSM presenting to a sexually transmitted disease clinic changed from 2013 to 2016. Among 1243 MSM (68% non-Hispanic White, 22% Hispanic, and 10% non-Hispanic Black), PrEP awareness increased overall, but awareness was lower among Hispanic and non-Hispanic Black MSM relative to non-Hispanic White MSM. Awareness converged among non-Hispanic Black and White MSM by 2016, but remained consistently lower among Hispanic MSM. Improved efforts are needed to address disparities in PrEP awareness.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Conscientização , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Infecções por HIV/etnologia , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
20.
Soc Psychiatry Psychiatr Epidemiol ; 54(7): 871-881, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30895353

RESUMO

OBJECTIVES: Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue. METHODS: We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders. PARTICIPANTS: Two hundred sixty-six patients with first episode psychosis, aged 18-64 years, who presented to mental health services in south London in 1997-1999 and 446 with FEP who presented in 2010-2012. RESULTS: When the two samples  were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80-8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52-6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56-6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71-3.98) and did not meet conventional levels for statistical significance. CONCLUSION: Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Transtornos Psicóticos/etnologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Londres , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Esquizofrenia/etnologia , Adulto Jovem
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