HIV-infected children benefit from Improved caregiver training

Main Category: HIV / AIDS
Also Included In: Pediatrics / Children's Health;  Caregivers / Homecare
Article Date: 19 Aug 2013 - 0:00 PDT Current ratings for:
HIV-infected children benefit from Improved caregiver training

Children born with HIV can live longer and richer lives if their caregivers receive training in ways to enhance the children's development, according to research led by Michigan State University.

The program also reduces depression in the caregivers which, in most cases, are the children's HIV-infected mothers, MSU researcher Michael Boivin and colleagues report in The Journal of Pediatrics.

An HIV diagnosis once all but guaranteed an African child would die within a few years, but more effective and widely available drugs have made it commonplace for children there to live with the disease into or beyond adolescence.

Still, with gravely ill caregivers - many of whom must also work long hours in the fields to provide food - these kids miss out on the affection and regular interaction that are crucial for their physical, social and cognitive development in early childhood, said Boivin, professor in the departments of Psychiatry and of Neurology and Ophthalmology.

"Better access to treatment has clinically stabilized these children and extended their lives, but their quality of life is still very much at risk," Boivin said. "The effects of the disease on their development and the compromised caregiving available to them compound the public health challenges already faced by African children in resource-poor settings."

Funded by the National Institutes of Health, the study involved a training program called Mediational Intervention for Sensitizing Caregivers, or MISC, which uses day-to-day interaction at home to enhance children's social skills, language and cognitive ability.

"MISC is about training mothers or other caregivers on ways they can be sensitive to their child's natural tendencies to learn, and to direct those tendencies in everyday life to enrich the child's development," said Boivin.

The study involved 120 preschool-aged children with HIV living in rural Uganda. Their primary caregivers were randomly assigned to receive childcare training through MISC or through an education program focused on improving children's health and nutrition.

After a year, the children whose caregivers received the MISC training showed significantly more developmental progress than the others, with particularly strong gains in memory and learning skills.

Somewhat surprisingly, there were significantly fewer deaths from diseases that take advantage of the patient's compromised immune system in the MISC group than among other children, suggesting the training may help pediatric HIV patients live longer.

Boivin said it could be that MISC-trained caregivers "became more attuned to their children's health needs and were more likely to seek medical help in a timely manner when the children are fighting an opportunistic illness."

Caregivers in the MISC group also were significantly less depressed six months into the study than those in the other group, perhaps because of the social support they received during MISC training.

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"Bring your own device" to work tech trend helps nurses provide improved patient care

Main Category: Nursing / Midwifery
Also Included In: IT / Internet / E-mail
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
"Bring your own device" to work tech trend helps nurses provide improved patient care

Not long ago, hospital IT departments supplied and maintained the hardware and software that nurses used to perform work-related tasks. Then came the mobile revolution, when consumers increasingly began carrying smartphones and tablets to assist them in their personal lives as well as in business. As a direct result, many nurses today are following the trend known as BYOD - bring your own device.

"RNs have greater familiarity with their own devices and the more familiar they are, the greater the tendency there is for nurses to optimize the use of the device to its fullest capacity for improved patient care," says Judith Church, DHA, MSN, faculty member in the health care and health care informatics programs at American Sentinel University.

A recent survey by Fierce Mobile Healthcare found that 61 percent of hospitals and health systems responding said that half their employees use personal mobile devices for work. Fifty percent said this use was limited to email and calendar applications, but 36 percent said that employees were accessing patient data.

Another report, Point of Care Computing for Nursing 2012, examined the BYOD patterns of nurses and found that 69 percent of hospitals say their nursing staff is using personal devices at work.

The Pros and Cons of BYOD in Nursing
Church says that BYOD can increase productivity or job performance because people are more comfortable with their own device, have more control over the computing environment and enjoy an enhanced sense of work-life balance, to name a few benefits.

The nurses surveyed in the report specifically stated they use their own mobile devices to improve patient safety and reduce the risk of medical errors. They believe their personal devices enable them to fill in critical communication gaps with the technologies provided by the hospital - for example, allowing them to easily access clinical reference materials at the point of care or quickly communicate with other clinicians to coordinate care.

Yet, BYOD can put IT departments in the difficult position of having to provide support for all these personal devices.

For example, IT might have to build a platform that will ensure hospital software works on all four mobile operating systems (Apple, Android, Microsoft Windows and Blackberry). These diverse devices also create security and HIPAA issues associated with mobile technology.

