There is a great demand and need for oral health care during the course of HIV disease (HIV Costs and Services Utilization Study; Marcus et. al., 2005). HIV+ patients identified three key barriers to obtaining oral health treatment: 1) beliefs and attitudes of dental health care providers (DHCPs) may have lead to their unwillingness to treat HIV/AIDS patients; 2) the existence of racial and ethnic disparities in health care in the United States, and 3) how DHCPs perceive their risk of contracting HIV. The fear and stigma associated with treating patients with HIV further compromises their access to care and their health status. Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care imperative. Plus, Florida has some of the highest numbers of HIV/AIDS patients in the nation. This study was descriptive, cross-sectional and used quantitative methods to explore the dental hygienists' behavioral and normative beliefs, attitudes, and intentions toward treating patients with HIV/AIDS. A three-phase pilot study was conducted to assess the validity and reliability of the survey instrument. An email delivery method was used to implement the survey, and a 22% response rate was achieved (n=219). The majority of respondents were female (96%), white (89%), married (77%), currently working (86%), and had treated HIV/AIDS patients in private practice (80%). Bivariate analysis showed that dental hygienists' intentions toward treating HIV/AIDS patients were significantly associated with five independent variables, and binary logistic regression confirmed the significance of two of these associations. Overall, study participants indicated that they were willing to, and had positive attitudes toward, clinically treating HIV/AIDS patients; they were confident in their ability to treat them, and their normative beliefs did not hinder their intention to do so, and they did not worry about acquiring HIV in the workplace. Three recommendations were made: increase access to oral health care for HIV/AIDS patients within community settings by removing barriers to care, incorporate cultural/sensitivity training in all dental/dental hygiene school curriculums, and mandate Florida HIV/AIDS continuing education requirements every biennium for dentists and dental hygienists.

Drawing on the literatures of history, sociology, epidemiology, and microbiology, this thesis compares syphillis with human immunodeficiency virus, with special reference to the social and historical factors likely to be relevant to the control or eradication of acquired imune dificiency syndrom (AIDS). The sudden appearance of a new disease causing suffering and death in a community, engenders apprehension and fear which is often manifested as hysteria against, and vilification of, those who have the disease. This fear is greatly increased should the disease be sexually-transmitted. Syphilis in a venereal form, occured in Europe toward the end of the 15th Century. Initially it was an acute, fulminating disease which rapidly spread through Europe and Asia. Attempts to control the disease have gone through periods of either partial successes or massive failures and have ended in frustration for the authorities. When the syndrome of acquired immune deficiency (AIDS) was first reported, it was seen in Western countries in homosexual men. However, as non-homosexual community members and children became infected, it became apparent to authorities that a pandemic was accurring. Within a few years, the disease was identified worldwide. Isolation of the virus (HIV-1), and development of test for detection of carriers, plus restoration of clean blood and blood-product supplies, have reassured the community to some extent. The history of syphilis shows that neither the epidemiological medical, nor the economic political approaches to disease control work, although there are positive aspects resulting from both. It is social responses that will offer the most hope in the long term for the control of AIDS and other sexually-transmitted diseases.

