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  • McFadden Hauge posted an update 2 days, 20 hours ago

    BACKGROUND Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support. PURPOSE To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development. METHODS We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence. RESULTS Elevated depressive symptoms were directly associated with significantly lower adherence (est = -8.60, 95% confidence interval [-15.02, -2.18], p less then .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p less then .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p less then .01). Tolinapant , defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence. #link# CONCLUSIONS Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support. © Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.The use of oral fluid tests to detect drugs is of growing interest in various areas, including treatment centres, roadside and workplace testing. In this study, we investigated drug detection in oral fluid samples collected using a commercially available device, Oral Eze. Drug detection in oral fluid was compared to paired urine samples, which were simultaneously collected. We also evaluated the collection device by comparing A and B oral fluid samples. Finally, we studied the stability of various drugs in samples stored for at least one year. The drug profile was investigated by comparing the drugs detected in oral fluid samples to paired urine samples collected in a treatment centre. A total of 113 paired oral fluid and urine samples were investigated for the presence of drugs in the following groups amphetamines, benzodiazepines, opiates and opioids, cocaine, and cannabis. A and B samples were collected from different workplaces through an uncontrolled sampling procedure (n = 76). The stability of drugs in A samples was assessed after storage at -20 °C for one year. There was good correlation between drugs detected in oral fluid samples and urine samples. The heroin metabolite, 6-MAM, was more frequently detected in oral fluid samples than in urine samples, while cannabis was better detected in urine samples. Drugs in oral fluid samples were stable when stored at -20 °C for at least one year. However, in many positive A and B oral fluid samples, there was significant variation in the concentrations obtained. The drug profiles in oral fluid were consistent with urine samples, and the analytes were stable for at least one year. The concentrations detected in A and B samples were not always correlated. Hence, the collection device may need to be further standardised and improved. © The Author(s) 2020. Published by Oxford University Press. All rights reserved. For Permissions, please email journals.permissions@oup.com.In the Winter 2019 issue, in the paper by Lucy et al., the link for the website that carries the appendix (CPBDL) has been updated.In the Winter 2019 issue, in the e-paper by Harmon et al., the name of one of the coauthors was spelled incorrectly. Corrected Gabrielle Scronce.Chronic pain is a problem that has become common across communities. Currently there is no uniform approach for treating chronic pain. The purpose of this study was to explore whether an association exists between personality type and the predisposition to developing chronic pain. Using a personality profile tool, we surveyed 29 subjects suffering from chronic pain and found that 25 of the 29 approached their pain experience from a “feeling” or subjective perspective. Emotion, rather than logic, was more likely to drive these subjects’ understanding of their chronic pain state. Considering this predilection toward emotion should be part of treating patients with chronic pain states. Educators who prepare future health professionals and those professionals currently in practice should appreciate the psychosocial nature of chronic pain and direct treatment, at least in part, toward the psychosocial component of the lived pain experience.AIMS Current physical therapy curricula may not adequately address pain education. Pain Neuroscience Education (PNE) is an education tool that focuses on the influence of psychosocial pain triggers to help the patient gain better understanding of the pain experience. PNE is a potentially effective pain management intervention for sufferers of chronic pain. This research explored whether a single lecture/demonstration could produce evidence of enhanced understanding among Physical Therapist Assistant (PTA) and Doctor of Physical Therapy (DPT) students regarding chronic pain. METHODS The Neuroscience Pain Questionnaire (NPQ) and Health Care Providers Pain and Impairment Relationship Scale (HC-Pairs) were both administered pre and post lecture. The NPQ was completed again at 6 months post lecture by subjects who were DPT students. Case vignettes were administered to the DPT students to assess their ability to apply their understanding of PNE. RESULTS There was a significant improvement in scores from pre to post NPQ (knowledge of pain) and HC-Pairs (attitudes and beliefs).

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