Comorbidities and psychosocial factors as correlates of self-reported falls in a nationwide sample of community-dwelling people aging with HIV in Germany.

BACKGROUND: Falls are a frequent health problem with potentially severe consequences among the elderly. Due to the aging HIV population, there is a growing interest in falls as a geriatric syndrome in HIV research and clinical practice. Previous studies found rather high prevalences of falls in this population and focused on biomedical and demographic risk factors for falls. Psychosocial risk factors like stigma, social support or loneliness were not previously assessed as correlates of fall events in this population. METHODS: We assessed self-reported fall frequency in the past 12 months in a nationwide sample of 897 community-dwelling people aged 50 years or older living with HIV in Germany using a cross-sectional study design. We calculated odds of any fall for sociodemographic and HIV-related variables in bivariate analyses and for comorbidities, and psychosocial variables in bivariate and adjusted analyses. RESULTS: Eighteen percent of our participants reported at least one fall in the preceding 12 months, 12 % reported recurring falls. A lower socioeconomic status, being single and living alone were significantly associated with a higher risk for falling. An AIDS diagnosis was related to fall risk, but time since diagnosis and a detectable viral load were not. Reporting at least one comorbidity increased fall risk in our sample 2.5 times (95% CI: 1.59; 3.97). The strongest association with fall risk was found for diseases of the central nervous system, heart disease, rheumatism, osteoporosis, and chronic pain. Experienced HIV stigma (AOR: 2.11; 95% CI: 1.58; 2.83) and internalized HIV stigma (AOR: 1.43; 95% CI: 1.12; 1.85), as well as social support (AOR: .92; 95% CI: .86; .99) and loneliness (AOR: 1.51; 95% CI: 1.22; 1.87) were significantly related to fall risk in bivariate and adjusted analyses. CONCLUSIONS: We found a low prevalence of falls in our sample of community-dwelling people aging with HIV. Our results show evidence for a strong association between comorbidity and falling, and between psychosocial factors and falling. Especially the strong association between experienced HIV stigma and fall risk is noteworthy and adds falls to the list of health outcomes affected by HIV stigma.

Sociodemographic, HIV-Related Characteristics, and Health Care Factors as Predictors of Self-Reported Vaccination Coverage in a Nationwide Sample of People Aging with HIV in Germany.

Preventing infectious diseases through vaccination becomes more significant among the growing population of people aging with HIV. Coverage rates for vaccinations and factors associated with vaccination utilization among this population in Germany are unknown. We assessed the coverage of eight recommended vaccinations in a certain time frame in our convenience sample of 903 people living with HIV aged 50 years and older. We analysed coverage rates and used bivariate and multiple linear regression analyses to identify factors associated with number of reported vaccinations. Coverage rates in our sample ranged between 51.0% for meningococcus disease and 84.6% for the triple vaccination against tetanus, diphtheria, and pertussis. All rates were higher compared to the German general population. Seven factors were related to the number of vaccinations in multiple regression analysis: sexual orientation, education, relationship status, CD4 count, time since last visit to HIV specialist, type of HIV specialist, and distance to HIV specialist. Vaccination coverage among people aging with HIV in Germany is high, but not optimal. To improve vaccination uptake, strengthened efforts need to be focused on female and heterosexual male patients, socioeconomically disadvantaged patients, and patients with barriers to access regular HIV care.

Associations Between Experienced and Internalized HIV Stigma, Adversarial Growth, and Health Outcomes in a Nationwide Sample of People Aging with HIV in Germany.

HIV-related stigmatization and adversarial growth are known to influence health outcomes in people living with HIV. But not much is known how these psychosocial factors are related to each other and how they interact to influence health outcomes. We tested whether the effect of experienced and internalized stigma on mental health and self-rated health is mediated by adversarial growth, and whether each of these factors is uniquely associated with health outcomes. In our sample of 839 people aging with HIV in Germany based on a cross-sectional study design we did not find an indirect effect of experienced HIV stigma on health outcomes and a very small indirect effect of internalized HIV stigma. All variables were significant predictors of health outcomes in multiple regression analyses.

RESUMEN: Se sabe que el estigma y el crecimiento postraumático asociados al VIH influyen en los indicadores del estado de salud de las personas que viven con el virus. Sin embargo, se desconoce cómo estos factores psicosociales se relacionan entre sí, y cómo interactúan sobre los indicadores del estado de salud. En este estudio comprobamos si los efectos de la experiencia e internalización del estigma sobre la salud mental y la evaluación subjetiva del estado salud están mediados por el crecimiento postraumático, así como el impacto único de cada uno de estos factores sobre los indicadores de salud. Usando un diseño de estudio transversal en una muestra de 839 personas que viven con VIH en Alemania, no encontramos un efecto indirecto del estigma experimentado en los indicadores de salud, pero sí, un efecto indirecto muy pequeño del estigma internalizado. Todas las variables se mostraron predictores significativos de los resultados de salud en un análisis de regresión múltiple.

Social inequalities in health-related quality of life among people aging with HIV/AIDS: the role of comorbidities and disease severity.

