Presence Of Family Support Research Articles

Towards ending the US HIV epidemic by 2030: Understanding social determinants of health and HIV in Mississippi

ABSTRACTThe disproportionate burden of HIV-related inequities borne by African Americans in the US South amplifies the role of social determinants of health (SDH) in shaping social patterning of illness. Despite some attention, SDH remain overlooked in a biomedically oriented, federal HIV policy. Mississippi is the poorest state with the worst HIV outcomes, nationally. Using qualitative methods, we investigated how primarily African American, HIV-positive Mississippians experienced SDH and health inequities in their daily lives. Employing grounded theory and in-depth interviews (n = 25) in an urban and rural site in 2015 yielded these findings: (1) absence of an enabling structural environment; (a) HIV-stigma constructed via social discourse; (b) lack of psycho-social support and HIV education; (c) insufficient economic and social support resources; and (2) presence of family support for coping. Due to stigma, being HIV-positive seemed to lead to further status loss; diminished social position; reduced life chances; and contractions in particular freedoms. Stigma further compounded existing inequalities – contributing to the moral, social experience of those living with HIV. Trump’s plan to end HIV by 2030 creates the opportunity to rethink the biomedical-paradigm and fully engage SDH – using social science theory and methods that address multi-level social determinants in ways that are also policy-responsive.

Dukungan keluarga dan kualitas hidup pasien diabetes mellitus

Family support and quality of life of diabetes mellitus patients in Panjatan II public health center, Kulon ProgoPurposeThis study aimed to determine the relationship between family support in terms of four dimensions (emotional, appraisal, instrumental, and information) to the quality of life of patients with type 2 diabetes at the health center II Panjatan Kulon Progo regency.MethodsThis research was a cross-sectional analytical study with sample size of 150 patients with diabetes mellitus type 2. Data analysis used Pearson correlation coefficient, independent t-test and simple linear regression tests.ResultsThere were correlations between the presence of family support and complications with the quality of life of diabetes mellitus patients. There were correlations of emotional, awarding, and instrumental dimensions of family support to the quality of life of diabetes mellitus patients.ConclusionIncreased support of emotional dimensions, reward dimensions and instrumental dimensions will improve the quality of life of patients with diabetes mellitus.

Prevalence, Gender Differences and Associated Factors of Depression among Adults with Type 2 Diabetes, Jordan

Our objectives were to estimate the prevalence of depression and its associated factors among type 2 diabetes mellitus patients. A cross-sectional study was conducted among type 2 diabetics aged ≥ 18 years during the period from 1st of November 2013 to 1st of March 2014. A total of 1591 patients were studied. Depression was assessed using the Arabic version of Patient Health Questionnaire-9 (PHQ-9), a cut-off point of 10 was used to categorize depression. Prevalence rates of overall, major and minor depression were 40%, 8.7% and 25.5%, respectively. Multiple logistic regression analysis indicated that age, sex, educational level, smoking status, DM complications especially neuropathy, vitamin D3 level and family support were significant. Whereas, marital status, monthly income, BMI, glycemic control and support of friends and significant others were not significant. Old age, maleness, higher education, non-smoking, adequate vitamin D3 level, absence of DM complications and presence of family support were significantly less likely to have depression. Depression is highly prevalent among diabetic patients. Factors associated with depression differ by gender and perceived family support is a protective factor against depression.

Keeping Engaged During Deployment: The Interplay Between Self-Efficacy, Family Support, and Threat Exposure

This study investigated the importance of 2 resilience resources for service members’ ability to deal with threat during deployment. Military self-efficacy and family support were measured before deployment and related to work engagement and burnout levels of service members during deployment. We hypothesized that in high threat situations, low self-efficacy would lead to unfavorable outcomes, whereas in low threat situations, high self-efficacy could have negative consequences. In addition, we hypothesized that family support would compensate for both effects. The results showed these expected 3-way interactions. We found that strong self-efficacy helped service members deal with exposure to threatening situations during deployment, leading to more work engagement and less burnout. However, having strong self-efficacy without being exposed to threat during deployment reduced service members’ work engagement and increased burnout. In addition, we found that the presence of family support compensated for these effects. Service members with low self-efficacy benefitted from family support when threat exposure was high, whereas service members with high self-efficacy benefitted from family support when threat exposure was low. As such, family support seemed to act as a compensatory mechanism for the potential negative effects of self-efficacy. This underlines the importance of studying the interplay between resources that help service members deal with deployment experiences. Practical implications relate to supporting service members’ resilience through enhancing multiple resources.

