54 research outputs found
PLoS Med
No full textBackgroundThe effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting.Methods and FindingsObservational data from HAART-na\uefve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4\u20134.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1\u20138.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06\u20130.95).ConclusionsHAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States.Please see later in the article for the Editors' SummaryIn 2009, an estimated 2.5 million children were living with HIV, the majority of whom (2.3 million) were in sub-Saharan Africa. Most (90%) of these children acquired HIV from their HIV-infected mothers during pregnancy, birth, or breastfeeding, highlighting the importance of giving effective drugs for the prevention of mother to child transmission. As such interventions are still not widely accessible or available in most resource-limited countries, where the burden of HIV is highest, every day an estimated 1,000 children were newly infected with HIV in 2009, but only 360,000 children were receiving highly active antiretroviral therapy (HAART).Why Was This Study Done?Most observational studies of the effects of treatment on child survival have been undertaken in high-income countries, such as Italy and the United States. As most children with HIV live in low-resource areas, where multiple factors, such as delayed presentation to care and a higher incidence of co-occurring conditions, might adversely affect treatment outcomes, there is a specific need for information on the effects of HAART in children with HIV living in low-income countries. Although some investigations have taken place in pediatric cohorts from such countries (for example, C\uf4te d'Ivoire, Haiti, Lesotho, Thailand, and Zambia), the effect of HAART on mortality has not been accurately quantified among children in a resource-deprived setting. Therefore, in this observational clinical cohort study, the researchers investigated the effect of HAART on mortality in HIV-infected children in Kinshasa, in the Democratic Republic of the Congo (DRC).What Did the Researchers Do and Find?The researchers analyzed data from 790 children enrolled into an HIV program in Kinshasa, DRC, between December 2004 and May 2010 and used a statistical model (marginal structural models) to adjust for time-dependent confounding factors, such as the fact that HAART is typically initiated in sicker patients, for example, those with lower CD4 cell percentages. Assuming that all children starting HAART received it uninterruptedly throughout follow-up, using this statistical model, the researchers were able to compare the hazard ratio of death had all children initiated HAART to that had no children initiated HAART during follow-up.What Do These Findings Mean?These findings show that treatment with HAART markedly improved the survival of children infected with HIV in Kinshasa, DRC, and suggest that HAART is as effective in improving the survival of HIV-infected children in a severely resource-deprived country (still recovering from civil war) as in more resource-privileged settings\u2014an important finding given that the vast majority of children receiving HAART live in resource-poor areas. This study provides additional evidence that accelerating rollout of antiretroviral therapy to children with HIV in resource-poor countries is lifesaving and effective. Future research needs to address how effective HAART is in understudied populations in resource-poor countries, such as undernourished children or those with co-infections such as tuberculosis.Additional InformationPlease access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001044.2011P30 AI050410/AI/NIAID NIH HHS/United StatesU2G PS001179/PS/NCHHSTP CDC HHS/United States5U2GPS001179-01/PHS HHS/United StatesU62/CCU422422/PHS HHS/United States21695087PMC31148691056
Rewriting the classics : Goethe and Schiller in the theatre of Elfriede Jelinek (Ulrike Maria Stuart and FaustIn and out)
No full textDepuis ses débuts littéraires, les classiques sont régulièrement convoqués dans l’écriture hautement intertextuelle d’Elfriede Jelinek par le truchement de citations tronquées, disséminées. Sa production dramatique récente est marquée par une confrontation redoublée avec les classiques germanophones, avec de nombreuses récritures produites depuis le milieu des années 2000. Parmi elles, le texte de théâtre Ulrike Maria Stuart (publié en ligne pendant trois jours en 2006, imprimé seulement en 2015) fait écho à la pièce de Friedrich Schiller Marie Stuart, et FaustIn and out (accessible gratuitement sur le site de Jelinek depuis 2011) joue avec l’œuvre « incommensurable » de Goethe, (l’Ur-)Faust. Cette étude effeuille les différentes strates du palimpseste et met au jour les espaces investis par la récriture à travers un parcours balisé, dispositif à entrées multiples permettant de décrire le fonctionnement et les enjeux de la récriture du point de vue de sa production, mais aussi de sa réception, notamment dans les mises en scène. En analysant comment l’espace de la récriture se mue en désécriture et tire profit d’une écriture « seconde » ou mineure (Deleuze), les enjeux