Detection of splenic microabscesses with ultrasound as a marker for extrapulmonary tuberculosis in patients with HIV: A systematic review.

BACKGROUND: In 2015, 1.2 million new cases of tuberculosis (TB) were diagnosed in patients with HIV. Diagnostic limitations and resource shortages in endemic areas can delay diagnosis and treatment, particularly with extrapulmonary TB (EPTB). Research suggests that ultrasound can identify splenic microabscesses caused by EPTB, but data are limited on the frequency of this finding in patients with culture-proven EPTB. OBJECTIVES: To estimate the frequency of splenic EPTB microabscesses detected with ultrasound in patients with HIV and TB co-infection. METHODS: Studies published in six major databases as of November 2017 were systematically reviewed based on the PRISMA guidelines. Cohen's kappa test was used to determine inter-rater agreement. Articles included for data abstraction passed the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) evaluation. Freeman-Tukey transformation was used to calculate weighted proportions. Heterogeneity was evaluated by Forest plot and I2 calculation. RESULTS: After abstract screening, article review and QUADAS-2 evaluation, five studies were selected for data extraction. A total of 774 patients in these studies were infected with HIV. Splenic lesions were seen with ultrasound in 21.0% of patients with HIV (95% confidence interval (CI) 10.6 - 33.8). TB diagnosed by culture, biopsy, smear, or molecular methods was found to be the cause of 88.3% (95% CI 72.3 - 97.9) of splenic microabscesses seen on ultrasound in patients with HIV. CONCLUSIONS: Ultrasound evaluation of the spleen in patients with HIV and symptoms suggestive of TB in endemic regions is a viable diagnostic adjunct. Ultrasound detection of splenic microabscesses in HIV patients is probably sufficient indication to initiate TB treatment prior to obtaining culture data. Strong conclusions cannot be drawn owing to the high heterogeneity of this small number of studies.

Detection of splenic microabscesses with ultrasound as a marker for extrapulmonary tuberculosis in patients with HIV: a systematic review

Background. In 2015, 1.2 million new cases of tuberculosis (TB) were diagnosed in patients with HIV. Diagnostic limitations and resource shortages in endemic areas can delay diagnosis and treatment, particularly with extrapulmonary TB (EPTB). Research suggests that ultrasound can identify splenic microabscesses caused by EPTB, but data are limited on the frequency of this finding in patients with culture-proven EPTB. Objectives. To estimate the frequency of splenic EPTB microabscesses detected with ultrasound in patients with HIV and TB co-infection. Methods. Studies published in six major databases as of November 2017 were systematically reviewed based on the PRISMA guidelines. Cohen's kappa test was used to determine inter-rater agreement. Articles included for data abstraction passed the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) evaluation. Freeman-Tukey transformation was used to calculate weighted proportions. Heterogeneity was evaluated by Forest plot and I2 calculation. Results. After abstract screening, article review and QUADAS-2 evaluation, five studies were selected for data extraction. A total of 774 patients in these studies were infected with HIV. Splenic lesions were seen with ultrasound in 21.0% of patients with HIV (95% confidence interval (CI) 10.6 - 33.8). TB diagnosed by culture, biopsy, smear, or molecular methods was found to be the cause of 88.3% (95% CI 72.3 - 97.9) of splenic microabscesses seen on ultrasound in patients with HIV. Conclusions. Ultrasound evaluation of the spleen in patients with HIV and symptoms suggestive of TB in endemic regions is a viable diagnostic adjunct. Ultrasound detection of splenic microabscesses in HIV patients is probably sufficient indication to initiate TB treatment prior to obtaining culture data. Strong conclusions cannot be drawn owing to the high heterogeneity of this small number of studies

Determining global population distribution: methods, applications and data.

Evaluating the total numbers of people at risk from infectious disease in the world requires not just tabular population data, but data that are spatially explicit and global in extent at a moderate resolution. This review describes the basic methods for constructing estimates of global population distribution with attention to recent advances in improving both spatial and temporal resolution. To evaluate the optimal resolution for the study of disease, the native resolution of the data inputs as well as that of the resulting outputs are discussed. Assumptions used to produce different population data sets are also described, with their implications for the study of infectious disease. Lastly, the application of these population data sets in studies to assess disease distribution and health impacts is reviewed. The data described in this review are distributed in the accompanying DVD.