PURPOSE: While socioeconomic inequalities in health-related quality of life are well documented in the scientific literature, research has neglected to look into the reasons for these inequalities. The purpose of this study is to determine in what way social inequalities in health-related quality of life among patients with the same chronic disease could be explained by variations in disease severity. METHODS: We used the data of 748 people aging with HIV in Germany who took part in the nationwide study 50plushiv and provided self-report data on socioeconomic status, health-related quality of life (SF-12) and various markers of disease severity (comorbidity, falls, late presentation and AIDS diagnosis). Regression analyses were applied to determine the impact of SES on HRQOL after adjusting for disease severity variables. RESULTS: The mental and physical subscales of the SF-12, comorbidity burden and falls were significantly related to SES. SES explained 7% of the variance in PCS scores and 3% of the variance in MCS scores after adjusting for age and time since diagnosis. Markers of disease severity explained 33% of the variance in PCS scores and 14% of the variance in MCS scores. After adjusting for disease severity SES was still significantly related to PCS and MCS scores. CONCLUSIONS: The diverse sample of people aging with HIV showed social inequalities regarding HRQOL and most of the disease severity markers. SES was significantly related to mental and physical HRQOL after adjusting for disease severity. Possible explanations for this phenomenon are discussed.

[Diagnosed Depression and Utilization of Health Care Services and Preventive Measures in the General Adult Population in Germany - Results from a Nationwide Cross-Sectional Telephone Survey]. / Diagnostizierte Depression und Inanspruchnahme von medizinischen Versorgungs- und Vorsorgeleistungen bei Erwachsenen in Deutschland.

OBJECTIVE: To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany. METHODS: Cross-sectional analysis of data from a representative telephone survey (men N = 18,675, women N = 24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed. RESULTS: Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health check-ups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men. CONCLUSIONS: Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis.

Contagiousness under antiretroviral therapy and stigmatization toward people with HIV.

Perceived contagiousness is a major dimension underlying HIV-related stigmatization. Antiretroviral therapy (ART) can diminish contagiousness by reducing viral load levels in HIV-infected individuals. To test the assumption that reductions in contagiousness can lead to a decrease in stigmatizing reactions, we conducted an experimental online study. A sample of 752 participants (50.9% female) read a short vignette depicting an HIV-positive individual with either a high or a low viral load and were either given or not given information about the association between viral load and contagiousness. Subsequently, participants were asked to rate their willingness to stigmatize this individual by responding to two measures of social and physical distance. Differences between the low and the high viral load information groups and the combined no-information groups (forming a quasi-control group) were analyzed using analysis of covariance (ANCOVA), controlling for gender and baseline perceptions of contagiousness. The covariates, perceived contagiousness at baseline and gender, were associated with social and physical distancing, but the viral load/information factor was only significant in physical distancing. Planned contrast analyses confirmed that physical distancing in the informed group was lower in the low viral load condition compared to the high viral load condition and to the control group. We thus found evidence for the significant role of perceived contagiousness in the HIV-related stigma and were able to experimentally demonstrate the potential of ART to reduce HIV-related stigmatization by lowering viral load and contagiousness, when these changes are accompanied by a decreased perception of contagiousness.

An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception.

OBJECTIVES: This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction. STUDY DESIGN AND SETTING: Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria. RESULTS: The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations. CONCLUSIONS: The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making.

Documentation and Communication of Psychooncological Findings in an Interdisciplinary Breast Cancer Center.

BACKGROUND: Psychooncological interventions are an integral component of the treatment of breast cancer patients in certified breast cancer centers. Effective multidisciplinary care requires excellent communication among the team members, including written communication. The study explores how written communication can be implemented in a multidisciplinary team treating cancer patients. PATIENTS AND METHODS: A computerized form to enter psychooncological findings into a software designed for the documentation of the diagnostics and therapy of patients with breast cancer was developed. RESULTS: The psychooncological module includes the sections phase of therapy, mood disturbances, difficulties in handling the disease/treatment, psychosocial burdens, psychosocial resources and treatment recommendations as well as notes about a psychological diagnosis (International Classification of Diseases (ICD)-10) where appropriate. 555 psychooncological findings were documented in the newly designed module. 28% of the patients were diagnosed with a mental disorder. 45% received at least one intervention. CONCLUSIONS: The psychooncological module facilitates the combination of oncological and psychooncological documentation. It can give structured psychooncological information to the physicians. However, the development of the module has to be continued.

HINTERGRUND: Psychoonkologische Versorgung ist ein integraler Bestandteil der Behandlung in einem zertifizierten Brustzentrum. Erfolgreiche multidisziplinäre Versorgung erfordert ausgezeichnete Kommunikation zwischen den Teammitgliedern, insbesondere auch schriftliche Kommunikation. Die Studie stellt dar, wie ein schriftlicher Austausch in einem multidisziplinären Team umgesetzt werden kann. PATIENTEN UND METHODEN: Für das im Brustzentrum der Charité eingesetzte Dokumentationssystem wurde ein Formular zur Eingabe psychoonkologischer Befunde entwickelt. ERGEBNISSE: Das Psychoonkologie-Modul ist gegliedert in die Kategorien Therapiephase, Stimmung, Krankheitsbewältigung, psychosoziale Belastungen, psychosoziale Ressourcen und Weiterbehandlungsempfehlungen sowie gegebenenfalls Anmerkungen zu psychischen Diagnosen (Internationale Klassifikation der Krankheiten 10 (ICD-10)). 555 psychoonkologische Befunde wurden in dem neu entwickelten Modul dokumentiert. Bei 28% der Patienten wurde eine psychische Erkrankung diagnostiziert. 45% der Patienten erhielten mindestens eine Intervention. SCHLUSSFOLGERUNGEN: Das vorgestellte computergestützte Psychoonkologie-Modul ermöglicht eine Verbindung zwischen onkologischer und psychoonkologischer Dokumentation. Es kann strukturierte Informationen an die behandelnden Ärzte vermitteln, muss jedoch in einigen Punkten überarbeitet werden.