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.
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.
•Available surveys suggest that 26% and 27% of war survivors have PTSD and/or depression, respectively.•Samples with older participants reported higher prevalence of depression.•Higher rates of ...unemployment and higher percentages of women were linked to higher prevalence of PTSD.•Living with a partner was associated with lower prevalence of PTSD.
Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions.
To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions.
We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD.
The findings are limited by poor psychometric reporting practices.
Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.
Purpose
Cancer patient survival rates are rapidly growing, and further data are needed on the impact of the disease beyond diagnosis and treatment phases. The aims of this study were to analyze the ...prevalence and sociodemographic and medical risk factors of clinical distress. Additionally, we also explore the relationship between unmet psychosocial needs and both clinical distress and subgroups of survival periods.
Methods
A cross-sectional study of 450 women who at least 1 month before had completed the primary treatment for breast cancer was conducted. The Brief Symptom Inventory 18 and the Cancer Survivors Unmet Needs measure were used.
Results
One in four women showed clinical distress related to unmet psychosocial needs. None of the sociodemographic and medical predictors was associated with clinical distress. Needs focused on the possibility of recurrence and its cognitive-emotional impact were the most frequent. Needs tended to decrease through periods of survival; however, there was a considerable level of unmet needs even among long-term survivors.
Conclusions
The findings highlight the relevance of extending psychosocial care beyond the breast cancer primary medical treatment. Early and regular screen for distress and unmet supportive needs permits to identify high-risk groups that likely benefit from targeted preventive interventions.
Objective
Cancer survivors have unique healthcare needs. An important consideration for survivorship is chronic diseases and health risk factors. The purpose of this study is to describe ...demographics, risk factors, and comorbid health conditions in adult cancer survivors.
Method
We analyzed 2019 Arizona Behavioral Risk Factor Surveillance System data to compare cancer survivors to non-cancer survivors (aged 18 or older) to assess differences between the two populations. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated, and multivariable logistic regression models were performed.
Results
Eight thousand nine-hundred and twenty (8920) respondents (1007 survivors; 7913 non-cancer survivors) were included. Compared to non-cancer survivors, cancer survivors were more likely to be female, 65 years and older, non-Hispanic white, veterans, and less likely to be employed. Survivors had higher rates of coronary heart disease, stroke, chronic obstructive pulmonary disease, kidney disease, hypertension, arthritis, multiple chronic conditions, being overweight, and being a former smoker. Survivors were more likely to report fair/poor health than non-cancer survivors.
Discussion
These findings can be used by healthcare and public health practitioners to evaluate the programmatic efforts and resources, implement targeted interventions toward cancer survivors, and improve health and quality of life.
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