Aid Groups Research Articles

Health‐Related Quality of Life in Romanian Cochlear Implanted Patients

Objective: Cochlear implants are a well-established treatment method in severe to profound hearing loss. It is important to assess the benefits in term of health-related quality of life (HR QoL) not only on auditory-verbal performances. Method: We compared the HRQoL between a hearing aid group (50 patients) and a cochlear implant group (84 patients), split into 2 subgroups, according to the age of implantation. We used the Nijmegen HRQoL questionnaire. All implanted patients had MedEl devices and more than 6 months experience with the speech processor. Results: Although there were differences between children with hearing aids and children with implants in all areas of HRQoL, in the physical area these differences were greater than for psychological and social domains. HRQoL was positively correlated with auditory performance and speech intelligibility and negatively correlated with implantation age. Good auditory performance and speech intelligibility had a positive influence on HRQoL. The correlation coefficient, R = 0.78, indicates a very good linear and directly proportional correlation between the 3 variables, implantation age, SIR, and CAP and HRQoL. A total of 59.5% of quality of life’s variation is explained by the variation of these 3 parameters. Conclusion: Cochlear implant improves the auditory performance and speech production more than hearing aids. Children implanted at a younger age develop better than older patients, but even the older patients demonstrate good performances if they are properly selected. Associated diseases had a negative effect on outcomes, but cochlear implants improve their quality of life.

One-Year Follow-up of Non-institutionalized Dependent Older Adults: Mortality, Hospitalization, and Mobility

Non-institutionalized dependent older adults present high morbidity and mortality, demand care from their families, and consume primary health care resources. To expand knowledge about this group, we conducted a population-based one-year prospective cohort study of 130 non-institutionalized dependent older persons (age 60 and older), stratified according to baseline mobility: independent walking (group A), use of walking aids (group B), and bedridden or confined to a wheelchair (group C). The outcomes analysed were death, hospitalization, and mobility disability. Total mortality was 8.5 per cent (p = .05). Overall hospitalization rate was 34.6 per cent; the main causes were stroke and pneumonia. After one year, there was a decline in the proportion of subjects classified as independent walking (57% vs. 43%; p = .03). We conclude that there was a high rate of mortality and hospitalization in this group of dependent older people, and an increase in disability after a one-year follow-up.

Structural Characterization of Hemicellulosic Polysaccharides Isolated from Bamboo (Phyllostachys pubescens Mazel)

In the present work water soluble hemicellulosic polysaccharides HPW, 2% NaOH soluble hemicelluloses HPl and HPlll, and 5% KOH soluble fractions HPll and HPlV, were classically separated from bamboo (Phyllostachys pubescens Mazel) aged one year. In addition to sugar composition analysis, the hemicelluloses were also elucidated by GPC, FTIR, NMR and AFM techniques. Xylose (33.70-74.09%) and arabinose (25.03-59.04%) were the main neutral sugar, with ratios of arabinose to xylose being between 0.34 and 1.70. GPC measurement showed that the fractions HPW, HPlll and HPlV precipitated in ethanol presented much broader molecular weight distribution. FTIR and NMR analysis suggested that the bamboo hemicelluloses could be mainly defined as arabinoxylans substituted by (1→2)-linked 4-O-methyl-α-D-glucuronic aid and acetyl group as side chains. AFM images of HPlll revealed a distribution of both island and rod aggregations when 0.01 mg/mL sample in 0.1 M NH4Ac solution was deposited onto freshly cleared mica and air dried.

Afghanistan: Voiceless and Displaced

Afghanistan: Voiceless and Displaced

BASHH Scotland/Scottish HIV and AIDS group national audit 2009–2010: sexual health care for people living with HIV

A national Scottish audit of 282 patients with HIV infection attending 11 clinics showed the following levels of performance against quality improvement Scotland Sexual Health Services Standards: syphilis serology was offered in the previous six months to 55% of patients (range: 12-97% of patients in individual clinics), sexual history documented within four weeks of initial HIV diagnosis in 67% (12-100%) and offer of tests for sexually transmitted infections (STIs) documented within four weeks of HIV diagnosis in 45% (4-96%). Considerable variation in performance exists between clinics. The audit prompted interventions to further improve the sexual health care of people living with HIV infection.

