The availability of combination antiretroviral therapy has changed the lives of millions of people living with HIV (PLWH), for whom a once fatal infection can now be a manageable chronic disease. Yet ...only 30 percent of PLWH in the United States are virally suppressed, and significant gaps in access to care persist.
While programs to boost linkage to and retention in HIV care are critical to improving the health of PLWH, efforts to evaluate these programs are surprisingly scarce. Using cutting-edge implementation science, this book tackles the issue of how to better link and retain PLWH in ongoing primary medical care. A multipart case study examines successful strategies and provides detailed profiles of the organizations involved and their processes for reaching, linking, and retaining PLWH. Barriers and facilitators to implementation are explored qualitatively, network analysis is used to assess changes in interagency collaboration among organizations serving PLWH, and evidence-based recommendations are offered for improving linkage to HIV care in the U.S.
This book gives detailed, theoretically-informed readings of a range of fictional and autobiographical writing by and about the 'second generation' of Holocaust survivors.
Echoes of trauma are traced in the relational narratives that the sons and daughters of Holocaust survivors tell about their experiences growing up in survivor families. An innovative combination of ...the Core Conflictual Relationship Theme (CCRT) method with narrative-qualitative analysis revealed common themes and emotional patterns that are played out in the survivors' children's meaningful relationships, especially in those with their parents. The relational world of the second generation is understood in the context of an intergenerational communication style called 'knowing-not knowing', in which there is a dialectical tension between knowing and not knowing the parental trauma. In the survivors' children's current parent-adolescent relationships with their own children, they aspire to correct the child-parent dynamics that they had experienced by trying to openly negotiate conflicts and to maintain close bonds. Clinicians treating descendents of other massive trauma would benefit from the insights offered into these complex intergenerational psychological processes.
Hurricane Katrina forced the largest and most abrupt displacement in U.S. history. About 1.5 million people evacuated from the Gulf Coast preceding Katrina’s landfall. New Orleans, a city of 500,000, ...was nearly emptied of life after the hurricane and flooding. Katrina survivors eventually scattered across all fifty states, and tens of thousands still remain displaced. Some are desperate to return to the Gulf Coast but cannot find the means. Others have chosen to make their homes elsewhere. Still others found a way to return home but were unable to stay due to the limited availability of social services, educational opportunities, health care options, and affordable housing. The contributors to Displaced have been following the lives of Katrina evacuees since 2005. In this illuminating book, they offer the first comprehensive analysis of the experiences of the displaced. Drawing on research in thirteen communities in seven states across the country, the contributors describe the struggles that evacuees have faced in securing life-sustaining resources and rebuilding their lives. They also recount the impact that the displaced have had on communities that initially welcomed them and then later experienced “Katrina fatigue" as the ongoing needs of evacuees strained local resources. Displaced reveals that Katrina took a particularly heavy toll on households headed by low-income African American women who lost the support provided by local networks of family and friends. It also shows the resilience and resourcefulness of Katrina evacuees who have built new networks and partnered with community organizations and religious institutions to create new lives in the diaspora.
Although individuals born at extremely low birth weight (ELBW; < 1,000 g) are the most vulnerable of all preterm survivors, their risk for mental health problems across the life span has not been ...systematically reviewed. The primary objective of this systematic review and meta-analysis was to ascertain whether the risk for mental health problems is greater for ELBW survivors than their normal birth weight (NBW) peers in childhood, adolescence, and adulthood. Forty-one studies assessing 2,712 ELBW children, adolescents, and adults and 11,127 NBW controls were reviewed. Group differences in mental health outcomes were assessed using random effects meta-analyses. The impacts of birthplace, birth era, and neurosensory impairment on mental health outcomes were assessed in subgroup analyses. Children born at ELBW were reported by parents and teachers to be at significantly greater risk than NBW controls for inattention and hyperactivity, internalizing, and externalizing symptoms. ELBW children were also at greater risk for conduct and oppositional disorders, autistic symptoms, and social difficulties. Risks for parent-reported inattention and hyperactivity, internalizing, and social problems were greater in adolescents born at ELBW. In contrast, ELBW teens self-reported lower inattention, hyperactivity, and oppositional behavior levels than their NBW peers. Depression, anxiety, and social difficulties were elevated in ELBW survivors in adulthood. Group differences were robust to region of birth, era of birth, and the presence of neurosensory impairments. The complex needs faced by children born at ELBW continue throughout development, with long-term consequences for psychological and social well-being.