macrostructurels, esthétiques et socio-littéraires de ces textes se font jour. La confrontation à la classicité entre en résonance avec le nouveau positionnement de l’autrice au sein du champ littéraire, notamment à travers le processus de classicisation de son oeuvre, influant également sur le destin éditorial singulier des œuvres de notre corpus.Since her literary debut, the classics have regularly surfaced in the highly intertextual writing of Elfriede Jelinek by means of fragmentary and fleeting citations. Her recent dramatic productions are marked by an ever greater confrontation with the Germanic classics, with numerous rewritings produced since the mid-2000s. Among these, the play Ulrike Maria Stuart (published online over three days in 2006 and only published in print in 2015) echoes Friedrich Schiller’s play Marie Stuart, while FaustIn and out (accessible free of charge on Jelinek’s website since 2011) toys with the “immeasurable” work of Goethe, (Ur-)Faust. This study unravels the different strata of the palimpsest and revises the spaces occupied by rewriting through a well-defined path, an approach with multiple entry points that allows the functioning and issues of rewriting to be described from the perspective of both its production and its reception, notably in form of dramatization. By analysing how the space of rewriting evolves into a sort of unwriting and takes advantage of “secondary” or minor (Deleuze) writing, the macrostructural, aesthetic, and socio-literary stakes of these texts emerge. The confrontation with classicity resonates with the new positioning of the author within the literary field, especially through the process of the classicisation of her works, and influences the uncommon editorial approach framing the works of the corpus under investigation
J Acquir Immune Defic Syndr
No full textBackgroundThe long-term effects of combined antiretroviral therapy (cART) on CD4 percentage in HIV-infected children are incompletely understood, with evidence from resource-deprived areas particularly scarce even though most children with HIV live in such settings. We sought to describe this relationship.MethodsObservational longitudinal data from cART-naive children enrolled between December 2004 and May 2010 into an HIV care and treatment program in Kinshasa, Democratic Republic of Congo were analyzed. To estimate the effect of cART on CD4 percentage while accounting for time-dependent confounders affected by prior exposure to cART, a marginal structural linear mean model was used.ResultsSeven hundred ninety children were active for 2090 person-years and a median of 31 months; 619 (78%) initiated cART. At baseline, 405 children (51%) were in HIV clinical stage 3 or 4; 528 (67%) had advanced or severe immunodeficiency. Compared with no cART, the estimated absolute rise in CD4 percentage was 6.8% [95% confidence interval (CI), 4.7% to 8.9%] after 6 months of cART, 8.6% (95% CI, 7.0% to 10.2%) after 12 months, and 20.5% (95% CI, 16.1% to 24.9%) after 60 months. cART-mediated CD4 percentage gains were slowest but greatest among children with baseline CD4 percentage <15. The cumulative incidence of recovery to \u201cnot significant\u201d World Health Organization age-specific immunodeficiency was lower if cART was started when immunodeficiency was severe rather than mild or advanced.ConclusionscART increased CD4 percentages among HIV-infected children in a resource-deprived setting, as previously noted among children in the United States. More gradual and protracted recovery in children with lower baseline CD4 percentages supports earlier initiation of pediatric cART.R01 HS018731/HS/AHRQ HHSUnited States/U2G PS001179/PS/NCHHSTP CDC HHSUnited States/U62/CCU422422/PHS HHSUnited States/5U2GPS001179-01/PHS HHSUnited States/P30 AI050410/AI/NIAID NIH HHSUnited States
Barriers to and Facilitators of Adherence to Pediatric Antiretroviral Therapy in a Sub-Saharan Setting: Insights from a Qualitative Study
No full textDespite the need for HIV-positive children to adhere effectively to antiretroviral treatment (ART), a guiding theory for pediatric ART in resource-limited settings is still missing. Understanding factors that influence pediatric ART adherence is critical to developing adequate strategies. In-depth qualitative interviews were undertaken in Kinshasa, Democratic Republic of the Congo, with 20 sets of HIV disclosed and nondisclosed children along with respective caregivers to better characterize barriers, facilitators, and adherence experiences in children taking ART. Commonly cited barriers included lack of food or nutritional support, lack of assistance or supervision for children, lack of assistance for caregivers, and being unable to remember to take medicines on a consistent basis. Facilitators included having a strong caregiver–child relationship and support system along with strategies for maintaining adherence. Similar themes arose within the child–caregiver sets, but were often characterized differently between the two. Children who were aware of their HIV status displayed fewer instances of frustration and conflict concerning taking medicines and within the child–caregiver relationship. Continued study on pediatric ART adherence should account for differing perspectives of children and caregivers, as well as between status disclosed and nondisclosed children. Areas of future intervention should focus on child–caregiver relationships, disclosure of HIV status, and available nutritional and psychosocial support for children and their caregivers