<p>Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda.</p>

<p>Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda.</p>

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2017-06-16T13:14:49Z No. of bitstreams: 1 arquivototal.pdf: 13105860 bytes, checksum: d6801e542fe38720e18050b17687cb96 (MD5) / Made available in DSpace on 2017-06-16T13:14:49Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 13105860 bytes, checksum: d6801e542fe38720e18050b17687cb96 (MD5) Previous issue date: 2017-02-16 / Food insecurity (FI) reaches 22.6% of the Brazilian population, but its prevalence and consequence in people living with HIV/Aids (PLWHA) are little known in Brazil. The consequences were studied in PLWHA, considering its effect on clinical morbidity associated with HIV/Aids, on the metabolic changes of HIV Lipodistrophic Syndrome, cardiovascular risk (CVR) and adherence to treatment. A cohort of 400 PLWHA accompanied on a reference service in the State of Paraíba, between March 2015 to May 2016, which were classified in two groups for exposure to FI, obtained by Brazilian Range of food insecurity and accompanied by a year to evaluate the outcomes. Described if the frequencies of socio-demographic variables, clinical, laboratory and the CVR; through its association with FI, using the Chi square and Mann-Whitney tests. Instrument devised to assess adherence to antiretroviral therapy (ART). Using Kaplan-Meier estimators and Nelson-Aalen to estimate survival. The Logrank test compared the curves for variable, and we used Cox regression model to estimate the risk associated with each outcome. Devised decision tree model to identify individuals with viral load (VL) detectable. The sample was characterized by most male (61.5%), race/color brown (54.8%), mean and median age of 44 years, 57.1% education; incomplete elementary school, 48.5% were retired, 32.8% with per capita incomes between 1/3 to 1/2 minimum wage in force. The average time to diagnosis was 7.8 years and use of HAART was 6.9 years. The prevalence of was 70.7% 399 of PLWHA, being higher in households with children under 18 years old, and FI afflicted 19.5 percent of these people. Moderate or severe FI (MFI/SFI) was associated with female sex, race/color; white, low education, low income per capita, being unemployed, not being adherent to HAART and have undetectable VL. There was no difference between the groups for levels of hemoglobin, hematocrit, serum proteins, glucose, lipid profile and body mass index. Individuals in MFI/SFI were more smokers, sedentary and with higher levels of ultra sensitive protein C. The CVR was classified as high 7.9, 40.7% of PLWHA and when used, respectively, the Framingham risk score and the Overall risk score, and not related to MFI/SFI. The Accession score 42 presented 63% of accuracy to detect the PLWHA with undetectable VL and 58.5 percent ranked as adherents. Poor adherence to HAART increased by 1.6 times the risk for care in the hospital, at 1.7 times the risk to introduce infectious diseases associated with HIV/Aids and immunodeficiencies in 1.9 times the risk to submit to undetectable VL after 12 months. The MFI/SFI was associated with worse survival to seek care at the hospital, introduce infectious diseases associated with HIV/Aids immunodeficiency and have CD4 count less than 350 cells/mm3, during the following 12 months. Individuals adhering to treatment in food safety or FI take had better survival for present undetectable VL. Being in MFI/SFI increased by 1.7 times the risk to seek care at the hospital, 1.9 times the risk for infectious disease associated with HIV/Aids immunodeficiency and 1.7 times the risk for HIV/Aids related diseases not associated with immunodeficiency, during the following 12 months. At the end of this period the VL was undetectable in 76.7 percent of 322 individuals, each with their own new tests. The evaluation of VL, CD4 cell count and treatment adherence was able to predict correctly 80.0% of PLWHA regarding detectable after 12 months VL from rules obtained by the decision tree model. The FI is a stressor that worsens the clinical evolution of PLWHA in the following 12 months, such as vulnerability to be better investigated and valued for the effective control of the Aids epidemic. / A insegurança alimentar (IA) atinge 22,6% da população brasileira, porém sua prevalência e consequência em pessoas vivendo com HIV/Aids (PVHA) são pouco conhecidas no Brasil. Estudaram-se as consequências da IA em PVHA, considerando seu efeito sobre a morbidade clínica associada ao HIV/Aids, sobre alterações metabólicas da Síndrome Lipodistrófica do HIV, o risco cardiovascular (RCV) e a adesão ao tratamento. Realizou-se uma coorte de 400 PVHA acompanhadas em serviço de referência no Estado da Paraíba, entre março de 2015 a maio de 2016, que foram classificadas em dois grupos quanto à exposição à IA, obtida pela Escala Brasileira de Insegurança Alimentar e acompanhadas por um ano para avaliação dos desfechos. Descreveram-se as frequências das variáveis sociodemográficas, clínicas, laboratoriais e o RCV; com sua associação com IA, utilizando os testes quiquadrado e Mann-Whitney. Elaborou-se instrumento para avaliar a adesão à terapia antirretroviral (TARV). Utilizaram-se os estimadores de Kaplan-Meier e Nelson-Aalen para estimar a sobrevivência. O teste Logrank comparou as curvas por variável, e utilizou-se modelo de regressão de Cox para estimar o risco associado a cada desfecho. Elaborou-se modelo de árvore de decisão para identificar os indivíduos com carga viral (CV) detectável. A amostra caracterizou-se por maioria do sexo masculino (61,5%), raça/cor parda (54,8%), média e mediana da idade de 44 anos, 57,1% com escolaridade até ensino fundamental incompleto, 48,5% eram aposentados, 32,8% com renda per capita entre 1/3 a 1/2 salário mínimo vigente. O tempo médio de diagnóstico foi de 7,8 anos e de uso de TARV foi de 6,9 anos. A prevalência de IA foi de 70,7% em 399 PVHA, sendo maior nos domicílios com menores de 18 anos, e a IA grave acometeu 19,5% dessas pessoas. A IA moderada ou grave (IAMo/IAG) esteve associada ao sexo feminino, à raça/cor não branca, à baixa escolaridade, baixa renda per capita, estar desempregado, não ser aderente à TARV e ter CV detectável. Não houve diferença entre os grupos para níveis de hemoglobina, hematócrito, proteínas séricas, glicemia, perfil lipídico e índice de massa corporal. Indivíduos em IAMo/IAG eram mais tabagistas, sedentários e com maiores níveis de Proteína C ultrassensível. O RCV foi classificado como alto em 7,9 e 40,7% das PVHA quando se utilizaram, respectivamente, o Escore de Risco de Framingham e o Escore de Risco Global, e não se relacionou com IAMo/IAG. O Escore de Adesão 42 apresentou acurácia de 63% para detectar as PVHA com CV detectável e classificou 58,5% como aderentes. A má adesão à TARV aumentou em 1,6 vezes o risco para atendimento no hospital dia, em 1,7 vezes o risco para apresentar doença infecciosa associada à imunodeficiência do HIV/Aids e em 1,9 vezes o risco para apresentar CV detectável no seguimento de 12 meses. A IAMo/IAG esteve associada com pior sobrevida para procurar atendimento no hospital dia, apresentar doença infecciosa associada à imunodeficiência do HIV/Aids e ter contagem de CD4 menor que 350 células/mm3, durante o seguimento de 12 meses. Indivíduos aderentes ao tratamento em segurança alimentar ou IA leve tiveram melhor sobrevida para apresentar CV detectável. Estar em IAMo/IAG aumentou em 1,7 vezes o risco para procurar atendimento no hospital dia, em 1,9 vezes o risco para doença infecciosa associada à imunodeficiência do HIV/Aids e em 1,7 vezes o risco para doença relacionada ao HIV/Aids não associada à imunodeficiência, durante o seguimento de 12 meses. Ao final deste período a CV estava indetectável em 76,7% dos 322 indivíduos, que dispunham de novos exames. A avaliação da CV, contagem de células CD4 e adesão ao tratamento foi capaz de predizer corretamente 80,0% das PVHA quanto à CV detectável após 12 meses a partir de regras obtidas pelo modelo de árvore de decisão. A IA é um estressor que piora a evolução clínica de PVHA no seguimento de 12 meses, destacando-se como ponto de vulnerabilidade a ser melhor investigado e valorizado para o controle efetivo da epidemia de Aids.