The beliefs among patients with epilepsy in Saudi Arabia about the causes and treatment of epilepsy and other aspects.

The current survey sought to identify the religious and cultural beliefs about the causes and treatment of epilepsy in people with epilepsy from Saudi Arabia and a number of other aspects relating to the possibility of cure, coping with the condition, and public awareness. Study instruments were developed on the basis of the literature, a focus group of people with epilepsy, and feedback from people in the field with local knowledge. These were then piloted. A survey was then carried out among a total of 110 adults with epilepsy. Participants were asked to complete questionnaires inquiring into their beliefs about the causes and range of treatments used for epilepsy. Each participant was allowed to choose more than one cause and more than one treatment method. The questionnaires were administered face to face by a clinical psychologist (HAA) to improve the quality of the responses. We found that most adults with epilepsy in Saudi Arabia believe that epilepsy is a condition with multifactorial causation and for which more than one treatment method should be applied. A test from God was the most commonly ascribed cause (83% as well as 40% who believed that some cases of the illness were a punishment from God). The belief in the concept of God's will helped many in the cohort to accept their illness as part of their destiny. Ninety-six percent of the patients believed that there were also medical causes (such as an illness, brain insult, inflammation, heredity, contagion), and a similar proportion believed that there were also religious causes. Smaller proportions believed epilepsy could be due to cultural (78%) or psychosocial causes (64%). Thirty-four percent of people believed that there could be sometimes no cause, but only 2% thought that epilepsy never had any identifiable cause. Most patients did not believe that one treatment alone would help. Ninety-three percent of patients believed in medical treatment, 93% in religious treatment, and 64% in traditional treatments, and 7% believed in changing lifestyle (eating balanced food and positive thinking). Seventy-eight percent of the sample believed that their epilepsy was a curable illness. Ninety-six percent believed that faith and practicing religious rituals helped in coping with epilepsy, and 92% believed that family support helped in coping with epilepsy. Nine percent of patients had stopped their medication for religious reasons or because of a sense of shame, and 7% had at one time been forced by their family to stop their medication. Ninety-two percent of the sample reported having enough family support. Ninety-five percent believed that Saudi society needs more awareness to understand epilepsy. In Saudi Arabia, religious and cultural beliefs about the causes and treatment of epilepsy exist alongside medical beliefs. The holding of religious beliefs, the practicing of religious rituals, and the presence of family support were found to be of great importance in coping with epilepsy, and their role needs to be fully appreciated in the medical management of the condition.

The Association of Family Support After Childbirth With Posttraumatic Stress Disorder in Women With Preeclampsia.

Background:Stressful situations and life-threatening issues such as preeclampsia can lead to Post-traumatic stress disorders [PTSD]. It seems that within social supports, family support has more effect on mental health.Objectives:The aim of this study was to determine the association between family supports in the postpartum period with occurrence of post-traumatic stress disorder following preeclampsia.Patients and Methods:In this descriptive longitudinal study, 100 women with preeclampsia admitted in government hospitals of Mashhad were selected using convenience sampling. Post-traumatic stress disorder was diagnosed by psychiatrist interview and perinatal posttraumatic stress questionnaire (PPQ) in sixth week postpartum and family support was measured by family support scale (FSS) in second and sixth weeks postpartum. Data analyzed by SPSS 16 using Spearman correlation coefficient, paired sample T-test and Kruskal-Wallis test.Results:A reverse significant association was found between family support in weeks 2 and 6 (92.6 ± 22.6, 83.7 ± 21.6, respectively) and PTSD (mean score of 4.8 ± 2.5) (respectively, P = 0.010 and P =0.011). The most important variables affecting PTSD with presence of family support in weeks 2 and 6 were postpartum depression in week 6 as well as trait anxiety at the time of admission.Conclusions:The more support in weeks 2 and 6 postpartum, the less PTSD occurs. Therefore, it is suggested to health care providers who face mothers after delivery to evaluate the support received by mothers and help those with inadequate or inappropriate support.