Objective: We examined the trajectories of sleep problems in adolescents after the Wenchuan earthquake, and assessed predictors such as posttraumatic stress disorder symptoms. Methods: We surveyed ...adolescents at 1, 1.5, 2, and 2.5 years after the Wenchuan earthquake. In total, 391 adolescents completed self-report questionnaires. Results: We identified five latent sleep problem trajectories, specifically, U-shaped (3.8%), low-stable (68.0%), high-stable (10.8%), increasing (8.7%), and decreasing (8.7%) trajectories. Additionally, we found that posttraumatic stress disorder hyper-arousal symptoms were more frequent in individuals who had non-low-stable trajectories. Adolescents in the U-shaped group were less likely to have intrusive symptoms. Conclusion: After natural disasters, consequent sleep problems in adolescents do not remain stable over time, and sleep problem trajectories had considerable heterogeneity.
Purpose
The purpose of this study was to explore breast cancer survivors’ interest in and preferences for technology-supported exercise interventions.
Methods
Post-treatment survivors
n
= 279;
M
...age
= 60.7 (SD = 9.7) completed a battery of online questionnaires in August 2015. Descriptive statistics were calculated for all data. Logistic regression analyses were conducted to examine relationships between survivors’ interest in a technology-supported exercise interventions and demographic, disease, and behavioral factors. These same factors were examined in relation to perceived effectiveness of such interventions using multiple regression analyses.
Results
About half (53.4%) of survivors self-reported meeting public health recommendations for physical activity. Fewer than half reported using an exercise or diet mobile app (41.2%) or owning an activity tracker (40.5%). The majority were interested in receiving remotely delivered exercise counseling (84.6%), participating in a remotely delivered exercise intervention (79.5%), and using an exercise app or website (68%). Survivors reported that the most helpful technology-supported intervention components would be an activity tracker (89.5%), personalized feedback (81.2%), and feedback on how exercise is influencing mood, fatigue, etc. (73.6%). Components rated as least helpful were social networking integration (31.2%), group competitions (33.9%), and ability to see others’ progress (35.1%).
Conclusions
Preferences for technology-supported exercise interventions varied among breast cancer survivors. Nonetheless, data indicate that technology-supported interventions may be feasible and acceptable. Engaging stakeholders may be important in developing and testing potential intervention components.
From fleeing the Warsaw Ghetto and living underground to
fighting for social justice in 1960s' Seattle and helping smash the
communist system in 1980s' Poland, this is a narrative that erupts
into ...critical moments in Jewish, Polish, and American history. It
is also a story of the hidden anguish that accompanies and courses
through that history, of the living haunted by the dead. The story
is told through a conversation, often contentious, between Michael
Steinlauf, historian of Polish-Jewish culture and child of
Holocaust survivors, and the anthropologist and artist Elżbieta
Janicka. It is illustrated with scores of photographs and
documents.
ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ...ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England.
A nationally representative survey was undertaken (n = 3885, aged 18-69, April-July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (<18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n = 6983) mortality was similarly analysed as a measure of premature mortality.
Of the total, 46.4% of respondents reported ≥1 and 8.3% ≥4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus ≥4 ACEs; cancer, 2.38 (1.48-3.83); diabetes, 2.99 (1.90-4.72); stroke, 5.79 (2.43-13.80, all P < 0.001). Individuals with ≥4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39-2.79), P < 0.001).
Radically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are available but rarely implemented at scale. Treating the resulting health costs across the life course is unsustainable.
Purpose
Sleep disturbance may be an overlooked modifiable risk factor for health disparities among African-American breast cancer survivors (AABCS). This study aimed to identify the prevalence of and ...risk factors for sleep disturbance in a cohort of AABCS.
Methods
The study was conducted among participants in the Women’s Circle of Health Follow-up Study, a longitudinal study of breast cancer in 10 counties in New Jersey. Cases were identified shortly after diagnosis by the New Jersey State Cancer Registry. Self-reported sleep disturbance (Pittsburgh Sleep Quality Index) and other factors (e.g., socioeconomic status, menopausal status) were assessed at pre-diagnosis (
n
= 637), 10 months post-diagnosis (
n
= 261), and 24 months post-diagnosis (
n
= 632). Clinical data were obtained via medical record abstraction, and height and weight were measured by study staff.
Results
Most AABCS (57%) reported clinically significant sleep disturbance before diagnosis, and this rate remained largely unchanged at 10 months (53%) and 24 months post-diagnosis (61%). Average sleep disturbance scores indicated clinically significant disturbance at all three assessments (
M
range = 6.67–7.57). Most reported sleeping fewer than the recommended 7 hours per night at each assessment (range 57–65%). Risk factors for sleep disturbance were identified at each assessment, including pre-diagnosis (less education), 10 months post-diagnosis (lack of insurance, treatment with chemotherapy), and 24 months post-diagnosis (younger age, less education, lower income, obesity, and lymphedema). Treatment with endocrine therapy was a protective factor at 10 months post-diagnosis.
Conclusion
Most AABCS report clinically significant sleep disturbance from before diagnosis through 24 months post-diagnosis. These rates appear indicate AABCS experience significant sleep-related disparities.
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