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BACKGROUND: The relationship between insufficient financial resources and psychological health has been extensively studied and established in various contexts. However, there remains uncertainty regarding the potential impact of the Nigerian naira currency redesign policy on the psychological well-being of Nigerians. This policy, which aimed to demonetize the economy and promote economic stability, involved changes to the physical appearance of some naira denominations (200, 500 and 1000). Understanding the effects of this policy on psychological health is essential for evaluating its overall societal impact and identifying potential areas for improvement in future currency redesign initiatives. METHODS: The study is a cross-sectional mixed-methods study involving 2237 respondents across the six geopolitical zones of Nigeria. Utilizing the simple random, snowball and convenience sampling technique, social media platforms (Facebook and WhatsApp) were used to recruit respondents. Variables were analyzed at descriptive and inferential levels. The qualitative component comprised seven (7) in-depth interviews with participants across the geo-political zones. RESULTS: The perceptions of respondents towards the policy were diverse across different demographic groups. It was widely perceived that the timing of the policy was inappropriate, considering the challenges faced in utilizing online payment platforms and the significant inaccessibility of cash. Furthermore, the analysis revealed that demographic variables played a role in explaining systematic variations in the experience of financial scarcity and its effect on psychological health during the cash crunch that ensued as a result of the Nigerian naira currency redesign policy. CONCLUSIONS: This study identified a significant association between the psychological inventory of financial scarcity and psychological well-being among residents in Nigeria during the cash crunch resulting from the Naira redesign policy. The findings suggest that the financial scarcity experienced by Nigerians due to the policy had a substantial impact on individuals' psychological well-being. We recommend that a holistic approach be undertaken by policymakers to ensure that policy actions not only address economic objectives but also safeguard the mental health and overall well-being of the population.
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Salud Mental , Humanos , Nigeria , Masculino , Femenino , Estudios Transversales , Adulto , Persona de Mediana Edad , Adulto Joven , Adolescente , Política Pública , Bienestar PsicológicoRESUMEN
We investigated the effects of cause of death and the presence of prolonged grief disorder (PGD) on eliciting public stigma toward the bereaved. Participants (N = 328, 76% female; Mage = 27.55 years) were randomly assigned to read one of four vignettes describing a bereaved man. Each vignette differed by his PGD status (PGD diagnosis or no PGD diagnosis) and his wife's cause of death (COVID-19 or brain hemorrhage). Participants completed public stigma measures assessing negative attributions, desired social distance, and emotional reactions. Bereavement with PGD (versus without PGD) elicited large and significantly stronger responses across all stigma measures. Both causes of death elicited public stigma. There was no interaction between cause of death and PGD on stigma. With increased PGD rates expected during the pandemic, the potential for public stigma and reduced social support for people bereaved via traumatic deaths and people with PGD requires mitigation.
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Aflicción , COVID-19 , Masculino , Humanos , Femenino , Adulto , Pesar , Estigma Social , Percepción SocialRESUMEN
We investigated the effects of cause of death (COVID-19 with an underlying medical condition vs. without) and prolonged grief disorder status (PGD present or absent) on participants' reported public stigma towards the bereaved. Participants (N = 304, 66% women; Mage = 39.39 years) were randomly assigned to read one of four vignettes describing a bereaved man. Participants completed stigma measures assessing negative attributions, desired social distance, and emotional reactions. Participants reported significantly stronger stigmatizing responses towards an individual with PGD (vs. without PGD) across all stigma measures. There was no significant difference in stigma based on cause of death; however, stigma was reported regardless of cause of death. There was no significant interaction between cause of death and PGD on stigma. This study supports the robust finding of public stigma being reported toward an individual with PGD, suggesting these individuals are at risk of public stigma and not receiving adequate bereavement support.