College student bereavement, scholarship, and the university: a call for university engagement.

The prevalence of bereavement among traditional-aged college students should impel universities to assist bereaved students on their campuses. Dealing with bereavement can not only challenge a college student's completing the developmental tasks that our society sets for the later adolescent years, but also imperil the student's remaining in school and graduating. It is in the best interests of the university to develop and implement a variety of effective interventions to assist bereaved students. The author argues that universities are communities devoted to scholarly endeavors and should explicitly incorporate the dimension of compassion and caring. An abbreviated case study is used to illustrate the situations in which one grieving student found herself when she returned to school following the death of her father. A call is made for greater university engagement by forming a university-based bereavement center to coordinate and conduct coherent inquiry that fulfills the scholarly functions of discovery, application, and instruction. Four specific actions for a bereavement center are to train nonbereaved students to provide peer support, to provide structured interventions for college students at risk of bereavement complications, to raise consciousness about bereavement on the university campus, and to conduct research into various bereavement populations and bereavement topics.

Bereavement and spiritual change.

The thesis of this article is that bereavement is a life crisis that challenges one's assumptions about human existence and provides the grounds for spiritual change. Construing a new understanding of the meaning of human existence and revising assumptions about one's place in the universe is a singular form that indicates spiritual change at work. Three aspects must be present for a life crisis to produce spiritual change: The situation must create a psychological imbalance or disequilibrium that resists readily being stabilized; there must be time for reflection; and the person's life must forever afterwards be colored by the crisis. The premise of this article links spiritual change to what J.W. Fowler (1981) termed transformed faith consciousness and argues that the dual process model of coping with loss (M.S. Stroebe & H. Schut, 1995; M.S. Stroebe, H. Schut, & W.A. Stroebe, 1995; M.S. Stroebe, H. Schut, & J. Van Den Bout, 1994) provides a means to understand how dealing with grief can evoke spiritual change. Some brief case examples are used to examine the thesis that bereavement triggers spiritual change.

TAT results in a longitudinal study of bereaved college students.

The authors analyzed projective data obtained from 141 college students who wrote stories on three separate occasions to selected cards from the Thematic Apperception Test (TAT). The students included 46 members of support groups for bereaved college students, 34 members of a bereavement control group, and 61 nonbereaved students. The study used a repeated-measures pretest-posttest control group design to gather longitudinal data about the trajectory of bereavement with and without support group intervention. Coders, who reached consistently high interrater reliability, looked for themes of death, grief, coping, and affiliation in the stories. Multivariate analysis of variance (MANOVA) and repeated-measures MANOVA tests were applied to analyze coding results. Overall MANOVA results indicated significant group differences in the responses to the TAT cards. Repeated-measures MANOVA found group differences in use of themes of death and grief and found Group x Time differences in maintaining a sense of self-efficacy while in a crisis. A majority of the stories contained affiliation imagery but without any group differences in the use of such imagery.

Psychological development during four years of bereavement: a longitudinal case study.

Bereavement in the lives of college students is more prevalent than many persons realize. A survey replicated 4 times on the Kansas State University campus demonstrated that, at any point in time, over 25% of the students were in the 1st year of grief following the death of a family member and nearly 30% in the 1st year of grief following the death of a friend. Grief work can hinder traditional-age college students from resolving normal developmental tasks, such as forming autonomous lives, developing a clear sense of direction, and entering into lasting, intimate relationships. This article provides longitudinal case study information about a traditional-age college student following the death of her father. The data come from multiple sources. Data from the Impact of Events Scale document changes in intrusive and avoidant thoughts and images; journal entries show changes in the student's ongoing relationship with her father, coping with his death and subsequent events colored by her bereavement, and life lessons; data from the Grant Foundation Bereavement Inventory show changes in the student's attachment, reunion fantasies, disbelief about her father's death, identification with her father, and feelings of disloyalty as time passed. Comparisons are made to responses of 80 bereaved students who participated in a separate longitudinal study.