Identifying Potential Predictors of High-Quality Oral Anticoagulation Assessed by Time in Therapeutic International Normalized Ratio Range: A Prospective, Long-Term, Single-Center, Observational Study

BackgroundThe efficacy and risks of oral anticoagulation are largely associated with maintaining the quality of anticoagulation control. Nevertheless, few studies have addressed which factors, if any, are associated with this control. ObjectiveThis study aimed to identify predictors of high-quality oral anticoagulation. MethodsA prospective observational study enrolled all adult patients on intended long-term oral anticoagulation attending a public anticoagulation clinic. Patients with high-quality anticoagulation, defined as percentage of time in therapeutic international normalized ratio (INR) range (TTR) ≥66%, were compared with those with poor anticoagulation control (TTR <66%). Measures included cognitive, psychological, and relevant behavioral factors, in addition to traditionally implicated ones, such as age, comorbidity, and concurrent medications. ResultsParticipation was requested from all 233 patients followed up at the anticoagulation clinic. Eighty-six did not meet the inclusion criteria (49 due to intended anticoagulation duration <90 days, 37 due to the need for a caregiver responsible for medications). A total of 147 patients were enrolled, of whom 13 (8.8%) were lost to follow-up. Therefore, data were analyzed from 134 patients (mean [SD] age, 55 [14.2] years [range, 19–87 years]), who were followed up for a mean (SD) duration of 272 (87) days. The total mean TTR was 64.7%, which is comparable to values achieved in clinical trials. The good-control group had 61 patients (45.5%) (mean TTR, 77.7% [8.5%]) and the poor-control group had 73 patients (54.5%) (mean TTR, 50.4 [11.7%]). On multivariate logistic regression analysis, high-quality anticoagulation was independently associated with regular vitamin K intake, expressed by its variability in daily dosage (odds ratio [OR] = 0.79; 95% CI, 0.64–0.98); male sex (OR = 2.41; 95% CI, 1.06–5.49); duration of anticoagulation treatment >2 months (OR = 3.23; 95% CI, 1.25–8.36); presence of family support (OR = 3.32; 95% CI, 1.16–9.48); functional and cognitive ability to take medications as prescribed, defined as good medication management capacity (MMC; as assed using the Drug Regimen Unassisted Grading Scale) (OR = 4.18; 95% CI, 1.63–10.68); and no regular use of alcohol (OR = 8.59; 95% CI, 1.45–51.09). ConclusionsThe data suggest that independent predictors of high-quality oral anticoagulation included regular vitamin K intake, male sex, duration of anticoagulation treatment >2 months, presence of family support, good MMC, and no regular alcohol use. These findings may help clinicians to decide whether to start anticoagulation in intermediate-risk patients, to identify patients who will require closer attention on their anticoagulation management, and to direct their efforts to improve the quality of oral anticoagulation.

Application of Self-Efficacy Theory in Adherence to Iron Chelation Therapy: A Single-Center Cross-Sectional Study