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VPS13A is a lipid transfer protein localized at different membrane contact sites between organelles, and mutations in the corresponding gene produce a rare neurodegenerative disease called chorea-acanthocytosis (ChAc). Previous studies showed that VPS13A depletion in HeLa cells results in an accumulation of endosomal and lysosomal markers, suggesting a defect in lysosomal degradation capacity leading to partial autophagic dysfunction. Our goal was to determine whether compounds that modulate the endo-lysosomal pathway could be beneficial in the treatment of ChAc. To test this hypothesis, we first generated a KO model using CRISPR/Cas9 to study the consequences of the absence of VPS13A in HeLa cells. We found that inactivation of VPS13A impairs cell growth, which precludes the use of isolated clones due to the undesirable selection of edited clones with residual protein expression. Therefore, we optimized the use of pool cells obtained shortly after transfection with CRISPR/Cas9 components. These cells are a mixture of wild-type and edited cells that allow a comparative analysis of phenotypes and avoids the selection of clones with residual level of VPS13A expression after long-term growth. Consistent with previous observations by siRNA inactivation, VPS13A inactivation by CRISPR/Cas9 resulted in accumulation of the endo-lysosomal markers RAB7A and LAMP1. Notably, we observed that rapamycin partially suppressed the difference in lysosome accumulation between VPS13A KO and WT cells, suggesting that modulation of the autophagic and lysosomal pathway could be a therapeutic target in the treatment of ChAc.
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Neuroacantocitosis , Enfermedades Neurodegenerativas , Humanos , Proteínas de Transporte Vesicular/genética , Proteínas de Transporte Vesicular/metabolismo , Sistemas CRISPR-Cas/genética , Células HeLa , Sirolimus/farmacología , Enfermedades Neurodegenerativas/metabolismo , Lisosomas/metabolismo , Neuroacantocitosis/genética , Neuroacantocitosis/metabolismoRESUMEN
Background The human cerebellum has a large, highly folded cortical sheet. Its visualization is important for various disorders, including multiple sclerosis and spinocerebellar ataxias. The derivation of the cerebellar cortical surface in vivo is impeded by its high foliation. Purpose To image the cerebellar cortex, including its foliations and lamination, in less than 20 minutes, reconstruct the cerebellocortical surface, and extract cortical measures with use of motion-corrected, high-spatial-resolution 7.0-T MRI. Materials and Methods In this prospective study, conducted between February 2021 and July 2022, healthy participants underwent an examination with either a 0.19 × 0.19 × 0.5-mm3, motion-corrected fast low-angle shot (FLASH) sequence (14.5 minutes) or a whole-cerebellum 0.4 × 0.4 × 0.4-mm3, motion-corrected magnetization-prepared 2 rapid gradient-echo (MP2RAGE) sequence (18.5 minutes) at 7.0 T. Four participants underwent an additional FLASH sequence without motion correction. FLASH and MP2RAGE sequences were used to visualize the cerebellar cortical layers, derive cerebellar gray and white matter segmentations, and examine their fidelity. Quantitative measures were compared using repeated-measures analyses of variance or paired t tests. Results Nine participants (median age, 36 years [IQR, 25-42 years; range, 21-62 years]; five women) underwent examination with the FLASH sequence. Nine participants (median age, 37 years [IQR, 34-42 years; range, 25-62 years]; five men) underwent examination with the MP2RAGE sequence. A susceptibility difference between the expected location of the granular and molecular cerebellar layers was visually detected in the FLASH data in all participants. The segmentations derived from the whole-cerebellum MP2RAGE sequence showed the characteristic anatomic features of the cerebellum, like the transverse fissures and splitting folds. The cortical surface area (median, 949 cm2 [IQR, 825-1021 cm2]) was 1.8 times larger, and the cortical thickness (median, 0.88 mm [IQR, 0.81-0.93 mm]) was five times thinner than previous in vivo estimates and closer to ex vivo reference data. Conclusion In vivo imaging of the cerebellar cortical layers and surface and derivation of quantitative measures was feasible in a clinically acceptable acquisition time with use of motion-corrected 7.0-T MRI. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Dietrich in this issue.