Change comes slowly for women in rural Bangladesh.

PIP: Survey results from two disparate rural areas of Bangladesh, Sirajgong and Gopalpur subdistricts in the north-central part of the country and Abhoynagar and Fultala subdistricts in the southwest, offer the opportunity to assess the changing status of women in rural Bangladesh. The survey, conducted by the Mother and Child Health/Family Planning Extension Project of the International Center for Diarrheal Disease Control during 1982-89, collected data on 7433 ever-married women 15-56 years old. The analysis focused on two indicators: women's freedom to move outside their homes (mobility) and women's authority in household decision making. Although most respondents moved freely between households, they rarely traveled outside their village alone. In addition, respondents had little input in household decisions regarding health or expenditures. 65% felt they should be able to decide whether to see a doctor when they were ill or to buy medicine for a sick child, but only 7% actually made such decisions on their own. The majority approved of women working outside their homes, but only 11% did so. Both mobility and authority tended to increase with a woman's age. Women who lived in households headed by their in-laws had less mobility and much less authority. Women from poor homes had greater mobility, but wealth had little effect on household decision making. Education tended to increase decision-making authority but decrease mobility. Finally, the greater economic development, ecological stability, cultural diversity, and social progressiveness in the southwestern region tended to increase both mobility and authority.^ieng

Are young people in the Philippines taking chances with HIV / AIDS?

PIP: The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.^ieng

Awareness and knowledge of AIDS among Indian women: evidence from 13 states.

Over 30,000 ever-married women in 13 (out of 25) Indian states where HIV is thought to be highly prevalent-Maharashtra, West Bengal, Tamil Nadu, and ten other less populous states-were surveyed about their awareness and knowledge of AIDS. Only one in six women had heard of AIDS. Among those, knowledge about transmission and prevention is poor. Multivariate analyses reveal that rural, poorly educated, and poor women are the least likely to be AIDS-aware and if aware, have the poorest understanding of the syndrome. Despite low levels of awareness and knowledge, we find a strong positive association between AIDS awareness and knowledge and condom use.

PIP: An estimated 1.6-1.75 million people in India are infected with HIV. 32,077 ever-married women in Arunachal Pradesh, Assam, Delhi, Goa, Gujarat, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Tamil Nadu, Tripura, and West Bengal states were surveyed in the 1992-93 National Family Health Survey about their awareness and knowledge of AIDS. HIV is believed to be highly prevalent in those states. Only 17% of the women had heard of AIDS and among those women, levels of knowledge about HIV transmission and prevention are poor. Multivariate analysis found rural, poorly educated, and poor women to be the least likely to be AIDS-aware, and if aware, to have the poorest understanding of what AIDS is. A strong positive association was nonetheless found between AIDS awareness and knowledge and condom use.

Models for understanding adolescent coping with bereavement.

Several issues impinge on scholars and practitioners interested in adolescent bereavement. First and foremost, adolescent bereavement over the death of a family member or a friend is more prevalent than many persons recognize. Second, scholars and practitioners need models that link adolescent development with adolescent coping during bereavement. Third, models are needed (a) to assist in rethinking what "recovery from bereavement" denotes and (b) to afford criteria for assessing recovery from bereavement. The author reviews findings on bereavement during adolescent development and gives particular attention to three models that enhance our understanding of coping with the life crises bereavement presents to adolescents. One model links grief during adolescence to developmental tasks; another model presents adaptive tasks and coping skills; and the third model identifies sentiments essential for human wholeness. Findings from a variety of studies with bereaved adolescents provide data to test the usefulness of the models. The closing discussion centers on implications for working with bereaved adolescents.

Women in 13 states have little knowledge of AIDS.

