Tsegaye Bekele

Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/AIDS

Abstract Research has established a link between perceived social support and health-related quality of life (HRQOL) among persons living with HIV/AIDS. However, little is known about the ways through which social support influences HRQOL. This study examined the direct and indirect effects of perceived social support on physical and mental HRQOL in a sample of 602 adults living with HIV in Ontario, Canada. Participants completed the Medical Outcomes Study-HIV (MOS-HIV) health survey, the MOS-HIV Social Support Scale (MOS-HIV-SSS), and the Center for Epidemiological Studies Depression-Revised scale. Data on demographic and clinical characteristics were also collected. The direct and indirect effects of social support on the two MOS-HIV HRQOL summary measures, that is, physical health summary (PHS) and mental health summary (MHS), were estimated in multiple linear regression analyses. Perceived social support had significant direct effects on PHS (B=0.04, p<0.01) and MHS (B=0.05, p<0.01). It also had significant indirect effect on both PHS (B=0.04, p<0.01) and MHS (B=0.11, p<0.01), mediated by depressive symptoms. Interventions that enhance social support have the potential to contribute to better HRQOL either directly or indirectly by decreasing the deleterious effect of depressive symptoms on HRQOL.

Cognitive function and fatigue after diagnosis of colorectal cancer

BACKGROUND Cognitive impairment and fatigue have been associated with cancer and its treatment. We present baseline data from a large longitudinal study that evaluates cognitive function, fatigue, and potential underlying mechanisms following diagnosis of colorectal cancer (CRC). PATIENTS AND METHODS We evaluated CRC patients with stage I-III disease before or after surgery, participants with limited metastatic disease and healthy controls (HC). Neuropsychological evaluation included clinical and computerised tests. Participants completed questionnaires for fatigue and quality of life (QOL)-(FACT-F), anxiety/depression, and cognitive symptoms (FACT-Cog). Ten cytokines, clotting factors, sex hormones, carcinoembryonic antigen (CEA), and apolipoprotein E genotype were evaluated. Primary end points were cognitive function on clinical tests evaluated by a Global Deficit score (GDS) and fatigue. Associations between test results, demographic, and disease related factors were explored. RESULTS We assessed 291 participants with early-stage disease [median age 59 (23-75) years, 63% men], 72 with metastatic disease, and 72 HC. Using GDS, 45% (126/281) of participants with early-stage CRC had cognitive impairment versus 15% (11/72) of HC (odds ratio 4.51, 95% confidence interval 2.28-8.93; P < 0.001), with complex processing speed, attention/working memory, and verbal learning efficiency being most affected. Women with early-stage CRC had greater cognitive impairment than men [55/105 (52%) versus 71/176 (40%), P < 0.050]. Cognitive symptoms were self-reported by 21% (59/286) of early-stage patients versus 17% (12/72) of HC; fatigue by 52% (149/287) of early-stage patients and 26% (19/72) of HC (P < 0.0001). Women reported more fatigue than men (P = 0.003). Fatigue, QOL, anxiety/depression, and cognitive symptoms were associated with each other (r = 0.43-0.71), but not with neuropsychological performance. Most cytokines were elevated in cancer patients. Cognitive function was not associated with cytokines, sex hormones, clotting factors, CEA, or apolipoprotein E genotype. CONCLUSIONS The incidence of cognitive impairment was three to five times higher in CRC patients than HC, with women having higher impairment rates than men. The cognitive impairment profile suggests dysfunction primarily in fronto-subcortical brain systems. TRIAL REGISTRATION NCT00188331.

Mastery and Coping Moderate the Negative Effect of Acute and Chronic Stressors on Mental Health-Related Quality of Life in HIV

Acute and chronic life stressors have a detrimental effect on the health of people living with HIV. Psychosocial resources such as mastery, coping, and social support may play a critical role in moderating the negative effects of stressors on health-related quality of life. A total of 758 participants provided baseline enrolment data on demographics (age, gender, ethnicity, sexual orientation, education, employment, income), clinical variables (CD4 counts, viral load, AIDS-defining condition, time since HIV diagnosis), psychosocial resources (mastery, coping, social support), life stressors (National Population Health Survey [NPHS] Stress Questionnaire), and health-related quality of life (SF-36). We performed hierarchical multivariate regression analyses to evaluate the potential moderating effects of psychosocial resources on the relationship between stressors and health-related quality of life. The top three stressors reported by participants were trying to take on too many things at once (51%), not having enough money to buy the things they needed (51%), and having something happen during childhood that scared them so much that they thought about it years later (42%). Life stressors were significantly and inversely associated with both physical and mental health-related quality of life. Mastery and maladaptive coping had significant moderating effects on mental health but not on physical health. These results suggest that developing interventions that improve mastery and reduce maladaptive coping may minimize the negative impact of life stressors on the mental health of people with HIV. They also highlight that it is important for clinicians to be mindful of the impact of life stressors on the health of patients living with HIV.