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Esclerosis Múltiple , Sustancia Blanca , Masculino , Humanos , Femenino , Adulto , Estudios Prospectivos , Imagen por Resonancia Magnética/métodos , Cerebelo/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Esclerosis Múltiple/diagnóstico por imagen , Encéfalo/anatomía & histologíaRESUMEN
BACKGROUND: Olaparib is given in a fixed dose of twice-daily 300 mg in patients who are diagnosed with ovarian cancer, breast cancer, prostate cancer or pancreas cancer and has a high interpatient variability in pharmacokinetic exposure. The objective of this study was to investigate whether pharmacokinetic exposure of olaparib is related to efficacy and safety in a real-life patient' cohort. METHODS: A longitudinal observational study was conducted in patients who received olaparib for metastatic ovarian cancer of whom pharmacokinetic samples were collected. A Kaplan-Meier analyses was used to explore the relationship between olaparib exposure, measured as (calculated) minimum plasma concentrations (Cmin), and efficacy, Univariate and multivariate cox-regression analyses were performed. Also, the Cmin of patients who experienced toxicity was compared with patients who did not experience any toxicity. RESULTS: Thirty-five patients were included in the exposure-efficacy analyses, with a median olaparib Cmin of 1514 ng/mL. There was no statistical significant difference in PFS of patients below and above the median Cmin concentration of olaparib, with a hazard ratio of 1.06 (95% confidence interval: 0.46-2.45, p = 0.9)). For seven patients pharmacokinetic samples were available before toxicity occurred, these patients had a higher Cmin of olaparib in comparison with patients who had not experienced any toxicity (n = 33), but it was not statistically significant (p = 0.069). CONCLUSIONS: Our study shows that exposure of olaparib is not related to PFS. This suggests that the approved dose of olaparib yields sufficient target inhibition in the majority of patients.
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Neoplasias Ováricas , Masculino , Humanos , Femenino , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Ftalazinas/efectos adversos , Piperazinas/efectos adversos , Estimación de Kaplan-MeierRESUMEN
BACKGROUND: Abiraterone acetate is an irreversible 17α-hydroxylase/C17, 20-lyase (CYP17) inhibitor approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC) patients. Inhibition of this enzyme leads to low testosterone and cortisol levels in blood. There is growing evidence that clinical efficacy of abiraterone is related to the rate of suppression of serum testosterone. However, quantification of very low levels of circulating testosterone is challenging. We therefore aimed to investigate whether circulating cortisol levels could be used as a surrogate biomarker for CYP17 inhibition in patients with mCRPC treated with abiraterone acetate. PATIENTS AND METHODS: mCRPC patients treated with abiraterone acetate were included. Abiraterone and cortisol levels were measured with a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS). On treatment cortisol and abiraterone concentrations were related to treatment response and progression free survival. RESULTS: In total 117 patients were included with a median cortisol concentration of 1.13 ng/ml (range: 0.03 - 82.2) and median abiraterone trough concentration (Cmin) of 10.2 ng/ml (range: 0.58 - 92.1). In the survival analyses, abiraterone Cmin ≥ 8.4 ng/mL and cortisol < 2.24 ng/mL were associated with a longer prostate-specific antigen (PSA) independent progression-free survival than patients with an abiraterone concentration ≥ 8.4 ng/mL and a cortisol concentration ≥ 2.24 ng/mL (13.8 months vs. 3.7 months). CONCLUSION: Our study shows that cortisol is not an independent predictor of abiraterone response in patients with mCRPC, but it is of added value in combination with abiraterone levels, to predict a response on abiraterone.