"The drawback to BYOD in nursing is that it contributes to a non-standardization of a work arena's equipment," says Church. "Nurses should realize that IT policies exist for a reason to protect data integrity and security and should adhere to them at all times when participating in a BYOD initiative."

Using BYOD to Improve Nursing Workflows
Integrating BYOD with nursing call systems can improve both staff and patient satisfaction. Call systems based on overhead paging or lights that can only be seen from the nursing station may soon become obsolete in favor of newer systems that can wirelessly transmit alerts right to a nurse's smartphone when the patient pushes a button.

Alerts can take the form of text messages, emails, pages or phone calls. In some cases, patients may be able to send a specific type of alert - a request for bathroom assistance or pain medicine, for example - that are then routed to the appropriate staff person.

"BYOD can play a significant role in nursing to improve workflows," says Church. "The individual device and user prowess will contribute to optimal standardization of devices across the physical and electronic work environment."

Church points out that BYOD is a trend that will continue in health care because of its financial implications.

"The BYOD trend will thrive in nursing because health care organizations save money when the employee purchases the device. Since nurses are most familiar with their own devices, they will work more effectively and efficiently. Equipment - no matter what it is - is only as effective as its setup and use," adds Church.

It's clear that health care must find ways to reap the benefits of mobile technologies, while reducing the risks and protecting patient data.

"BYOD initiatives should be expanded to include nurses as well as physicians in order to increase nurse productivity and improve patient care and satisfaction," adds Church.

For more information about American Sentinel University's MSN, nursing informatics specialization, please visit http://www.americansentinel.edu/health-care/m-s-nursing/m-s-nursing-nursing-informatics.

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Brain functioning in HIV-infected adults improved by Exercise

Main Category: HIV / AIDS
Also Included In: Obesity / Weight Loss / Fitness;  Neurology / Neuroscience
Article Date: 15 Aug 2013 - 1:00 PDT Current ratings for:
Brain functioning in HIV-infected adults improved by Exercise

Regular exercise is not only good for health, but can give people living with HIV a significant mental boost. This is according to a study by Dr. David J. Moore and colleagues at the University of California, San Diego (UCSD), published in Springer's Journal of NeuroVirology.

The study found that HIV-infected adults who exercise suffered significantly less neurocognitive impairment compared to patients who do not exercise.

Moore and his team, including UCSD medical student Catherine Dufour, found that HIV-infected adults who exercise were approximately half as likely to show signs of neurocognitive impairment as compared to those who do not. They also had better working memory and could process information faster than patients who follow a sedentary lifestyle.

Despite recent advances in antiretroviral treatment, impaired brain functioning is a reality faced by nearly half of all people living with HIV. This ranges from asymptomatic neurocognitive impairment, to more pronounced deficits that interfere with daily functioning, such as problems with financial management, driving and taking medication regularly.

The major benefit of exercise to the brain seems to be the reduction of neurocognitive risk factors, such as high blood pressure and abnormally high levels of lipids in the blood. Metabolic syndrome associated with the use of antiretroviral treatment is also linked to an increase in cerebrovascular risk factors, such as diabetes, hypertension and obesity.

In the study, 335 community-dwelling HIV-infected people were asked how much exercise they undertook during the previous 72 hours, and persons were classified into those who engaged in significant exercise (e.g., activities that make the heart beat rapidly) and those who did not. Seven cognitive areas commonly affected by HIV were tested, including verbal fluency, working memory, speed of information processing, learning, recall, executive function and motor function.

The study extends prior findings about the link between exercise and cognition among HIV-infected people by showing that this association is also true in a diverse and large group of people living with the disease. Compounding factors were taken into account, such as demographics, HIV disease characteristics, substance use, past and current depression, mental health status and physical functioning.

"Exercise as a modifiable lifestyle behavior may reduce or potentially prevent neurocognitive impairment in HIV-infected persons," says Moore. "Physical exercise, together with other modifiable lifestyle factors such as education, social engagement, cognitive stimulation and diet could be fruitful interventions to support people living with HIV."

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Physical exercise is associated with less neurocognitive impairment among HIV-infected adults

Dufour, C.A. et al (2013). Journal of NeuroVirology DOI 10.1007/s13365-013-0184-8.