Movement Patterns in Free Water Play after Swimming Teaching with Flotation Aids

The aim of this study was to investigate the movement patterns of children during free play in a swimming school setting. It was hypothesized that children being taught using flotation vests would be less likely to surface dive, jump, and dive during free play. In this study, 24 participants were observed using a video camera during a 10-minutes free play at the end of a learn-to-swim session. Each subject had undergone 10 lessons either using a flotation vest (n = 11) or without (n = 13). The results showed that the flotation aid group (FLOAT) had significantly fewer surface dives (p=0.006, using a two sample t-test) compared to the control group (CON) and that FLOAT asked for flotation toys significantly more than CON (p = 0.03). No statistically significant differences between groups were observed for breathing, diving, and water entry skills, and the distance moved on land in water due to low statistical power, but FLOAT participants seemed to be less likely to do vertically-oriented movements. We concluded that children learning to swim using flotation aids had a tendency to move more horizontally during free play, and to not choose vertical axis movements (jumping and surface diving), compared to children being taught without the flotation vest.

SMART Recovery: Self-Empowering, Science-Based Addiction Recovery Support

Self-Management and Recovery Training (SMART Recovery) is an international nonprofit organization that provides free, self-empowering, science-based mutual aid groups for abstaining from any substance or activity addiction. This article summarizes the development of the organization, the current status of face-to-face and online meetings, the characteristics of participants, the nature of the SMART Recovery approach to recovery (i.e., the intersection of what is self-empowering, evidence-based, and likely to be of use in a mutual aid group facilitated by a nonprofessional volunteer), the limited evidence of effectiveness currently available, and some of the prominent questions in need of investigation about SMART Recovery.

Commentary: Can mortality rates among adult antiretroviral therapy patients in Europe reach levels similar to those experienced in the general population?

Since 1996, widespread availability of combination antiretroviral therapy (ART) has significantly improved survival of HIV-infected persons in industrialized countries. This has prompted researchers in Europe and North America to investigate whether mortality among HIV-infected persons receiving ART might reach levels similar to those in the general population. In this paper by Lewden et al., more than 80 000 patients from 31 European countries are included in an analysis to estimate crude ART patient mortality rates for persons 518 years of age, who initiated ART during 1998–2008, had a known gender and date of birth, known baseline CD4þ T-cell (CD4) count, and 51 follow-up visit. The standardized mortality ratio (SMR) is used to compare mortality between ART patients and the general population. The SMR is the ratio of the observed number of deaths in the ART cohorts to the expected number of deaths if ART cohorts had experienced general population country-, calendar-year-, gender-, and age-specific mortality. SMRs were estimated using random effects Poisson models, adjusted for age, gender, HIV transmission group and history of AIDS at ART start. The overall ART patient mortality rate of 1.2 per 100 person years (PY) is similar to that recently reported for 13 cohorts from nine countries in Europe and North America (0.95/100 PY for the period 2001– 2009) and 23 cohorts from 10 European countries, Australia and Canada (0.86/100 PY for the period 2004–2006), supporting previous estimates that average annual risk of death for ART patients has declined since 1996–2001, when estimates of about 3/100 PY were reported. The authors were specifically interested in assessing whether ART patient mortality could reach levels similar to those experienced in the general population, if ART patients achieved and maintained CD4 counts 5500/mm. This article builds on previous work by Lewden et al. in 2007, which reported that ART patients in a French cohort, who maintained CD4 counts 5500/mm, had mortality rates similar to those of the general population 6 years after ART start. In this analysis, only certain subgroups of patients who achieved CD4 counts 5500/mm reached mortality rates similar to those observed in the general population. First, among all male ART patients, who achieved and maintained a CD4 count 5500/mm for 53 years, mortality was similar to that of males in the general population [SMR 1.0, 95% confidence interval (CI) 0.8–1.4]. In contrast, mortality among all female ART patients, who achieved a CD4 count 5500/mm, was always higher than that of females in the general population, even after 5 years with a CD4 count 5500/mm. Higher SMRs among females compared with males has been documented in other studies. Authors suggest that differences in the prevalence of low socio-economic status (SES) and/ or smoking between HIV-infected and uninfected persons may be more pronounced for females than males and this might explain the higher SMRs for females. Adjustment of SMRs for SES indicators and smoking burden, variables not available to authors for this analysis, would be needed to further investigate SMR differences by sex. Secondly, among the subgroup of non-injection drug users (non-IDUs) with a CD4 count 5500/mm, males immediately on achieving this CD4 threshold (SMR 0.9, 95% CI 0.7–1.2), and females after 3 years in this CD4 stratum (SMR 1.1, 95% CI 0.7–1.7), had similar mortality rates to those in the Published by Oxford University Press on behalf of the International Epidemiological Association 2012. International Journal of Epidemiology 2012;1–2