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Acetato de Abiraterona , Neoplasias de la Próstata Resistentes a la Castración , Masculino , Humanos , Acetato de Abiraterona/uso terapéutico , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Hidrocortisona , Esteroide 17-alfa-Hidroxilasa , Cromatografía Liquida , Espectrometría de Masas en Tándem , Resultado del Tratamiento , Antígeno Prostático Específico/uso terapéutico , Testosterona/uso terapéuticoRESUMEN
The aim of this review was to map the literature assessing associations between maternal or infant immune or gut microbiome biomarkers and child neurodevelopmental outcomes within the first 5 years of life. We conducted a PRISMA-ScR compliant review of peer-reviewed, English-language journal articles. Studies reporting gut microbiome or immune system biomarkers and child neurodevelopmental outcomes prior to 5 years were eligible. Sixty-nine of 23,495 retrieved studies were included. Of these, 18 reported on the maternal immune system, 40 on the infant immune system, and 13 on the infant gut microbiome. No studies examined the maternal microbiome, and only one study examined biomarkers from both the immune system and the gut microbiome. Additionally, only one study included both maternal and infant biomarkers. Neurodevelopmental outcomes were assessed from 6 days to 5 years. Associations between biomarkers and neurodevelopmental outcomes were largely nonsignificant and small in effect size. While the immune system and gut microbiome are thought to have interactive impacts on the developing brain, there remains a paucity of published studies that report biomarkers from both systems and associations with child development outcomes. Heterogeneity of research designs and methodologies may also contribute to inconsistent findings. Future studies should integrate data across biological systems to generate novel insights into the biological underpinnings of early development.
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Microbioma Gastrointestinal , Lactante , Niño , Humanos , Desarrollo Infantil , Encéfalo , Sistema Inmunológico , BiomarcadoresRESUMEN
ISSUES ADDRESSED: Fathers remain less likely to participate in parenting interventions which can limit their ability to receive support and build their parenting capacity. The advent of social media has engendered novel opportunities for fathers to connect with, and support, one another in the form of online peer support. Growth of these online communities exemplifies the demand from fathers to relate to other fathers who are navigating parenthood. However, the benefits of membership to these communities remain unclear. This study evaluated the perceived benefits of members of an online father-to-father, community-created and moderated Facebook group designed for Australian fathers in both rural and metropolitan regions. METHODS: One-hundred and forty-five Australian fathers (aged 23-72 years) who were members of the same online fathering community completed an online survey where they qualitatively described their experiences as members of this community. RESULTS: Content analysis of open-ended survey questions revealed that fathers identified a series of unique and important personal and familial benefits, which were largely attributed to their ability to connect with fellow fathers. Specifically, the opportunity to have convenient access to a safe space for fathers to connect was highly valued, providing fathers with opportunities to support, discuss and normalise parenting experiences. CONCLUSIONS: Online father-to-father connection is a highly valued resource for fathers who are navigating parenthood. SO WHAT?: Online, community-led groups for fathers contribute to perceptions of genuineness and ownership by its members and provide a unique opportunity to connect and seek support for parenting.
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Padre , Medios de Comunicación Sociales , Masculino , Humanos , Australia , Responsabilidad Parental , Encuestas y CuestionariosRESUMEN
PURPOSE: Single-voxel MRS (SV MRS) requires robust volume localization as well as optimized crusher and phase-cycling schemes to reduce artifacts arising from signal outside the volume of interest. However, due to local magnetic field gradients (B0 inhomogeneities), signal that was dephased by the crusher gradients during acquisition might rephase, leading to artifacts in the spectrum. Here, we analyzed this mechanism, aiming to identify the source of signals arising from unwanted coherence pathways (spurious signals) in SV MRS from a B0 map. METHODS: We investigated all possible coherence pathways associated with imperfect localization in a semi-localized by adiabatic selective refocusing (semi-LASER) sequence for potential rephasing of signals arising from unwanted coherence pathways by a local magnetic field gradient. We searched for locations in the B0 map where the signal dephasing due to external (crusher) and internal (B0 ) field gradients canceled out. To confirm the mechanism, SV-MR spectra (TE = 31 ms) and 3D-CSI data with the same volume localization as the SV experiments were acquired from a phantom and 2 healthy volunteers. RESULTS: Our analysis revealed that potential sources of spurious signals were scattered over multiple locations throughout the brain. This was confirmed by 3D-CSI data. Moreover, we showed that the number of potential locations where spurious signals could originate from monotonically decreases with crusher strength. CONCLUSION: We proposed a method to identify the source of spurious signals in SV 1 H MRS using a B0 map. This can facilitate MRS sequence design to be less sensitive to experimental artifacts.
