Background: Up to 4 million people in Tanzania are at risk for the parasitic disease onchocerciasis. A treatment program, Community-Directed Treatment with Ivermectin (CDTI), has made significant gains in prevention and treatment. Understanding factors affecting participation could help boost treatment coverage and sustain gains made in controlling onchocerciasis in endemic areas. Purpose: To explore community-perceived factors related to participation in and sustainability of the CDTI program in southwest Tanzania. Methods: Multilevel triangulation design using surveys, focus group discussions (FGDs), and semistructured interviews to collect data in two villages in the Morogoro Rural District of Tanzania. In total, 456 villagers participated in the survey and 42 in FDGs. Five community-directed distributors (CDDs) and three community health workers were interviewed. Findings: High levels of awareness of onchocerciasis (90%) and methods of prevention and treatment (95%) were reported. Over 75% of participants knew how ivermectin was distributed and 74% have taken the drug. Over 90% of villagers knew that distribution of the drug was for treatment and prevention. Only 43% knew the cause of onchocerciasis. Through FGDs, villagers reported barriers to participation, including lack of comprehensive understanding of the disease, fears of medication, distrust of the method determining dose, lack of health education materials, insufficient CDD-resident communication, and inflexible drug distribution mechanisms. Conclusions: Sustaining programs without supporting growth of CDDs and reinforcing education of communities could lead to a decrease in treatment and an increase in the public health threat. This research uncovered a need for more effective community education and sensitization. Clinical Relevance: Understanding barriers to participation in communitybased programs can assist public health and community health nurses and key stakeholders including Ministries of Health and local and regional health systems in the development of education and support materials to enhance health literacy and encourage program participation.
The aim of this study was to conduct a longitudinal test of an explanatory model of depression, where religiosity and/or spirituality (R/S) represents a potentially protective factor in college students in the USA. A Web-based survey was administered monthly to 214 students from religious and public colleges. At 1 month and 6 months, the measures of R/S, depression, stress, and cognitive vulnerability were administered. Between 2 and 5 months, only the measures of stress and depression were administered. The data were analyzed to test the hypothesis that R/S buffers the effect of stress on depression over time in the context of cognitive vulnerability. The results supported a direct and protective effect over time between R/S and depression, but a buffering effect on the relationship between stress and depression was not found. Although all aspects of R/S were demonstrated to protect the participants from depression, it did not appear that the relationship between R/S and stress or R/S and cognitive vulnerability explains this relationship. Nurses who are working with college students should take holistic approaches to their emotional difficulties, realizing the potentially beneficial effects of students' religiousness or spirituality.
Background: The COVID-19 pandemic is a novel population-level stressor. As such, it is important to examine pandemic-related changes in mental health and to identify which individuals are at greatest risk of worsening symptoms.Methods: Online questionnaires were administered to 34,465 individuals in the UK, recruited from existing cohorts or via social media. Around one third (n = 12,718) with prior diagnoses of depression or anxiety completed pre-pandemic mental health assessments, allowing prospective investigation of symptom change. We examined changes in depression, anxiety and PTSD symptoms using prospective, retrospective and global ratings of change assessments. We also examined the effect of key risk factors on changes in symptoms.Outcomes: Prospective analyses showed small decreases in depression (PHQ-9: - .43 points) and anxiety symptoms (GAD-7: -.33 points), and increases in PTSD symptoms (PCL-6: .22 points). Conversely, retrospective analyses demonstrated large significant increases in depression (2.40 points) and anxiety symptoms (1.97 points) and 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Using both prospective and retrospective symptom measures, regression analyses demonstrated that worsening depression, anxiety and PTSD symptoms were associated with i) prior mental health diagnoses, ii) female gender; iii) young age, and iv) unemployed or student status.Interpretation: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously-reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias underestimating prior symptom severity.
Objectives 3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors (statins) are standard treatment for hyperlipidaemia. In addition to lipid-lowering abilities, statins exhibit multiple anti-inflammatory effects. The objectives of this study were to determine whether treatment of patients with RA with lovastatin decreased CRP or reduced disease activity. Methods We conducted a randomized double-blind placebo-controlled 12 week trial of lovastatin vs placebo in 64 RA patients with mild clinical disease activity but an elevated CRP. The primary efficacy end point was the reduction in mean log CRP. Secondary end points included disease activity, RF and anti–CCP antibody titres. Mechanistic end points included levels of serum cytokines. Safety was assessed; hepatic and muscle toxicities were of particular interest. Results Baseline features were similar between groups. No significant difference in mean log CRP reduction between the two groups was observed, and disease activity did not change from baseline in either treatment group. Mechanistic analyses did not reveal significant changes in any biomarkers. A post hoc analysis of subjects not using biologic therapy demonstrated a significantly greater proportion achieving ⩾20% reduction in CRP from baseline in the lovastatin group compared with placebo (P-value = 0.007). No difference was observed in subjects receiving biologics. Lovastatin was well tolerated with no serious safety concerns. Conclusion This study showed no anti-inflammatory or clinical effects on RA disease activity after 12 weeks of treatment with lovastatin. Lovastatin had a modest effect on CRP in subjects not using biologics, suggesting statins may be anti-inflammatory in selected patients. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT00302952.
Adorning the typical conference attendee badge, the "Values Mug Shot" sparked conversation and we dare say "envy" of those who did not attend the session on first person action research at a recent Association of Practical and Professional Ethics (APPE) conference. These mug shots were part of a discussion and participatory session on how one class of doctoral students chose to reflect on our own ethics and values, and how these tactics could be used in the classroom to encourage others to do the same. Due to a class exercise meant to create deep introspection on values, we stood before a group of conference goers, confident in our ability to share personal reflections on values and ethics. We were eager to share with others our experiences because we believed the methods we had learned and in some cases developed could be used in other classes to help students deeply, personally explore the "living out" of ethical positions. Our presentation incorporated experiential elements, allowing attendees to try out some of our methods. Now, this article takes another step, as we put into written form our project, including its theoretical foundations, specific examples, and implications for further use of this approach to ethics education. All education can be seen as attempting to produce changes cognitively, affectively, behaviorally, or some combination of these and in ethics education this may be an even more central and crucial concern. Success seems to require change in all three areas, as students engage cognitively with the subject matter, which produces affective development, all resulting in modified actions. But such
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