Abstract 5284 Introduction: Poor adherence to iron chelation therapy (ICT) in beta-Thalassemia Major (TM) is associated with increased risk of cardiac complications and endocrinopathies, and lower survival, with substantial cost to the patient and the health care system. Canada is unique in that several predictors of non-adherence (Financial barriers to medical care, cost of medication and inadequate follow-up) are minimized due to the presence of universal health care, governmental subsidies for medications for patients with chronic disease, and the availability of comprehensive care center for most of the thalassemia patients in the country. Also, the availability of Deferiprone (DFP) via compassionate release program since July 2004 provides an alternative to patients intolerant or having suboptimal response to Deferoxamine (DFO) or Deferasirox (DFX). We hypothesize that the absence of these barriers improve adherence in the Canadian thalassemic population. We also explored self-efficacy as a concept of adherence behavior in our patient population, defined as “individuals' personal beliefs regarding their capabilities to carry out a specific task to achieve a desired outcome” (Bandura, 1989). Methods: A cross-sectional survey was conducted in June and July 2011 at a regional comprehensive care center for transfusion-dependent thalassemia patients. We assessed the age, sex, education, employment status, insurance coverage, types and dosage of ICT, self-reported level of adherence, and side effects. We adapted the Medication Adherence Self-Efficacy Scale (MASES) to assess self-efficacy (Ogedegbe, 2003). Results: Survey return rate was 45% (46/103), with each type of ICT proportionally represented (P = 0.6401). Eight surveys were discarded due to incompletion and 38 were analyzed. Thirty-two patients were on single agent ICT (6 on DFO, 23 on DFX, 3 on DFP) and 6 patients were on combination treatment (1 on DFO+DFX; 3 on DFO+DFP; 2 on DFX+DFP). Median duration of iron chelation was more than 10 years. All patients had either government (n = 10) or workplace (n = 28) coverage. Twenty-three patients (61%) were self-described as completely adherent and 15 were not completely adherent. Mean level of adherence is 90% (SD 16%), similar to those reported in the literature (Trachtenberg et al., 2011), with no significant difference between the different types of ICT (P = 0.1085). Half of the non-adherent patients (8/15, 53%) miss 1 prescribed day of medication per week. There was no significant difference between adherent and non-adherent patients in age (P = 0.1484), sex (P = 0.3764), type of insurance coverage (P = 4752), family support (P = 0.7190), type of ICT (P = 0.0611), participation and satisfaction with the Exjade Patient Support Program (P = 1.000 and 0.3012 respectively), duration of chelation (P = 0.3951), rate of side effects (P = 0.4167), or feelings of depression (P = 0.4780). There was a trend towards differences in education level (P = 0.0565) and a higher proportion of professionals in the non-adherent group. The mean self-efficacy score of patients self-described as completely adherent was significantly higher than the non-completely adherent group (2.66 vs 1.93, P&lt;0.0001). Discussion: In this self-reported survey of patients on ICT in a Canadian regional comprehensive care center, age, presence of family support, and feelings of depression were not found to be a significant predictor of poor adherence, unlike previous studies. This could be because previous studies only examined certain types of ICTs whereas the present study examined all forms of chelation. Small sample sizes of patients on DFO and DFP is the main limitation of the study. This is also the first known application of self-efficacy theory in explaining adherence to ICT. Further studies are required to examine the internal consistency and test-retest reliability of MASES in evaluating self-efficacy in adherence to ICT. Disclosures: Kuo: Novartis Canada: Research Funding. Off Label Use: Deferiprone is an unlicensed drug in Canada and USA. It is an oral iron chelator.

The MIRECC Version of the Global Assessment of Functioning Scale: Reliability and Validity

This study examined the reliability and convergent, discriminant, and predictive validity of the Mental Illness Research, Education, and Clinical Center (MIRECC) version of the Global Assessment of Functioning (GAF) scale. The MIRECC GAF measures occupational functioning, social functioning, and symptom severity on three subscales. MIRECC GAF ratings were obtained for 398 individuals with schizophrenia or schizoaffective disorder who were receiving treatment at three Veterans Affairs mental health clinics. Assessments were completed by using the Positive and Negative Syndrome Scale and the Quality of Life Interview at baseline and nine months later. All three MIRECC GAF subscales exhibited very high levels of reliability. The occupational and symptom subscales showed good convergent and discriminant validity. The social subscale was related to measures of social functioning and, to a greater degree, symptom severity. The occupational and social subscales significantly predicted their respective domains at the nine-month follow-up. The symptom subscale predicted negative symptoms at follow-up; however, it did not predict positive symptoms or cognitive disorientation. Instead, the social subscale was predictive of cognitive disorientation at follow-up. When the standard GAF was routinely administered by clinicians, scores demonstrated little validity. The three MIRECC GAF subscales can be scored reliably, and they have good concurrent and predictive validity. Further work is needed on brief measures of patient functioning, especially measures of social functioning.