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Artefactos , Imagen por Resonancia Magnética , Encéfalo/diagnóstico por imagen , Humanos , Campos Magnéticos , Imagen por Resonancia Magnética/métodos , Fantasmas de ImagenRESUMEN
In a standard spin echo, the time evolution due to homonuclear couplings is not reversed, leading to echo time (TE)-dependent modulation of the signal amplitude and signal loss in the case of overlapping multiplet resonances. This has an adverse effect on quantification of several important metabolites such as glutamate and glutamine. Here, we propose a J-refocused variant of the sLASER sequence (J-sLASER) to improve quantification of J-coupled metabolites at ultrahigh field (UHF). The use of the sLASER sequence is particularly advantageous at UHF as it minimizes chemical shift displacement error and results in relatively homogenous refocusing. We simulated the MRS signal from brain metabolites over a broad range of TE values with sLASER and J-sLASER, and showed that the signal of J-coupled metabolites was increased with J-sLASER with TE values up to ~80 ms. We further simulated "brain-like" spectra with both sequences at the shortest TE available on our scanner. We showed that, despite the slightly longer TE, the J-sLASER sequence results in significantly lower Cramer-Rao lower bounds (CRLBs) for J-coupled metabolites compared with those obtained with sLASER. Following phantom validation, we acquired spectra from two brain regions in 10 healthy volunteers (age 38 ± 15 years) using both sequences. We showed that using J-sLASER results in a decrease of CRLBs for J-coupled metabolites. In particular, we measured a robust ~38% decrease in the mean CRLB (glutamine) in parietal white matter and posterior cingulate cortex (PCC). We further showed, in 10 additional healthy volunteers (age 34 ± 15 years), that metabolite quantification following two separate acquisitions with J-sLASER in the PCC was repeatable. The improvement in quantification of glutamine may in turn improve the independent quantification of glutamate, the main excitatory neurotransmitter in the brain, and will simultaneously help to track possible modulations of glutamine, which is a key player in the glutamatergic cycle in astrocytes.
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Ácido Glutámico , Glutamina , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Glutamina/metabolismo , Espectroscopía de Resonancia Magnética/métodos , Límite de Detección , Ácido Glutámico/metabolismo , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismoRESUMEN
The increased signal-to-noise ratio (SNR) and chemical shift dispersion at high magnetic fields (≥7 T) have enabled neuro-metabolic imaging at high spatial resolutions. To avoid very long acquisition times with conventional magnetic resonance spectroscopic imaging (MRSI) phase-encoding schemes, solutions such as pulse-acquire or free induction decay (FID) sequences with short repetition time and inner volume selection methods with acceleration (echo-planar spectroscopic imaging [EPSI]), have been proposed. With the inner volume selection methods, limited spatial coverage of the brain and long echo times may still impede clinical implementation. FID-MRSI sequences benefit from a short echo time and have a high SNR per time unit; however, contamination from strong extra-cranial lipid signals remains a problem that can hinder correct metabolite quantification. L2-regularization can be applied to remove lipid signals in cases with high spatial resolution and accurate prior knowledge. In this work, we developed an accelerated two-dimensional (2D) FID-MRSI sequence using an echo-planar readout and investigated the performance of lipid suppression by L2-regularization, an external crusher coil, and the combination of these two methods to compare the resulting spectral quality in three subjects. The reduction factor of lipid suppression using the crusher coil alone varies from 2 to 7 in the lipid region of the brain boundary. For the combination of the two methods, the average lipid area inside the brain was reduced by 2% to 38% compared with that of unsuppressed lipids, depending on the subject's region of interest. 2D FID-EPSI with external lipid crushing and L2-regularization provides high in-plane coverage and is suitable for investigating brain metabolite distributions at high fields.