Travelers as Sentinels for Chikungunya Fever, Brazil

Travelers as Sentinels for Chikungunya Fever, Brazil

HBV/HIV co-infection: The dynamics of HBV in South African patients with AIDS

As sub-Saharan Africa is highly endemic for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections, and their co-infection requires special management, we aimed to assess the serological and molecular characteristics of HBV in patients with AIDS. This was a cross-sectional, case control study, which enrolled 200 patients with AIDS and 200 HIV-negative controls. HBV serology was done in all participants and HCV serology in participants with a hepatitis B core antibody (anti-HBc) only serological pattern. Nested HBV polymerase chain reaction (PCR) and HBV viral load assays were used for HBV molecular detection. Hepatitis B surface antigen (HBsAg) prevalence was 3-fold higher while the 'anti-HBc only' pattern was 6-fold higher in the AIDS group compared with the controls. Mean HBV viral load was significantly higher in HBsAg-positive patients with CD4+ cell counts <100 cells/μl than in patients with CD4+ cell counts of 100-200 cells/μl (p=0.019). There were markedly reduced hepatitis B surface antibody (anti-HBs) titres in the AIDS group compared with the controls (p=0.002). A significant proportion of AIDS patients with an 'anti-HBc only' pattern had CD4+ cell counts <100 cells/μl (p=0.004). Occult HBV prevalence was 3.5% in the AIDS group compared with 1% in the controls (p=0.092). When occult HBV infection was taken into consideration, the overall HBV prevalence became 10% in the AIDS group and 3% in the control group. We showed an increased HBV prevalence in patients with AIDS and identified a CD4+ cell count <100 cells/μl as a major risk factor for the 'anti-HBc only' pattern and increased HBV replication. These data have significant public health implications for HBV in developing countries, especially in areas where antiretroviral (ARV) guidelines do not cater for HBV/HIV co-infection.

Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty

To examine the impact of a videobooklet patient decision aid supplemented by an interactive values clarification exercise on decisional conflict in patients with knee osteoarthritis (OA) considering total knee arthroplasty. A total of 208 patients participated in the study (mean age 63 years, 68% female, and 66% white). Participants were randomized to 1 of 3 groups: 1) educational booklet on OA management (control), 2) patient decision aid (videobooklet) on OA management, and 3) patient decision aid (videobooklet) + adaptive conjoint analysis (ACA) tool. The ACA tool enables patients to consider competing attributes (i.e., specific risks/benefits) by asking them to rate a series of paired comparisons. The primary outcome was the decisional conflict scale ranging from 0-100. Differences between groups were analyzed using analysis of variance and Tukey's honestly significant difference tests. Overall, decisional conflict decreased significantly in all groups (P < 0.05). The largest reduction in decisional conflict was observed for participants in the videobooklet decision aid group (21 points). Statistically significant differences in pre- versus postintervention total scores favored the videobooklet group compared to the control group (21 versus 10) and to the videobooklet plus ACA group (21 versus 14; P < 0.001). Changes in the decisional conflict score for the control group compared to the videobooklet decision aid + ACA group were not significantly different. In our study, an audiovisual patient decision aid decreased decisional conflict more than printed material alone or the addition of a more complex computer-based ACA tool requiring more intense cognitive involvement and explicit value choices.