Stroke Impairment Predictors of Discharge Function, Length of Stay, and Discharge Destination in Stroke Rehabilitation

This article presents analytic results from a prospective study of 313 stroke rehabilitation patients, looking at the relative contributions of different stroke impairments toward prediction of discharge function, rehabilitation length of stay, and discharge destination after inpatient rehabilitation. The relationship between number of stroke risk factors and recurrence of strokes during rehabilitation was also evaluated. A total of 313 subjects were enrolled consecutively. Information on type of stroke and individual stroke-related impairment was collected prospectively. Recurrent stroke, rehabilitation length of stay, discharge destination, discharge function, and available family support at discharge were documented. Rates of impairment occurrence and coexistence are presented. Analysis using linear (length of stay, discharge function) and logistic (discharge destination) regression revealed significant contributory predictive effects of admission balance, aphasia, number of impairments, and family support on length of stay; admission balance and number of impairments on discharge function; and admission balance, body neglect, and presence of family support on discharge destination. In addition to admission function and balance, other factors to consider in predicting length of stay for patients should include the number of stroke-related impairments and family support. For discharge destination prediction, the presence of body neglect should be considered in addition to balance and family support. Evaluation of patients for right-sided neglect and left-sided neglect is important.

The role of active family nutritional support in Navajos' type 2 diabetes metabolic control.

We examined if active family nutritional support is associated with improved metabolic outcomes for Diné (Navajo) individuals living with type 2 diabetes. The presence of family support, using variables identified in earlier ethnographic research, was assessed via surveys in a convenience sample of 163 diabetic individuals. Diabetes outcome measures (HbA(1c), serum glucose, triglycerides, total cholesterol, creatinine, and systolic and diastolic blood pressure measures) were extracted from participants' medical records. Bivariate analyses and multiple logistic regressions were conducted. All measures of family support showed a relation with one or more indicators of metabolic control in bivariate analyses. In multivariate analyses, respondents were more likely to be in the best tertile for triglyceride (P < 0.05), cholesterol (P < 0.05), and HbA(1c) (P < 0.05) if another person cooked most of the meals. Respondents in families who bought/cooked "light" foods were more likely to be in the best tertile for triglyceride (P < 0.005) and cholesterol levels (P < 0.005), and those in families whose members ate "light" foods with them were more likely to be in the best tertile for triglycerides (P < 0.005). When all three support variables were entered into a multivariate model, only the variable "other family members cook the majority of the meals" was significantly associated with being in the lowest triglyceride (P = 0.05), HbA(1c) (P < 0.05), or cholesterol tertiles (P < 0.05). These relationships were most evident for women with diabetes. Active family nutritional support, as measured by culturally relevant categories, is significantly associated with control of triglyceride, cholesterol, and HbA(1c) levels. The findings suggest that the family is a more useful unit of intervention for Diné individuals than for the individual alone when designing diabetes care strategies.

The berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting

Objective: To examine the utility of the Berg Balance Scale (BBS) in predicting length of stay and discharge destination for patients admitted to a stroke rehabilitation unit. Design: Retrospective study. Setting: Regional tertiary inpatient stroke rehabilitation unit. Patients: One hundred twenty-eight of 141 patients admitted consecutively between January 1, 1995, and March 31, 1996. Main Outcome Measures: Length of stay and discharge destination. Results: Admission BBS scores and Functional Independence Measure scores correlated with length of stay ( r = −0.6 and −0.5, respectively, controlling for age). Logistic regression revealed that the following were independent predictors of being discharged home rather than to an institution (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.04-1.13), age (.89, .83-.95), and presence of family support (11.7, 3.1–44.3). Conclusions: Measuring the BBS scores of patients upon admission to an acute stroke rehabilitation unit may assist in approximating length of stay and predicting eventual discharge destination.