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Imagen Eco-Planar , Protones , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Imagen Eco-Planar/métodos , Humanos , Lípidos/química , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética/métodosRESUMEN
BACKGROUND: Parkinson's disease (PD) causes a loss of neuromelanin-positive, noradrenergic neurons in the locus coeruleus (LC), which has been implicated in nonmotor dysfunction. OBJECTIVES: We used "neuromelanin sensitive" magnetic resonance imaging (MRI) to localize structural disintegration in the LC and its association with nonmotor dysfunction in PD. METHODS: A total of 42 patients with PD and 24 age-matched healthy volunteers underwent magnetization transfer weighted (MTw) MRI of the LC. The contrast-to-noise ratio of the MTw signal (CNRMTw ) was used as an index of structural LC integrity. We performed slicewise and voxelwise analyses to map spatial patterns of structural disintegration, complemented by principal component analysis (PCA). We also tested for correlations between regional CNRMTw and severity of nonmotor symptoms. RESULTS: Mean CNRMTw of the right LC was reduced in patients relative to controls. Voxelwise and slicewise analyses showed that the attenuation of CNRMTw was confined to the right mid-caudal LC and linked regional CNRMTw to nonmotor symptoms. CNRMTw attenuation in the left mid-caudal LC was associated with the orthostatic drop in systolic blood pressure, whereas CNRMTw attenuation in the caudal most portion of right LC correlated with apathy ratings. PCA identified a bilateral component that was more weakly expressed in patients. This component was characterized by a gradient in CNRMTw along the rostro-caudal and dorso-ventral axes of the nucleus. The individual expression score of this component reflected the overall severity of nonmotor symptoms. CONCLUSION: A spatially heterogeneous disintegration of LC in PD may determine the individual expression of specific nonmotor symptoms such as orthostatic dysregulation or apathy. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Neuronas Adrenérgicas , Enfermedad de Parkinson , Neuronas Adrenérgicas/patología , Humanos , Locus Coeruleus/metabolismo , Imagen por Resonancia Magnética/métodos , Movimiento , Enfermedad de Parkinson/complicacionesRESUMEN
BACKGROUND: The World Health Organization recommends quinine plus clindamycin as first-line treatment of malaria in the first trimester of pregnancy and as a second-line treatment for uncomplicated falciparum malaria when artemisinin-based drug combinations are not available. The efficacy of quinine plus clindamycin was compared with that of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in children below 5 years of age. METHODS: An open-label, phase 3, randomized trial was conducted in western Kenya. Children aged 6-59 months with uncomplicated falciparum malaria were randomly assigned (1:1) via a computer-generated randomization list to receive 3 days of twice a day treatment with either oral quinine (20 mg/kg/day) plus clindamycin (20 mg/kg/day) or artemether-lumefantrine (artemether 20 mg, lumefantrine 120 mg) as one (for those weighing 5-14 kg) or two (for those weighing 15-24 kg) tablets per dose. The primary outcome was a PCR-corrected rate of adequate clinical and parasitological response (ACPR) on day 28 in the per-protocol population. RESULTS: Of the 384 children enrolled, 182/192 (94.8%) receiving quinine plus clindamycin and 171/192 (89.1%) receiving artemether-lumefantrine completed the study. The PCR-corrected ACPR rate was 44.0% (80 children) in the quinine plus clindamycin group and 97.1% (166 children) in the artemether-lumefantrine group (treatment difference - 53.1%, 95% CI - 43.5% to - 62.7%). At 72 h after starting treatment, 50.3% (94 children) in the quinine plus clindamycin group were still parasitaemic compared with 0.5% (1 child) in the artemether-lumefantrine group. Three cases of severe malaria were recorded as serious adverse events in the quinine plus clindamycin group. CONCLUSIONS: The study found no evidence to support the use of a 3-day low dose course of quinine plus clindamycin in the treatment of uncomplicated falciparum malaria in children under 5 years of age in Kenya, where artemether-lumefantrine is still effective. TRIAL REGISTRATION: This trial is registered with the Pan-African Clinical Trials Registry, PACTR20129000419241.
