RESUMEN
Although Northern Ireland has high levels of mental health problems, there has been a relative lack of systematic research on mental health services that can provide an evidence base for legal, policy, and service developments. This article aims to provide a review of the central issues relating to mental health service provision in Northern Ireland, and to gather the perceptions of different stakeholders of these services. The study utilised in-depth qualitative interviews, focus groups, and an online survey to collect data from respondents throughout the region. This method involved the completion of semistructured interviews with significant mental health commissioners and senior managers, and with service-users and their key workers. Focus groups sessions were also completed with mental health professionals, service-users, and carers. Data collection occurred between December 2014 and June 2015. Thematic analysis was used to identify key issues. The findings identified that considerable progress had been made not only in the development of mental health services in the last decade, but also highlighted the significant limitations in current services. Most notably, strengths in provision included the transition from long-stay hospital care to community-based services and person-centred approaches. The researchers identified the need to improve funding, address problems with fragmentation, and gaps in service provision. Based on these findings, the authors consider the implications for practice and policy relating to the human and organisational aspects of service development. In particular, services should be developed focusing on a recovery ethos and on person-centred and relationship-based approaches. The needs of carers should additionally be considered and programmes developed to tackle stigma.
Asunto(s)
Servicios de Salud Mental/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Humanos , Entrevistas como Asunto , Servicios de Salud Mental/normas , Irlanda del Norte , Atención Dirigida al Paciente/organización & administración , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
BACKGROUND: Ethnic diversity is increasingly encountered in the HIV-infected population in North America, and it is unknown if beliefs surrounding illness and treatment vary among different ethnic groups. OBJECTIVE: Our objectives were to determine whether self-reported adherence, illness perceptions and treatment beliefs regarding HIV differ based on ethnicity. SETTING: This study was conducted during outpatient HIV clinic visits between March 1, 2010 and April 30, 2010 at two hospital-based clinics in Edmonton, AB, Canada. METHODS: A cross-sectional sample of 65 patients on antiretroviral therapy (34 Caucasian, 23 Aboriginal, and 8 from other ethnic groups) attending hospital-based clinics completed a self-administered survey; medical records were reviewed for demographic and treatment information. MAIN OUTCOME MEASURE: An ANOVA with covariates was performed to measure variation of beliefs and adherence between ethnic groups. RESULTS: Mean self-reported adherence in the past week and past month was high (96 %) and the majority of patients (78.5 %) had a viral load <40 copies/mL. Patients had high perceived necessity scores and a low degree of perceived concern with antiretroviral therapy. In our study, treatment beliefs, illness perceptions, and self-reported adherence did not vary between ethnicities (p > 0.05). CONCLUSION: Treatment beliefs, illness perceptions, and adherence appear to be largely similar in English-speaking patients with diverse ethnic backgrounds who have been on treatment for at least 3 months. Strong supports may overcome any cultural differences in treatment beliefs that were expected at the outset.
Asunto(s)
Etnicidad/psicología , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Cumplimiento de la Medicación/psicología , Adulto , Anciano , Alberta , Antirretrovirales/uso terapéutico , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , AutoinformeRESUMEN
Patients with Plasmodium vivax malaria are treated with primaquine to prevent relapse infections. We report primaquine failure in a patient with 3 relapses without any possibility of re-infection. Using whole genome sequencing of the relapsing parasite isolates, we identified single nucleotide variants as candidate molecular markers of resistance.
Asunto(s)
Tolerancia a Medicamentos/genética , Genoma de Protozoos , Malaria Vivax/metabolismo , Plasmodium vivax/genética , Polimorfismo de Nucleótido Simple , Adulto , Antimaláricos/farmacocinética , Antimaláricos/farmacología , Antimaláricos/uso terapéutico , Biotransformación , Cloroquina/farmacocinética , Cloroquina/farmacología , Cloroquina/uso terapéutico , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Malaria Vivax/tratamiento farmacológico , Malaria Vivax/parasitología , Masculino , Plasmodium vivax/efectos de los fármacos , Primaquina/farmacocinética , Primaquina/farmacología , Primaquina/uso terapéutico , Recurrencia , Análisis de Secuencia de ADNRESUMEN
OBJECTIVE: To determine the seroprevalence of herpes simplex virus infection in a population of HIV-infected individuals in Canada. METHODS: HIV-infected patients attending 5 infectious disease clinics for follow-up care were approached to participate in the study. After informed consent was obtained, subjects completed a questionnaire documenting HIV-risk behavior, duration of infection, history of oral and/or genital herpes, and treatment for HIV and/or genital herpes. Blood for HSV type-specific serology was drawn and tested by enzyme-linked immunosorbent assay (Focus Diagnostics HerpeSelect HSV-1, HSV-2 enzyme-linked immunosorbent assay IgG). Equivocal samples were repeated and any discrepant results were resolved with Western blot. RESULTS: Six hundred twenty-nine HIV-infected individuals participated. The mean age was 43.9 years, 74.7% were Canadian born and 72.3% were men. The majority of foreign-born subjects were black (endemic) and women. The seroprevalence of HSV-1 and HSV-2 was 78.1% and 54.6%, respectively. Women were 2.7 times more likely to be HSV-2 seropositive, non-Canadian-born participants were 2.0 times more likely to be HSV-2 seropositive, and nonwhite subjects were 3.2 times more likely to be seropositive. Men who had sex with other men had the lowest seroprevalence of HSV-2. Only 30.3% of HSV-2 positive subjects reported a history of genital herpes. CONCLUSIONS: A significant proportion of HIV-infected subjects attending 5 infectious disease clinics in Canada are coinfected with HSV. Routine type-specific HSV-2 testing should be introduced to direct education regarding symptoms, signs, and transmission reduction of genital herpes and perhaps ultimately HIV-1. Knowledge of HSV serostatus would also provide an opportunity to consider antiviral therapy.