PIP: India's 1992-93 National Family Health Survey included questions about AIDS awareness in 13 Indian states that were locations of heightened concern to health officials. Results for the representative sample of 32,077 ever-married women of reproductive age revealed that only about 1/6 of the women had ever heard of AIDS. Those who had heard of AIDS were asked follow-up questions, and their responses indicated that 18% could not identify a single mode of transmission, 42% believed that AIDS could be transmitted through kissing, 55% knew AIDS could be avoided by practicing "safe sex" (28% mentioned condoms), and 23% understood the life-threatening risks associated with AIDS. AIDS knowledge was greatest among those older than 20 years, urban residents, more educated women, and those who had greater exposure to the mass media. Television was the greatest source of AIDS information; other sources were newspapers, radio, magazines, and friends or relatives. While television and radio were major sources of information, exposure frequency was not associated with increased knowledge. Women who had the greatest number of information sources had the most AIDS knowledge (these women were probably more educated and wealthier than the average). Based on these findings, it is recommended that television, radio, and the print media become more effective AIDS communicators, that the role of teachers and schools in AIDS education be expanded, and that ways be developed to convey AIDS information to the rural population and among illiterate people.^ieng

Cost-effectiveness analysis of family planning programs in rural Bangladesh: evidence from Matlab.

The Family Planning Health Services Project in Matlab is often seen as more expensive than similar activities carried out by the government of Bangladesh. At the same time, it as been observed that the project is much more effective. The alleged high cost of the project is said to make it difficult to replicate throughout the nation. Previously, the true costs of the project had not been documented. This study systemically examines the cost of the project and assesses its cost-effectiveness. An experimental design framework is used as a basis for understanding the cost-effectiveness of the project, although a sensitivity analysis lends further support to the relative efficiency of the approach undertaken in Matlab. Although in the aggregate, the Matlab Project is more expensive than the government's family planning program, it is also more effective, generating enough output to offset the extra costs of the intensified delivery system.

PIP: The cost-effectiveness, in terms of cost per averted birth, of the Family Planning Health Services Project (FPHSP) in Matlab, Bangladesh was analyzed on 3 levels in comparison to that of the comparison area, which received the Government's family planning services. The Matlab project began in 1977, and is now renowned for its effectiveness, and quality and longevity of data. The experimental area received an intense, cafeteria-type family planning method mix (pills, tubectomy, condoms, foal, IUDs and injectables), with vaccinations, ORS and medicines by household delivery, structured horizontally, with in-depth, repeated surveys. The control area receives limited family planning methods (pills, tubectomy, vasectomy, condoms), ORS only, by vertical design. The project has yielded about 45% contraceptive prevalence of effective methods, and 6914 births averted from 1978-1985. The costing scheme is categorized into service rings denoted service delivery, supervision and administration, data management, research and international assistance and overhead. Research is included as a cost because it generates effects by a "Hawthorne effect." Costs have ranged from $133,000-164,000 yearly. Three models of cost analysis are presented and discussed from the viewpoint of sensitivity analysis. The estimated cost per birth prevented ranges from $150-220, figures that do not account for reduced mortality or improved reproductive health. The Matlab project generates about 3 times as many services as the government program. It costs more overall, but less per birth averted than the control government program. This suggests that the government program may benefit by offering a wider choice of contraceptive methods.

Atmosphere contamination following repainting of a human hyperbaric chamber complex.

The Naval Medical Research Institute currently conducts hyperbaric research in a Man-Rated Chamber Complex (MRCC) originally installed in 1977. Significant engineering alterations to the MRCC and rusting of some of its interior sections necessitated repainting, which was completed in 1988. Great care was taken in selecting an appropriate paint (polyamide epoxy) and in ensuring correct application and curing procedures. Only very low levels of hydrocarbons were found in the MRCC atmosphere before initial pressurization after painting and curing. After pressurization, however, significant chemical contamination was found. The primary contaminants were aromatic hydrocarbons: xylenes (which were a major component of both the primer and topcoat paint) and ethyl benzene. The role that pressure played in stimulating off-gassing from the paint is not clear; the off-gassing rate was observed to be similar over a large range in chamber pressures from 1.6 to 31.0 atm abs. Scrubbing the chamber atmosphere with the chemical absorbent Purafil was effective in removing the contaminants. Contamination has been observed to slowly decline with chamber use and is expected to continue to improve with time. However, this contamination experience emphasizes the need for a high precision gas analysis program at any diving facility to ensure the safety of the breathing gas and chamber atmosphere.