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Combinación Arteméter y Lumefantrina/uso terapéutico , Clindamicina/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Quinina/uso terapéutico , Combinación Arteméter y Lumefantrina/efectos adversos , Preescolar , Clindamicina/efectos adversos , Quimioterapia Combinada , Femenino , Humanos , Lactante , Kenia , Masculino , Quinina/efectos adversosRESUMEN
Expanding index and family-based testing (HBT) is a priority for identifying children living with HIV. Our study characterizes predictors that drive testing location choice for children of parents living with HIV. Kenyan adults living with HIV were offered a choice of HBT or clinic-based testing (CBT) for any of their children (0-12 years) of unknown HIV status. Multilevel generalized linear models were used to identify correlates of choosing HBT or CBT for children and testing all versus some children within a family, including caregiver demographics, HIV history, social support, cost, and child demographics and HIV prevention history. Among 244 caregivers living with HIV and their children of unknown HIV status, most (72%) caregivers tested children using CBT. In multivariate analysis, female caregivers [aRR 0.52 (95% CI 0.34-0.80)] were less likely to choose HBT than male caregivers. Caregivers with more children requiring testing [aRR 1.23 (95% CI 1.05-1.44)] were more likely to choose HBT than those with fewer children requiring testing. In subgroup univariate analysis, female caregivers with a known HIV negative spouse were significantly more likely to choose HBT over CBT than those with a known HIV positive spouse [RR 2.57 (95% CI 1.28-5.14), p = 0.008], no association was found for male caregivers. Child demographics and clinical history was not associated with study outcomes. Caregiver-specific factors were more influential than child-specific factors in caregiver choice of pediatric HIV testing location. Home-based testing may be preferable to families with higher child care needs and may encourage pediatric HIV testing if offered as an alternative to clinic testing.
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Cuidadores , Infecciones por VIH , Prueba de VIH , Adulto , Niño , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Prueba de VIH/métodos , Humanos , Kenia/epidemiología , Masculino , Apoyo SocialRESUMEN
In view of the mounting death toll of COVID-19 worldwide and the complicating circumstances that commonly accompany such losses, we studied the grief experiences of 209 adult mourners who lost a loved one to coronavirus with a focus on self-blaming emotions and unresolved issues with the deceased. We found universal endorsement of one or more forms of self-blame (guilt, regret, shame) or unfinished business (UB), with over one-third of mourners endorsing all four experiences. Those having a closer relationship to the deceased reported both greater distress over UB and more intense and dysfunctional grief symptomatology. Strikingly, unresolved conflict, a major dimension of UB, accounted for nearly 40% of the unique variance in problematic grief, which bore no relation to time since the loss.
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Aflicción , COVID-19 , Adulto , Emociones , Pesar , Culpa , Humanos , VergüenzaRESUMEN
Parental assistance with children's emotion regulation (ER) is a form of emotion socialization behavior that has recently been operationalized with the development of the Parent Assistance with Child Emotion Regulation (PACER) questionnaire. In line with Eisenberg et al.'s heuristic model of the socialization of emotion, this study sought to test the links between mothers' ER difficulties, their use of ER strategies with their child, and child irritability - a salient dimension of child regulatory difficulties. Cross-sectional data was collected online with mothers (N = 371) of children aged one month to 5 years (M = 2.07 years, SD = 1.25) and data were analysed using hierarchical multiple regression analysis. After controlling for child age and gender, maternal distress, and household income, we found small but significant associations between maternal ER difficulties and child irritability. However, maternal use of ER strategies did not account for further variance in child irritability. These findings suggest that there are meaningful associations between maternal ER and child irritability, although maternal strategies to support child ER appear independent of their own ER capacity. Whilst not associated with child irritability, maternal support for children's ER may be associated with other indicators of mental health risk and resilience.