Teacher Motivation Factors and ICT Integration in Teaching and Learning in Public Secondary Schools of Rwanda
No full textAbstract: Successful ICT integration in schools depends on how are motivated to use it. This study seeks to assess how motivation of teachers relates ICT integration in Public Secondary schools in Bugesera District Rwanda. Specifically, the study examined the factors that motivates teachers to use ICT in teaching process, to assess the level of ICT integration in secondary schools and lastly to determine relationship between teacher motivation and ICT integration in secondary schools. A sample size of 165 was sampled using Yamane’s formula. Stratified and random sampling techniques were used where 2 strata for teachers and head teachers were considered. Questionnaire and interview guides were used in gathering primary data. The findings showed that the majority of the teachers disagreed that they did not have access to regular training on the use of the ICT resources in Bugesera District, even though they received their salary regularly to satisfy their family needs, the teacher workload was moderate while the teacher student ratio was still high in secondary school which was a challenge for teacher to integrate ICT resources in teaching and learning process. It was revealed that there was a relationship between the teacher motivation and ICT use integration in secondary schools because the Karl Pearson correlation was 0.812 which showed the strong positive correlation. This means that when the teachers are well motivated either from intrinsically or extrinsically they apply different methods in teaching and learning process including the use of ICT integration in secondary schools. The researcher recommended the Ministry of Education and Rwanda Education Board should work closely with the leadership of the schools in order to encourage the teachers to integrate all learners in the process of using ICT tools during teaching and learning regardless their high number in the class. The school leaders should play important role in providing teachers with the access to ICT tools available in school. Last but not least, teachers should be encouraged to use ICT tools in schools and outside of the class like providing online lessons to learners.
Keywords: Extrinsic motivation, ICT Integration in Education, Intrinsic motivation, Teacher motivation.
Title: Teacher Motivation Factors and ICT Integration in Teaching and Learning in Public Secondary Schools of Rwanda
Author: Jean Paul Borh Bizimana, Hesbon Opiyo Andala, Faustin Mugiraneza
International Journal of Recent Research in Social Sciences and Humanities (IJRRSSH)
ISSN 2349-7831
Vol. 9, Issue 4, October 2022 - December 2022
Page No: 20-29
Paper Publications
Website: www.paperpublications.org
Published Date: 14-October-2022
DOI: https://doi.org/10.5281/zenodo.7199133
Paper Download Link (Source)
https://www.paperpublications.org/upload/book/Teacher%20Motivation%20Factors%20and%20ICT-14102022-5.pdfInternational Journal of Recent Research in Social Sciences and Humanities (IJRRSSH), ISSN 2349-7831, Paper Publications, Website: www.paperpublications.or
Caregivers’ Perspective on the Psychological Burden of Living with Children Affected by Sickle Cell Disease in Kinshasa, the Democratic Republic of Congo
No full textThere is limited information on knowledge, perceptions, and management of sickle cell disease (SCD) in Africa in general and in the Democratic Republic of the Congo (DRC) in particular. This study explored knowledge, perceptions, and burden of 26 parents/caregivers of children with SCD in three selected hospitals in Kinshasa, DRC. We conducted a focus group with in-depth interviews with parents/caregivers of children affected with SCD. Four themes were discussed, including knowledge and perceptions, diagnosis and management, society’s perceptions, and the psychosocial burden and the quality of life of the family affected by SCD. The majority of participants/caregivers felt that society, in general, had negative perceptions of, attitudes toward, and knowledge about SCD. They reported that children with sickle cell are often marginalized, ignored, and excluded from society or school. They face a number of challenges related to care, management, financial difficulties, and a lack of psychological support. The results suggest the need to promote measures and strategies to improve knowledge and management of SCD in Kinshasa, DRC
Depression screening in a primary care practice
No full textPurpose of Project: Depression affects more than 300 million people globally and is the most common mental health condition in primary care. Despite its prevalence, only about 50% of depressed patients are identified. This quality improvement project assessed the impact of implementing the Patient Health Questionnaire- 9 (PHQ-9) in a primary care practice to help identify depression in patients.