212-620-8063 Springer Science+Business Media

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Care may be improved for LGBT's by recording sexual orientation and gender identity in their medical records

Main Category: Psychology / Psychiatry
Also Included In: Primary Care / General Practice;  IT / Internet / E-mail
Article Date: 15 Aug 2013 - 1:00 PDT Current ratings for:
Care may be improved for LGBT's by recording sexual orientation and gender identity in their medical records

Recording the sexual orientation and gender identity (SOGI) of individuals in their health records would greatly facilitate identifying the unique health needs and health disparities of LGBT individuals, leading to improved quality and outcomes of their health care. The advantages of reporting this information and the growing support for including it in electronic health records (EHRs) are described in an article in LGBT Health, a new peer-reviewed journal from Mary Ann Liebert, Inc., publishers, launching in fall 2013. The article is available free on the website.

Sean Cahill, PhD and Harvey J. Makadon, MD, The Fenway Institute (Boston, MA), emphasize the need for more data and research on LGBT health and health disparities, as noted in a 2011 Institute of Medicine report that recommended routine collection of SOGI information and its inclusion in EHRs. Ready access to this information could facilitate conversations between clinicians and patients about risk factors and targeted preventive measures. Cahill teaches public policy at New York University (New York, NY) and Makadon is Clinical Professor of Medicine at Harvard Medical School (Boston, MA).

In the article "Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities" * the authors describe overwhelming support for routine collection of SOGI information among LGBT advocacy groups and HIV/AIDS organizations, as well as the support for SOGI data collection in the Healthy People 2020 initiative, and the Obama administration's Affordable Care Act.

"The Obama Administration has taken significant strides toward increasing LGBT data collection on health surveys," said Cahill. "Right now the federal government is considering whether to include SOGI as standard demographic questions in Stage 3 meaningful use guidelines, which set the standard for data collection in EHRs. We believe that including SOGI measures in these guidelines would dramatically increase our understanding of LGBT health disparities and our ability to address them."

"While there is no question about the benefits of collecting such data, some concern has been raised about the security of the EHR and potential misuses," says Editor-in-Chief, William Byne, MD, PhD, Icahn School of Medicine at Mount Sinai, New York, NY. "In addition to addressing how to best elicit the data, Cahill and Makadon also address such implementation concerns."

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Tumor suppressor may provide clues for improved treatment for neuroblastoma

Main Category: Neurology / Neuroscience
Also Included In: Cancer / Oncology;  Stem Cell Research
Article Date: 14 Aug 2013 - 0:00 PDT Current ratings for:
Tumor suppressor may provide clues for improved treatment for neuroblastoma

Loss of a gene required for stem cells in the brain to turn into neurons may underlie the most severe forms of neuroblastoma, a deadly childhood cancer of the nervous system, according to a Ludwig Cancer Research study. Published in Developmental Cell, the findings also provide clues about how to improve the treatment of this often-incurable tumor.

Neuroblastoma can appear in nervous tissue in the abdomen, chest and spine, among other regions of the body, and can spawn body-wracking metastasis. The most severe tumors respond poorly to treatment, and the disease accounts for 15 percent of cancer deaths in children.

Johan Holmberg, PhD, at the Ludwig Institute for Cancer Research Stockholm took a close look at the role of the CHD5 tumor suppressor during normal nervous system development. Previous studies had shown that the gene CHD5 is often inactivated in the most severe forms of neuroblastoma, but little was known about its function in healthy tissue or how it operates. The study, which was conducted in close collaboration with colleagues at Trinity College, Dublin, Ireland, addressed these two key issues.

The researchers found that CHD5 is required for the cellular transition from a stem cell to a mature neuron. In one experiment, the researchers knocked down the CHD5 gene by injecting a small RNA into the brains of fetal mice while in the womb.

"The result was a complete absence of neurons," says Ludwig researcher Holmberg who is based at the Karolinska Institutet. "Instead of becoming neurons, the cells with CHD5 knocked down stayed in a limbo-like state between an actively-dividing stem cell and a mature nerve cell. It was a very robust effect," added Holmberg.

The researchers also dissected how CHD5 operates, showing that it sticks to certain modifications of histone proteins. These modifications help control how genes are turned on and off. In the absence of CHD5, key stem cell genes are not turned off, and genes required for neuronal maturation are not turned on. The findings highlight how the failure of a cell to properly mature into its terminal state can underlie cancer, a relatively understudied area of research.

"It is necessary for cells in the healthy nervous tissue to be able to go from stem cells to neurons," explains Holmberg. "If you lose this capacity, these cells become locked in an immature state, which might yield quite dangerous tumor cells, especially in combination with additional cancer-promoting cellular events."