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The COVID-19 pandemic, coupled with significant social changes due to legislative and public health requirements, has changed the way in which people experience grief. We examined whether dysfunctional grief symptoms, disrupted meaning, risk factors, and functional impairment differed between people bereaved from COVID-19 and from other natural or violent causes in this same period. A sample of 409 participants (67.73% male; M = 37.54 years) completed an online survey in June 2021. There were no statistically significant differences between the three groups on any of the outcome variables; all three groups manifested clinical levels of functional impairment equal to or greater than bereaved groups diagnosed with complicated or prolonged grief disorder prior to the pandemic. Disrupted meaning partially mediated the relationship between risk factors on the one hand and functional impairment and dysfunctional grief symptoms on the other. Findings indicate that deaths during COVID-19, rather than deaths from COVID-19, may precipitate symptoms of significant clinical concern.
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Aflicción , COVID-19 , Causas de Muerte , Femenino , Pesar , Humanos , Masculino , Pandemias , Factores de Riesgo , SARS-CoV-2RESUMEN
OBJECTIVE: A multiplex gyrB PCR assay has been used to diagnose Acinetobacter baumannii. However, this assay has not been validated against the gold standard DNA-DNA hybridization assay, which is a laborious method. DNA-DNA hybridization assay is now replaced by whole genome sequence (WGS)-based methods. Two such methods are a k-mer-based search of sequence reads using the Kraken 2 program and average nucleotide identity (ANI). The objective was to validate the gyrB PCR assay with WGS-based methods. SUBJECTS AND METHODS: We cultured 270 sequential A. baumannii isolates from the rectal swabs of 32 adult patients. The identity of the isolates was determined by gyrB PCR. The sequences of 269 isolates were determined by Illumina sequencing and the taxonomy was inferred by the Kraken 2 program and ANI. RESULTS: All the 269 isolates were confirmed as A. baumannii by Kraken 2 and ANI. CONCLUSION: The gyrB PCR assay is now validated for easy identification of A. baumannii in comparison with gold standard WGS-based assays.
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Infecciones por Acinetobacter , Acinetobacter baumannii , Adulto , Humanos , Acinetobacter baumannii/genética , Infecciones por Acinetobacter/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , ADN , AntibacterianosRESUMEN
We analyse the time-series evolution of the cumulative number of confirmed cases of COVID-19, the novel coronavirus disease, for some African countries. We propose a mathematical model, incorporating non-pharmaceutical interventions to unravel the disease transmission dynamics. Analysis of the stability of the model's steady states was carried out, and the reproduction number R 0 , a vital key for flattening the time-evolution of COVID-19 cases, was obtained by means of the next generation matrix technique. By dividing the time evolution of the pandemic for the cumulative number of confirmed infected cases into different regimes or intervals, hereafter referred to as phases, numerical simulations were performed to fit the proposed model to the cumulative number of confirmed infections for different phases of COVID-19 during its first wave. The estimated R 0 declined from 2.452-9.179 during the first phase of the infection to 1.374-2.417 in the last phase. Using the Atangana-Baleanu fractional derivative, a fractional COVID-19 model is proposed and numerical simulations performed to establish the dependence of the disease dynamics on the order of the fractional derivatives. An elasticity and sensitivity analysis of R 0 was carried out to determine the most significant parameters for combating the disease outbreak. These were found to be the effective disease transmission rate, the disease diagnosis or case detection rate, the proportion of susceptible individuals taking precautions, and the disease infection rate. Our results show that if the disease infection rate is less than 0.082/day, then R 0 is always less than 1; and if at least 55.29% of the susceptible population take precautions such as regular hand washing with soap, use of sanitizers, and the wearing of face masks, then the reproduction number R 0 remains below unity irrespective of the disease infection rate. Keeping R 0 values below unity leads to a decrease in COVID-19 prevalence.