Cognitive Function in Patients With Colorectal Cancer Who Do and Do Not Receive Chemotherapy: A Prospective, Longitudinal, Controlled Study

PURPOSE Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs). PATIENTS AND METHODS Participants completed cognitive assessments and questionnaires reporting cognitive symptoms, fatigue, quality of life, and anxiety/depression at baseline (before chemotherapy, if given) and 6, 12, and 24 months. Blood tests included cytokines, clotting factors, apolipoprotein E genotype, and sex hormones. Primary end point was overall cognitive function measured by the Global Deficit Score at 12 months. RESULTS We recruited 289 patients with localized CRC (173 received chemotherapy; median age, 59 years; 63% male), 73 patients with limited metastatic/recurrent CRC, and 72 HCs. Cognitive impairment was more frequent in patients with localized CRC than HCs at baseline (43% v 15%, respectively; P < .001) and 12 months (46% v 13%, respectively; P < .001), with no significant effect of chemotherapy. Attention/working memory, verbal learning/memory, and complex processing speed were most affected. Cognitive impairment was similar in patients with localized and metastatic CRC. Cytokine levels were elevated in patients with CRC compared with HCs. There was no association between overall cognitive function and fatigue, quality of life, anxiety/depression, or any blood test. Cognitive symptoms at 12 months were reported in 25% of patients with localized CRC versus 17% of HCs (P = .19). More participants who received chemotherapy had cognitive symptoms at 6 months (32%) versus those who did not (16%; P = .007), with no significant difference at 12 months (29% v 21%, respectively; P = .19). Objective cognitive function was only weakly associated with cognitive symptoms. CONCLUSION Patients with CRC had substantially more cognitive impairment at every assessment than HCs, with no significant added effect of chemotherapy. Mechanisms of cognitive impairment remain unknown.

Mastery Moderates the Negative Effect of Stigma on Depressive Symptoms in People Living with HIV

Stigma continues to have a negative effect on the care, treatment, and support of people living with HIV. This study presents baseline data from 825 participants taking part in a cohort study that collects data on the clinical profile and social determinants of health of people with HIV. We performed multivariate regression analysis to evaluate whether mastery and social support moderated the negative effect of stigma on depressive symptoms. Stigma was associated with depressive symptoms after controlling for potential demographic and clinical confounders. In addition, higher levels of mastery and social support were associated with lower levels of depression. However, only mastery moderated the negative effects of stigma on depressive symptoms. For individuals with high levels of mastery, greater exposure to stigma does not translate into greater distress. Interventions targeting the mental health concerns of people with HIV should increase their focus on improving people’ sense of personal control.

Housing characteristics and their influence on health-related quality of life in persons living with HIV in Ontario, Canada: results from the positive spaces, healthy places study.

Although lack of housing is linked with adverse health outcomes, little is known about the impacts of the qualitative aspects of housing on health. This study examined the association between structural elements of housing, housing affordability, housing satisfaction and health-related quality of life over a 1-year period. Participants were 509 individuals living with HIV in Ontario, Canada. Regression analyses were conducted to examine relationships between housing variables and physical and mental health-related quality of life. We found significant cross-sectional associations between housing and neighborhood variables—including place of residence, housing affordability, housing stability, and satisfaction with material, meaningful and spatial dimensions of housing—and both physical and mental health-related quality of life. Our analyses also revealed longitudinal associations between housing and neighborhood variables and health-related quality of life. Interventions that enhance housing affordability and housing satisfaction may help improve health-related quality of life of people living with HIV.ResumenA pesar de que la falta de vivienda está vinculada a consecuencias adversas para la salud, conocemos poco sobre el impacto de los aspectos cualitativos de la vivienda sobre la salud. Este estudio examinó la asociación entre elementos estructurales de la vivienda, accesibilidad a la vivienda, satisfacción con la vivienda y la calidad de vida relacionada con la salud (CVRS) por un período de un año. Los participantes fueron 509 personas que viven con el VIH en Ontario, Canada. Análisis de regresión lineal multivariado se llevaron a cabo para examinar la relación entre las variables de vivienda y la calidad de vida relacionada a la salud física y mental. Los resultados de los análisis transversales mostraron una asociación significativa entre las variables de la vivienda y del vecindario - incluyendo lugar de residencia, accesibilidad de precio, la estabilidad de la vivienda y la satisfacción con las dimensiones materiales, de significado y espaciales de la vivienda - y la calidad de vida tanto física como mental. Nuestros análisis también revelaron asociaciones longitudinales entre las variables de vivienda y del vecindario con la CVRS a traves del tiempo. Las intervenciones que mejoran el acceso y la satisfacción con la vivienda pueden ayudar a mejorar la CVRS de las personas que viven con el VIH.