Methodology: A quality improvement model using PHQ-9 screening was implemented as standard of care for all new patient visits and all patients seen for annual visits. Chart review data was used to measure changes in screening rates. Records of new patient visits and annual wellness visits were reviewed 3-months prior to implementation and for 3-months post-implementation to identify the number of patients who were screened for depression using the PHQ-9.
Results: During the pre-implementation period, out of 160 eligible patients, 4 were assessed for depression, resulting in 3 patients being diagnosed with depression and referred for treatment. During the post-implementation period, out of 154 eligible patients, 88 were screened using the PHQ-9, resulting in 6 patients being diagnosed with depression and referred for treatment. Overall, there was a 54.5% increase in depression screening rates [X2 (1) = 80.71, p <.001].
Conclusions: This quality improvement project demonstrated a significant improvement in depression screening with the use of the PHQ-9 screening tool. It is an effective tool in helping to identify, diagnose, and treat depression in primary care.
Implications for Practice: The implementation of PHQ-9 into the standard of care at primary care practices can positively affect identification, diagnosis, and treatment of depression in patients. The early identification and treatment of depression with the PHQ-9 can decrease healthcare costs and positively influence the economy.D.N.P.Includes bibliographical reference
The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting: a cohort study.
No full textThe effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting.Observational data from HAART-naïve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4-4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1-8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06-0.95).HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States. Please see later in the article for the Editors' Summary
“The Peer Educator Is the Game-Changer of My Life”: Perceptions of Adolescents Living with HIV in DR Congo on Involving Peer Educators in the Process of HIV Disclosure
No full textSeveral approaches to the disclosure of HIV status to children and adolescents have been described. Each of these places particular emphasis on the role of parents and health care workers (HCWs) to mitigate the impact of disclosure on the adolescent without exploring the possible roles that other individuals might play in the process of disclosure. This article assesses the perceptions of adolescents living with HIV (ALHIV) about disclosure done by parents, guardians, HCWs, peer educators in the role of peer supporters, accidentally or by self-discovery, and the subsequent effects of disclosure method on their mental health. We used a qualitative study to conduct semi-structured interviews with 73 ALHIV at the Kalembelembe Paediatric Hospital, in DR Congo disclosed to by parents, guardians, HCWs, and/or peer educators, respectively, or disclosed to accidentally or by self-discovery. Microsoft Excel analysis matrix was used to organize the qualitative data. The majority of ALHIV whose disclosure involved a peer educator unanimously acknowledged the important role of the peer in accepting their HIV status, in their ART adherence, and their development of self-esteem. However, most ALHIV disclosed without involving peers declared that they had accepted their situation after a relatively long period followed by contact with the peer and integration in the self-support group. We found that the peer approach is the game-changer of the HIV status disclosure process that would allow ALHIV to accept their HIV status with minimum distress, it builds resilience, and allows them to adhere to treatment.publishedVersio
Physical and numerical modelling of drainage and consolidation of tailings near a vertical waste rock inclusion
No full textThe use of waste rock inclusions in tailings impoundments is a recent technique that offers many advantages, but it also raises a few technical issues that must be addressed to optimize their design. A laboratory physical modelling study was conducted to assess the effect of waste rock inclusion on the behavior of initially saturated tailings in terms of drainage and consolidation. The evolution of pore water pressures and settlements after hydraulic deposition of the fine-grained tailings (slurry), with and without a drainage inclusion, has been monitored and analyzed. This investigation also focused on the evolution of the tailings void ratio and volumetric water content, the amount of water transferred to the waste rock, and the movement of fine particles at the interface between the two materials. The experimental results are used to demonstrate how such waste rock inclusion can affect tailings consolidation by reducing pore water pressures with accelerated water drainage, for various imposed conditions. The experimental data are also analysed with numerical models to better understand the coupled processes involved. A discussion follows on practical implications of the use of waste rock inclusions in tailings impoundments.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
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