Este estudo discute a AIDS enquanto um fenômeno simbólico para indivíduos a partir da experiência clínica e do referencial teórico da psicologia analítica.A técnica utilizada foi a análise de registros de sonhos. Durante 22 meses foram registrados 125 sonhos de 9 de pessoas infectadas pelo HIV, e os sintomas relacionados à AIDS. Destes foram selecionadas três séries oníricas totalizando 74 sonhos, segundo os critérios: idade, sexo, orientação sexual, escolaridade, nível sócio-econômico, período de infecção, período de coleta de dados, local de atendimento e número e qualidade dos sonhos registrados. A análise foi realizada primeiro, a partir das associações e dos dados coletados durante as sessões, procurando verificar as relações entre os sonhos e o momento de vida do indivíduo. A seguir, identificou-se a constelação arquetípica mais presente em cada série, amplificando-a a nível arquetípico e relacionando-a com a situação psicológica do sujeito. Procurou-se também averiguar o movimento de compensação e/ou adaptação do inconsciente à experiência de vida marcada pela AIDS. E por último, analisou-se as três séries em conjunto procurando destacar os pontos relevantes para a compreensão do fenômeno da AIDS como um todo. A análise dos dados indica que a AIDS, enquanto fenômeno simbólico, pode ser inserida em um movimento de reestruturação amplo da personalidade. A compensação parece dar-se dentro deste processo e não em relação ao evento da AIDS isoladamente. Porém, foram registradas constelações do Self durante os eventos somáticos mais graves, o que pode indicar um esforço compensatório frente a uma situação de ameaça à vida. Os sintomas menos graves foram acompanhados pela emersão de conteúdos da sombra com os quais parecem ter uma relação simbólica. As várias referências ao mito de Dioniso ao longo das séries pode indicar, que a nível coletivo, a epidemia da AIDS faz parte de um movimento compensatório à cultura judaico-cristã-apolínea, que visa redimensionar a consciência, através da integração dos elementos instintivos da psique. / This study focuses on AIDS while a symbolic phenomenon in individuals, based on clinical experience supported by the analytical psychology theory. The technique used in this work was dream analysis. In a period of 22 months it was registered 125 dreams of 9 people infected with HIV, as well as the symptoms related to AIDS. It was selected three series of dreams totaling 74 dreams according to: age, sex, sex orientation, scholarship, social-economic level, period of infection and data registration, counseling place and amount of registered dreams. First, the analysis was made, from the associations and therapy sessions' data, in order to verify the relations between dreams and the individual situation. Next it was identified the archetypal constellation present in each series. This archetypal constellation was amplified at archetypal level and related to the psychological situation of the individual. It was also verified the compensation and the adaptation movement in relation to AIDS. Finally, the three series were analyzed all together and the significant aspects to the comprehension of AIDS phenomena were discussed. The data analysis suggests that AIDS, while a symbolic phenomenon, can be understood as part of a great movement of personality change. The compensation movement seems to take place in this process and not in relation to AIDS. However, Self constellations were registered during the most serious somatic events, what can denote a compensation in face of a threatening life situation. Less serious somatic events were followed by the emergence of shadow contents, with which they seem to have a symbolic relation. Many references to Dioniso myth can indicate at a collective level, a compensatory movement against the Judaic-Christian-Apolinean culture that aims the consciousness transformation by integrating the instinctive elements of the psyche.