Subsistence Farming: Antidote to Famine and Food Insecurity

A famine is a widespread scarcity of food that may apply to any faunal species. This phenomenon is usually accompanied or followed by regional malnutrition, starvation, epidemic, and increased mortality. Emergency measures in relieving famine primarily include providing deficient micronutrients, such as vitamins and minerals, through fortified sachet powders or directly through food supplements. Aid groups have begun to use a famine relief model based on giving cash or cash vouchers to the hungry to pay local farmers, rather than buying food from donor countries as the latter distorts local food markets. Long-term measures include investment in modern agriculture techniques, such as fertilizers and irrigation, which largely eradicated hunger in the developed world.Minerals (largely petroleum) accounted for an increasing proportion of exports through the 1970s, increasing from 13 percent in 1955 to 35 percent in 1965, to 93 percent in 1975, and then to the peak 96 percent in 1985. The dependence on oil and a few other export commodities made Nigeria (being a consumer nation) particularly vulnerable to world price fluctuations.God blessed Nigeria with vast arid land that can accommodate all classes of plants, crops, shrubs, and roots which should be able to feed the mass populace and should still remain in the form of exports which can generate foreign exchange earnings; hence to reverse our balance of payment deficit. Nigeria has emerging, though currently underperforming manufacturing sector is the second-largest on the continent, producing a large proportion of goods and services for the West African region.

A preliminary evaluation of the PEDI-CAT Mobility item bank for children using walking aids and wheelchairs

To examine the discriminant validity and scoring patterns of the PEDI-CAT Mobility item bank for children who use a walking aid or wheelchair. Parents whose children use a walking aid (n=35) or a wheelchair (n=31) completed the full PEDI-CAT Mobility item bank (105 items including 13 walking aid and 14 wheelchair items) on-line. An independent sample t-test was used to examine mean scores between the groups. Point spread and placement of the scores along the overall 20-80 test scale and response patterns for the 27 mobility device items were analyzed descriptively. Mean scaled scores were significantly different (p < 0.001) for the two groups. Mean score for the Wheelchair Group (38.37, SD=7.09) was lower than the Walking Aid Group (46.97, SD=5.10). The Walking Aid Group started and ended higher on the 20 to 80 scale metric than the Wheelchair Group. No floor or ceiling effects were seen for the scoring of the 27 items specifying use of a mobility device. The %scores of the PEDI-CAT Mobility domain could differentiate the functional mobility status between known groups of children who use a walking aid or wheelchair and provides specific items to measure functional mobility with use of a mobility device.

The British Polio Fellowship: its contribution to the development of inclusivity for disabled people

The organizations set up to cope with polio in the years of epidemic outbreaks in Europe constitute an interesting focus in historiography as an example of contemporary patients� associations and mutual aid groups. The main aim of this paper is to reconstruct and analyse the principal highlights in the birth and development of the British Polio Fellowship (BPF) and its historical meaning in the history of polio associationism. The Infantile Paralysis Fellowship (now BPF) was founded in 1939 and, since then, has played an important role in the development of services for disabled people. It was founded as an organization of disabled people, not an organization for disabled people and so has always been an authentic voice of polio-disabled people. Achievements during the past seventy years have included the development of employment for disabled people, improvements in financial benefits, provision of better access, provision of holidays, the creation of opportunities for respirator-dependent people to live in their own homes, and the development of disability sport.

Our Stories Give Us Power: Working for Justice at the Grassroots

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsJen RockJen Rock is an immigrant rights activist who has worked along the U.S.-Mexico border with a Tucson-based humanitarian aid group called No Más Muertes. She now lives in Philadelphia and works with the New Sanctuary Movement of Philadelphia.