Labor Force Participation and Health-Related Quality of Life in HIV-Positive Men Who Have Sex with Men: The Multicenter AIDS Cohort Study

Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV.ResumenDemasiadas personas que viven con VIH han abandonado permanentemente el mercado laboral y aquellas con reducida capacidad de trabajo no han podido mantener sus puestos de trabajo. Es necesario evaluar los efectos de la participación laboral sobre la salud en personas que viven con VIH. Este estudio presenta datos longitudinales de 1,415 hombres VIH-positivos que tienen sexo con hombres, recabados del Multicenter AIDS Cohort Study. Ecuaciones de Estimación Generalizadas mostraron que el empleo esta asociado con mejor calidad de vida en relacion a la salud fisica y mental y ademas sugiere un proceso de adaptación a la experiencia de desempleo. Análisis posteriores y provisionales también sugieren que las personas físicamente mas vulnerables pueden sufrir caidas mas pronunciadas de la salud debido a la pérdida de empleo, comparados con aquellos que generalmente estan mas saludables. Sin embargo, esto también puede ser el resultado de un efecto de selección mediante el cual una salud física disminuida contribuye al desempleo. Las politicas que promueven la participación en el mercado laboral no solo podrian aumentar las tasas de empleo, sino también mejorar la salud de las personas que viven con VIH.

School-age children’s safety attitudes, cognitions, knowledge, and injury experiences: how do these relate to their safety practices?

Background: A variety of factors affect the safety and risk practices of school-age children, but rarely have multiple factors been considered simultaneously. Objective: To examine children’s safety attitudes and cognitions more thoroughly and assess how these factors, along with children’s safety knowledge and injury experiences, relate to children’s safety practices. Methods: Over several classroom sessions, boys and girls in two age groups (7–9, 10–12 years) completed a psychometrically sound questionnaire that indexes their behaviors, attitudes, cognitions, knowledge, and injury experiences. Results: Fewer safety practices were reported by older than younger children and boys than girls. Children’s attitudes, cognitions, knowledge, and injury experiences each correlated with safety practices, but only safety attitudes and injury experiences predicted practices in a multivariate model. Conclusion: Exploring the relative influence of numerous factors on safety practices highlights the important role that attitudes play in predicting children’s safety practices. Implications of these results for injury prevention programming are discussed.

Food insufficiency, housing and health-related quality of life: results from the Positive Spaces, Healthy Places study

Studies of people living with HIV who are homeless or unstably housed show a high prevalence of food insufficiency (>50%) and associated poor health outcomes; however, most evidence is in the form of cross-sectional studies. To better understand this issue, we conducted a longitudinal study to examine the impact of food insufficiency and housing instability on overall physical and mental health-related quality of life (HRQoL) among people living with HIV in Ontario. Six hundred and two adults living with HIV were enrolled in the Positive Spaces, Healthy Places study and followed from 2006 to 2009. Interviewer-administered questionnaires were used, and generalized linear mixed-effects models constructed to examine longitudinal associations between food insufficiency, housing instability and physical and mental HRQoL. At baseline, 57% of participants were classified as food insufficient. After adjusting for potential confounders, longitudinal analyses revealed a significant, negative association between food insufficiency and physical and mental HRQoL outcomes, respectively [effect size (ES) with 95% confidence interval (CI): (ES = −2.1, CI = −3.9,−0.3); (ES = −3.5, CI = −6.1,−1.5)]. Furthermore, difficulties meeting housing costs were shown to have additional negative impacts on mental HRQoL. Food insufficiency is highly prevalent among people living with HIV in Ontario, particularly for those with unstable housing. This vulnerable group of individuals is in urgent need of changes to current housing programmes, services and policies, as well as careful consideration of their unmet nutritional needs.

Development of the BACKIE questionnaire: A measure of children's behaviors, attitudes, cognitions, knowledge, and injury experiences

OBJECTIVE The objective of this study was to develop a standardized questionnaire (BACKIE) that would assess the Behaviors (B), Attitudes (A), Cognitions (C), Knowledge (K), and Injury Experiences (IE) that elementary-school children possess pertaining to seven types of injuries, including: falls; motor vehicle collisions; burns; drowning; choking/suffocation; poisoning; and bicycle/pedestrian injuries. METHODS Over 500 children in grades two through seven completed the questionnaire, with a sub-sample repeating it two months later to assess test-retest reliability of the measure. RESULTS Psychometric assessment of the instrument revealed acceptable internal and test-retest reliabilities and results of a Confirmatory Factor Analysis provided support for the hypothesized factor structure. CONCLUSION Having a psychometrically sound measure that allows one to assess attitudes, cognitions, and knowledge is an essential first step to exploring the relative influence of these factors on childrens risk and safety practices.