1,721,064 research outputs found
Examining Mechanisms Linking Stigma and Health-Related Quality of Life in People Living with HIV
Full text linkHIV stigma continues to be one of the biggest barriers to good health and wellbeing for people living with HIV in Canada. While research has demonstrated the negative impact of stigma on a variety of important health outcomes, there is less understanding around exactly how this happens. This dissertation aims to shed light on this phenomenon by quantitatively modelling potential pathways through which stigma affects health-related quality of life for people living with HIV. This work uses data from the People Living with HIV Stigma Index in Ontario, a survey tool designed by and for people living with HIV that contains externally validated quantitative scales to measure stigma and health factors. Data was collected at baseline (t1) and at follow-up (t2) approximately one to two years later using the same measures. This work is built on a series of studies centered around mediation and moderation analyses that examine how stigma affects health-related quality of life and the factors that may alter this relationship. The first two studies examined how the impact of enacted stigma on health was mediated by internalized stigma and depression (Chapter 4) and anticipated stigma (Chapter 5). The next two studies examined the moderating effect of various determinants of health (Chapter 6) and social support (Chapter 7) on the relationship between stigma and health. These empirical analyses were accompanied by a description of the process of greater and meaningful engagement of people living with HIV that was implemented throughout the work (Chapter 8). This dissertation culminates in the Stigma and Health-Related Quality of Life Framework which describes the path from initial stigma marking to how individuals react through a selection of stigma mechanisms (internalized, enacted, and anticipated stigma) and the role of depression, different types of social support, and various determinants of health (age, sexual orientation, region, basic needs) in mediating or moderating the relationship between stigma and health. Outlining these pathways through which stigma acts to affect health can help in identifying targets for stigma reduction interventions that will be efficient and effective at improving the health and wellbeing of people living with HIV.Ph.D
Depression in People Living with HIV and Their Unmet Needs in Mental Health Care in Ontario: A Prospective Cohort Study
No full textNearly 50% of HIV-positive patients have a history of suffering from depression. Although the condition is treatable, depression in these patients is under-recognized and under-treated, resulting in poorer clinical and quality-of-life outcomes. There are also gaps and disparities in accessing mental health care among these patients, but current evidence is limited to U.S. studies.
The primary objectives of this thesis work were to: (1) establish the validity and reliability of self-report measurement instruments in identifying depression against DSM-IV criteria; (2) examine the burden of current depression and the underlying factors driving the burden; (3) estimate the rate of publicly-funded mental health service use and unmet needs for mental health care among HIV-positive patients with depression; and (4) examine the impact of depression on costly and preventable acute health services use in the Canadian health care system.
A prospective cohort study was conducted by following a cohort of HIV-positive patients from October 1, 2007 to March 31, 2013 in the province of Ontario, Canada. I adopted a novel longitudinal linked data approach. Various regression models were employed for the analysis.
Three self-report instruments (CES-D20, K10, and PHQ9) performed equally well and accurately when compared against DSM-IV criteria. With regards to the burden of depression, one in four HIV-positive patients was depressed. Half of depressed HIV-positive patients had a recurrent episode. In addition, there were delivery gaps in mental health care for depressed HIV-positive patientsâ one-half used mental health services and of these, one-half received minimally adequate care. Furthermore, HIV-positive patients with depression and/or substance use issues were associated with a 19â 70% elevated rate of emergency department (ED) admissions and a 17-67% elevated rate of potentially preventable ED admissions compared to those without these conditions.
In sum, depression is highly prevalent in HIV-positive patients and is likely to be chronic and recurrent over time. There are delivery gaps in mental health care for depressed HIV-positive patients. More effective mental health care policies and better access to mental health care services are required to address the unmet needs of HIV-positive patients and reduce the impact of depression on their lives.Ph.D.2018-11-30 00:00:0
HIV-Related Stigmas, Health Care Empowerment, and Self- Rated Health Among People Living with HIV in Ontario
Full text linkHIV-related stigma negatively impacts the health of people living with HIV; however, uncertainty remains around the mechanisms through which this occurs. Health care empowerment, which is defined as being engaged and committed to one’s care, and resilient to setbacks in health, may be a significant factor. As such, this study examined if health care empowerment mediated the relationship between HIV-related stigmas and self-rated health and how demographics may play a role, using the 2018 Ontario People Living with HIV Stigma Index Study. Results using ANOVA/Students t-tests and multiple linear regression/mediation showed that internalized, enacted, and anticipated stigma were all significantly elevated and related to self-rated health. Additionally, health care empowerment mediated internalized stigma and self-rated health’s association and was significantly lower for those who were younger, living with HIV for 10 or less years, heterosexual, and had less than high school education. Findings suggest the potential benefits of focused interventions.M.Sc
Depression in People Living with HIV and Their Unmet Needs in Mental Health Care in Ontario: A Prospective Cohort Study
Full text linkNearly 50% of HIV-positive patients have a history of suffering from depression. Although the condition is treatable, depression in these patients is under-recognized and under-treated, resulting in poorer clinical and quality-of-life outcomes. There are also gaps and disparities in accessing mental health care among these patients, but current evidence is limited to U.S. studies.
The primary objectives of this thesis work were to: (1) establish the validity and reliability of self-report measurement instruments in identifying depression against DSM-IV criteria; (2) examine the burden of current depression and the underlying factors driving the burden; (3) estimate the rate of publicly-funded mental health service use and unmet needs for mental health care among HIV-positive patients with depression; and (4) examine the impact of depression on costly and preventable acute health services use in the Canadian health care system.
A prospective cohort study was conducted by following a cohort of HIV-positive patients from October 1, 2007 to March 31, 2013 in the province of Ontario, Canada. I adopted a novel longitudinal linked data approach. Various regression models were employed for the analysis.
Three self-report instruments (CES-D20, K10, and PHQ9) performed equally well and accurately when compared against DSM-IV criteria. With regards to the burden of depression, one in four HIV-positive patients was depressed. Half of depressed HIV-positive patients had a recurrent episode. In addition, there were delivery gaps in mental health care for depressed HIV-positive patientsâ one-half used mental health services and of these, one-half received minimally adequate care. Furthermore, HIV-positive patients with depression and/or substance use issues were associated with a 19â 70% elevated rate of emergency department (ED) admissions and a 17-67% elevated rate of potentially preventable ED admissions compared to those without these conditions.
In sum, depression is highly prevalent in HIV-positive patients and is likely to be chronic and recurrent over time. There are delivery gaps in mental health care for depressed HIV-positive patients. More effective mental health care policies and better access to mental health care services are required to address the unmet needs of HIV-positive patients and reduce the impact of depression on their lives.Ph.D.2018-11-30 00:00:0
Risk factors for suboptimal adherence and facilitators of adherence to HAART in HIV-infection
Full text linkThèse numérisée par la Direction des bibliothèques de l'Université de Montréal
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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