Haiti prepares for cholera vaccination but concerns remain

Haiti prepares for cholera vaccination but concerns remain

Retinal manifestations of patients with human immunodeficiency virus, a multiethnics study in Malaysia.

To investigate the fundus findings of patients infected with human immunodeficiency virus (HIV) in correlation to Highly Active Antiretroviral Therapy (HAART) and CD4 count. Two hundred and two patients of the three major races (Chinese, Malay and Indian) in Malaysia were recruited in this population-based cross-sectional study. This consisted of confirmed HIV sero-positive patients with HAART treatment (n=95) or without HAART therapy (n=107) from December 2007 to March 2008. They were further classified into the HIV infected group, AIDS related complex (ARC) group and AIDS group. Each group was then subdivided according to their CD4 count. Clinical fundus findings were recorded. Sixty six patients (32.7%) showed presence of fundus manifestation, majority of which was HIV microangiopathy (89%) and the rest being Cytomegalovirus (CMV) retinitis (11%). The most common fundus lesion was cotton wool spot (34%). There was a higher incidence of fundus manifestation in the non HAART group than the HAART group (P=0.04) and in patients with CD4 count less than 200 cells/ml in both groups (P=0.01). The HAART therapy had remarkably reduced the percentage of fundus manifestation by 20% but CD4 count remains the marker for fundus manifestations. There were no significant differences noted in the retinal manifestation among the different races. (ANOVA, P=0.25). The fundus manifestations were higher in patients with CD4<200 cells/ml and in the non HAART group. Hence the HAART therapy is capable of reducing the incidence of fundus manifestations, however the CD4 count determines the occurrence of fundus manifestations.

Use of a Visual Aid to Improve Counseling at the Threshold of Viability

To pilot-test a visual aid developed to help counsel pregnant women. After agreeing to participate, pregnant women at >28 weeks of gestation were assigned randomly to counseling with or without a visual aid. The visual aid contained pictures, graphics, and short messages about delivery room resuscitation, chances of survival, anticipated neonatal course, and long-term neurodevelopmental disabilities. A neonatal fellow performed counseling with a standardized script for an anticipated delivery at 23 weeks of gestation. In precounseling and postcounseling sessions, women were given a structured interview to assess their knowledge of chances of survival and disability and attitudes toward resuscitation. Of the 89 women who participated, 76% were black and 59% read below a 9th-grade level. Compared with the no-visual aid group, women in the visual aid group recalled more disabilities and predicted longer neonatal stays (P = .01). For both groups, mothers' perceptions of the chances of survival were lower after counseling; the decrease was greater in the visual aid group (P = .03). The majority of women in each group opted for resuscitation, which was not affected by counseling. In multivariate analyses, use of the visual aid was a significant independent factor in explaining before/after differences in survival chances and recall of a long NICU stay and number of disabilities; higher literacy levels also were significant for recalling the number of disabilities. Use of a visual aid improved mothers' knowledge and showed promise as a decision aid for counseling at the threshold of viability.

Depletion of pro-inflammatory CD161+ double negative (CD3+CD4−CD8−) T cells in AIDS patients is ameliorated by expansion of the γδ T cell population