Adolescent reactions to sibling death: perceptions of mothers, fathers, and teenagers.

Fourteen families in which a child had died participated in this study; the mother, father, and one teenager from each family were interviewed. All participants completed a sibling bereavement inventory consisting of 109 scaled items that measured self-concept perceptions and grief reactions. The teenagers completed the inventory in terms of their own reactions; the mothers and fathers were instructed to complete the inventory as they anticipated their teenager would answer it. Mothers held significantly different views of their teenagers' self-concept and grief than did the fathers or the teenagers. Fathers' responses resembled those of their teenagers. In addition to accenting the need to study more fully the family dynamics involved when a child dies, the results call into serious question commonly held views regarding the accuracy and reliability of mothers' perceptions of bereaved children. The results suggest that more credence be given to fathers' observations about the phenomena of bereavement engaging their teenage children.

Learned helplessness: a model to understand and overcome a child's extreme reaction to failure.

The author reviews literature on children's reactions to perceived failure and offers suggestions for preventing these reactions. Learned helplessness is a model offered to explain why a child who makes a mistake gives up even though competent to succeed. Sex differences in reactions to failure and feedback about failure from others are reviewed as well as different effects which perceived failure has upon the performances of helpless versus competent children. Attributions regarding success and failure emerge as a significant factor in children's behavior. A workshop format is offered as a form of consulting with classroom teachers concerned over children's extreme reaction to failure.

Effects of sibling death on teenagers.

This study reports the effects of sibling death on 33 adolescents from white, middle- to upper-middle income families. Contact was made through mutual support groups for bereaved parents. A focused interview was used to gather data on bereavement reactions and on self-concept. Bereavement reactions investigated included kinds of emotional responses, effects on sleeping and eating, frequency of thoughts about the deceased sibling, effects on school work, means of dealing with the death and interpersonal relationships. Self-concept perception investigated were perceptions of personal maturity, lessons learned from the death and the importance of religious beliefs. Eleven further measures of self-concept were obtained by means of the "Offer Self-Image Questionnaire for Adolescents." By grouping responses into two time frames (before or a few weeks after the death and at the time of the interview), significant differences in reactions and perceptions were found among the participants.

Adolescents' grief reactions and self-concept perceptions following sibling death: A study of 33 teenagers.

Thirty-three teenagers were interviewed regarding their grief reactions and self-concept perceptions following sibling death. The teenagers also completed the Offer Self-Image Questionnaire for Adolescents (OSIQ). Grief reactions investigated were emotional responses, extent of preoccupations with thoughts of the dead sibling, effects on sleeping and eating habits, anniversary reactions, hallucinations of the dead sibling, thoughts of suicide, and effects on grades and study habits. In addition to OSIQ data, self-concept measures included self-concept in common contexts, perceptions of personal maturity, lessons learned from the sibling's death, relationship with the sibling prior to the death, and importance of religious beliefs. Results oft tests on OSIQ standard scores indicated that the participants were as adjusted as same-age same-sex norm groups. Chi-square analysis and univariateF tests of group differences identified emotional responses significantly associated with sex and age characteristics of the participants. Statistically significant results emerged regarding effects on grades and study habits, perceptions of personal maturity, and increased importance of religious beliefs. Discriminant analysis indicated that specific emotional responses were influenced by perceptions of family closeness and by perceptions of personal communication with family members. Two case descriptions highlight some of the typical patterns which the teenagers experienced.

The attitudes of twelve mental health agencies in Phoenix toward issues of community control and participation in social action.

A survey was used to compare the attitudes of twelve Phoenix area mental health agencies regarding community control and participation in social action. A modified Likert scale provided attitude choices for survey items. The researcher computed mean scores for the twelve agencies for survey items. Each agency's attitudes are compared to the attitudes of the other eleven agencies considered as a group. No agency differed significantly from the other eleven on community control. One agency significantly differed from the other eleven regarding participation in social action.