As ações de prevenção ao HIV/aids na ESF foram objetos desse estudo, cujo objetivo foi analisá-las, sob a ótica da vulnerabilidade na sua dimensão programática, identificar como as equipes de saúde da família reconhecem a vulnerabilidade ao HIV/aids nos seus territórios; descrever as ações de prevenção direcionadas às populações reconhecidas pelas equipes como vulneráveis e caracterizar as dificuldades, as potencialidades e os desafios na prevenção ao HIV/aids na ESF. Para alcançar tais objetivos optou-se por um estudo exploratório, com abordagem qualitativa, utilizando-se a metodologia do Estudo de Caso. O conceito de vulnerabilidade, em sua dimensão programática, foi usado como quadro teórico. A coleta de dados foi realizada por meio de entrevistas semi-estruturadas com gerentes de UBS de Saúde ou pessoas indicadas por eles e mediante técnica de grupo focal com equipes de saúde da família. O estudo foi conduzido no período de junho a dezembro de 2009, em 11 Unidades do distrito de Capão Redondo, região sul do Município de São Paulo, Brasil. Os resultados apontam que as equipes reconhecem a vulnerabilidade ao HIV/aids em seus territórios atrelada à dimensão individual, fundamentada na noção de risco da epidemiologia tradicional, identificando grupos ou comportamentos de risco. Fundamentadas nos mesmos conceitos, percebeu-se o predomínio de intervenções informativas, de caráter prescritivo e normativo, que tinha como principal finalidade a mudança de comportamento do indivíduo. Ações fortemente baseadas no modelo biomédico hegemônico. Como dificuldades encontradas destacaram-se àquelas relacionadas ao processo de trabalho das equipes, que apontam sobrecarga de trabalho pelas demandas dos programas prioritários; alta rotatividade dos profissionais e falta de capacitação dos mesmos para a prevenção ao HIV. A maior potência da ESF na prevenção da aids encontra-se no princípio da longitudinalidade, que permite qualificar o reconhecimento da vulnerabilidade do território e planejar as ações de prevenção de acordo com as necessidades da população. O maior desafio apontado pelas equipes está em reconhecer o processo de produção e reprodução social como determinante da vulnerabilidade ao HIV. Por fim, conclui-se que o modelo técnico-assistencial vigente na atenção básica, apesar de sua reconhecida potencialidade, ainda apresenta práticas embasadas na noção de risco e no modelo biomédico hegemônico, determinando, assim, a vulnerabilidade programática na prevenção ao HIV/aids. / Actions to prevent HIV/AIDS in the FHS were objects of this study, whose objective was to analyze them from the perspective of vulnerability in its programmatic dimension, to identify how the family health teams recognize the vulnerability to HIV/AIDS in their territories; describe the preventive actions directed to the populations recognized by the teams as vulnerable and characterize the problems, potentiality and challenges in the prevention of HIV/AIDS. To achieve these goals was chosen an exploratory study with a qualitative approach, using the methodology of the Case Study. The concept of vulnerability in its programmatic dimension, was used as a theoric framework. Data collection was conducted through semi-structured interviews with managers of Basic Health Units or people appointed from them and through focus group technique with family health teams. The study was conducted from June to December 2009, in 11 units in the district of Capão Redondo, south of São Paulo city, Brazil. The results show that teams recognize the vulnerability to HIV / AIDS in their territories linked to the individual dimension, grounded in the notion of risk in traditional epidemiology, identifying risk groups or risk behaviors. Reasoned on the same concepts, it was noted the predominance of interventions informational, and normative and prescriptive character that had as main purpose to change the behavior of individual. Actions strongly based on the hegemonic biomedical model. As difficulties faced stood out to those linked to the process of work teams, which aim to work overload by the demands of the priority programs, high turnover and lack of professional training to prevent HIV/AIDS. The biggest potential of the FHS is in the principle of longitudinality, which allows to qualify the recognition of the vulnerability of the territory and to plan preventive actions according to the needs of the population. The biggest challenge is appointed by the teams in recognize the process of social production and reproduction as a determinant of vulnerability to HIV/AIDS. Finally, we conclude that the current technical health care model in primary care, despite its recognized potential also presents practices based in the notion of risk and the hegemonic biomedical model, thus determining the programmatic vulnerability in preventing HIV/AIDS.