In this present investigation, flow cytometry was utilized to evaluate 13 healthy controls and 31 HIV-1 infected patients who had advanced to the AIDS stage of infection (CD4 count below 200cells/mm3), for the expression of CD161 on CD3+ double negative (DN) (CD3+CD4-CD8-) T cells, CD4+ T cells, CD8+ T cells and γδ T cells. The observed depletion of CD161+ T cells from peripheral circulation was due primarily to the loss of CD4+CD161+ T cells; as these cells represented 8.67±0.74% of the total healthy control peripheral T cell population, while the CD4+CD161+ T cells of the AIDS group represented only 3.35±0.41% (p=<0.0001) of the total peripheral T cell population. We have also shown here that the DN T cell population was more than doubled in the AIDS group, with the DN T cell population expanding from 3.29±0.45% of the healthy control peripheral T cell population to 8.64±1.16% (p=0.0001) of the AIDS group peripheral T cell population. By evaluating the expression of CD161 on the surface of the DN T cells we showed that within the healthy control group, 47.4±4.99% of the DN T cells were positive for the expression of CD161, while only 26.4±3.54% (p=0.002) of the AIDS group's DN T cells expressed CD161. Despite CD161 expression being halved on the DN T cells of the AIDS group, when we compared the total peripheral T cell percentage of CD161+ DN T cells between the healthy control group and the AIDS group, there was no statistical difference. Even though only 26.4% DN T cells within the AIDS group were positive for CD161+, the overall DN T cell population had expanded to such an extent that there was no statistical difference between the groups with regard to CD161+ DN T cells as a percentage of the total peripheral T cell population. Furthermore, we showed that within the DN T cell population, there was an approximate 2:1 ratio of γδ to αβ T cells, and this ratio was maintained in both the healthy control group and the AIDS group. While evaluating γδ T cells we also discovered that CD8+ γδ T cells were expanded from 0.62±.09% of the healthy control peripheral T cell population to 5.01±.88% (p=<0.0001) of the peripheral T cell population of the AIDS group; and that this population of CD8+ γδ T cells underwent the same reduction in percentage of cells expressing CD161+, further demonstrated that the phenomenon of CD161+ percentage reduction and compensatory increase in total cell population was affecting the entire circulating γδ T cell population.

Partnership research on nutrition transition and chronic diseases in West Africa – trends, outcomes and impacts

BackgroundNutrition-related chronic diseases (NRCD) are rising quickly in developing countries, and the nutrition transition is a major contributor. Low-income countries have not been spared. Health issues related to nutritional deficiencies also persist, creating a double burden of malnutrition (DBM). There is still a major shortage of data on NRCD and DBM in Sub-Saharan Africa. A research program has been designed and conducted in partnership with West African institutions since 2003 to determine how the nutrition transition relates to NRCD and the DBM in order to support prevention efforts.MethodsIn Benin, cross-sectional studies among apparently healthy adults (n=540) from urban, semi-urban and rural areas have examined cardiometabolic risk (hypertension, obesity, dyslipidemia, insulin resistance) in relation to diet and lifestyle, also factoring in socio-economic status (SES). Those studies were followed by a longitudinal study on how risk evolves, opening the way for mutual aid groups to develop a prevention strategy within an action research framework. In Burkina Faso, a cross-sectional study on the nutritional status and dietary patterns of urban school-age children (n=650) represented the initial stages of an action research project to prevent DBM in schools. A cross-sectional study among adults (n=330) from the capital of Burkina Faso explored the coexistence, within these individuals, of cardiometabolic risk factors and nutritional deficiencies (anemia, vitamin A deficiency, chronic energy deficiency), as they relate to diet, lifestyle and SES.ResultsThe studies have shown that the prevalence of NRCD is high among the poor, thereby exacerbating social inequalities. The hypothesis of a positive socio-economic (and rural–urban) gradient was confirmed only for obesity, whereas the prevalence of hypertension, insulin resistance and dyslipidemia did not prove to be higher among affluent city dwellers. Women were particularly affected by abdominal obesity, at 48% compared to 6% of men. Protective factors against the risk of NRCD were physical activity and adequate micronutrient intake. The research also showed that nutritional deficiencies were not restricted to schoolchildren in rural areas because in the capital of Ouagadougou, for example, 40% of schoolchildren were anaemic and 40% were vitamin A deficient. Partnership research has expanded to include advocacy and human resources training.ConclusionThese initial studies on NRCD in West Africa indicate the relevance and urgency of prevention, even among low-income groups and countries. They show that the fight against NRCD as well as nutritional deficiencies should focus on women. Seeing how researchers from the African partner institutions have connections with decision-making authorities, the research findings could have an impact on prevention policies and programs in communities and schools alike. Greater support must nevertheless be provided to lobbying and advocacy work for an even greater impact. As well, the sustainability of the research program remains a challenge that requires resource mobilization and training for the purpose.