No abstract available. / Dissertation (LLM)--University of Pretoria, 2013. / gm2014 / Centre for Human Rights / unrestricted

Class of 2012 Abstract / Specific Aims: To evaluate disease- and patient-related characteristics, mortality, and charges associated with non-AIDS defining malignancies (NADM) among inpatient settings in the United States from 2005 to 2009. Methods: This retrospective cohort investigation utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Nationwide Inpatient Sample. Inclusion criteria included adult inpatients ≥18 years with a diagnosis of HIV or AIDS and malignant neoplasms. Multivariate regression analyses were used to assess inpatient mortality and charges. Main Results: Overall, 104,488 were included. Average age associated with each case was 46.9 years (±10.66), with 21.9% cases being female (n=22,868). The mean length of stay was 8.6 days (±10.5) and inpatient mortality occurred in 7.7% of cases (n=8,035). The mean number of procedures performed was 2.3 (±2.5) and the mean number of diagnoses on record was 9.5 (±4.4). Charges for each episode of care averaged $59,483 (±85,748), summing to a national bill of $6.14 billion (2011 dollars) over the five-year course. A higher number of cases were associated with teaching hospitals (74.1%), the south (42%), large metropolitan areas (75.1%), median household income in the 0-25th percentile (41.2%), and Medicaid payers (34.3%). Increased mortality was associated with increased age, increased number of diagnoses and procedures, and the comorbidities of anemia, coagulopathy, lymphoma, and fluid and electrolyte disorders. Conclusions: This investigation of NADMs suggest a considerable clinical and economic burden of illness, summing to a 7.7% inpatient death rate and $1.3 billion in charges per year.

Magister Artium - MA / This study aimed to explore the attitudes to HIV testing among a group of black, low socio-economic status pregnant women from Gugulethu, South Africa. The key research interest was to evaluate the attitudes and understandings of HIV/AIDS that underpin the decision to comply or not comply with prenatal HIV testing. Theories of health behaviour concur that the extent to which an individual will engage in a given health behaviour, such as HIV test compliance, will be a function of the extent to which a person believes she is personally susceptible to the particular illness and her evaluation of the severity of the consequences of contracting the disease. / South Africa