The research could also lead to new ways to treat neuroblastoma, perhaps using currently approved drugs. One component of neuroblastoma treatment is retinoic acid, a drug that can drive neuronal maturation. Holmberg and his colleagues found that knocking down the expression of CHD5 in more benign neuroblastoma cells blocked their capacity to mature in response to retinoic acid treatment. "These cells were completely insensitive to treatment, no matter how much we gave them, mirroring the same unresponsiveness to retinoic acid in the more malignant CHD5-negative neuroblastoma cells," says Holmberg.

The results of these cell-based experiments are consistent with clinical findings that retinoic acid is often unsuccessful in patients with severe forms of the disease. Holmberg reasons that if CHD5 could be re-activated in such hard-to-treat patients, it might increase responsiveness to retinoic acid. The findings may also have relevance for other types of tumors. For instance, CHD5 is often inactivated in glioblastoma multiforme, the most common and most aggressive form of brain cancer in adults.

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Funding for this research came in part from Science Foundation Ireland; the Health Research Board; the Swedish Cancer Society, the Swedish Research Council, the Lilian Sagen and Curt Eriksson Research Foundation; DBRM; the Swedish Childhood Cancer Foundation; the Danish National Research Foundation; the Lundbeck Foundation; and the Novo Nordisk Foundation.

CHD5 Is Required for Neurogenesis and Has a Dual Role in Facilitating Gene Expression and Polycomb Gene Repression

Developmental Cell, Volume 26, Issue 3, 223-236, 12 August 2013. 10.1016/j.devcel.2013.07.008

Ludwig Institute for Cancer Research

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Scientists emphasize urgent need for improved disease surveillance and control in the Democratic Republic of Congo

Main Category: Tropical Diseases
Article Date: 01 Aug 2013 - 14:00 PDT Current ratings for:
Scientists emphasize urgent need for improved disease surveillance and control in the Democratic Republic of Congo

Following the most deadly conflict since World War II, and nearly two decades of population displacement, the Democratic Republic of Congo (DR Congo) now may represent one of the world's highest burdens of neglected tropical diseases (NTDs). A lack of surveillance activities and epidemiologic data is a key factor in delaying progress in disease control and elimination programs, scientists report in an editorial publishing Thursday, August 1 in PLOS Neglected Tropical Diseases.

Based on the limited information available, the researchers found that DR Congo may have some of the highest levels of intestinal helminth infections, lymphatic filariasis and schistosomiasis on the African continent. DR Congo also bears the greatest number of cases of leprosy in Africa and human African trypanosomiasis (HAT) globally. A number of important human viral infections including HIV/AIDS, Chikungunya, Ebola and monkeypox may have also first emerged from DR Congo.

Despite the likelihood of widespread NTDs, there are only minimal reported surveillance activities in DR Congo, a nation that is nearly the size of Western Europe. To strengthen DR Congo's health infrastructure and ultimately its economic output, the authors propose a comprehensive NTD mapping, control and research program.

"Identifying the reach and severity of NTDs is an essential first step to providing targeted treatments to millions of people in DR Congo," said co-author Dr. Anne Rimoin, associate professor in the Department of Epidemiology at the UCLA School of Public Health. "Increasing surveillance activity of NTDs and studying the emergence of key viral infections should be one of the top health priorities for the country."

As the authors recognize, the Ministry of Public Health of DR Congo has demonstrated willingness to expand NTD disease surveillance and control activities in the years ahead. With the support of the United States Agency for International Development (USAID), DR Congo is planning an ambitious program of NTD mapping and integrated diseases control focused on mass drug administration, while the World Health Organization, its Regional Office for Africa (AFRO) and the Belgium Development Agency have offered additional support.

"We have a responsibility to better understand the true burden of NTDs in DR Congo," said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and President of the Sabin Vaccine Institute. "Future findings from enhanced disease surveillance and research will help shape and achieve important global development milestones in a country that has missed out on much of the economic and social progress spreading throughout many other parts of Africa."

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Rimoin AW, Hotez PJ (2013) NTDs in the Heart of Darkness: The Democratic Republic of Congo’s Unknown Burden of Neglected Tropical Diseases, PLoS Negl Trop Dis 7(7): e2118. doi:10.1371/journal.pntd.0002118

PLOS Neglected Tropical Diseases is an open-access, peer-reviewed journal published weekly by the Public Library of Science (PLOS).

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Dance performance improved by 'going through the motions'

Main Category: Psychology / Psychiatry
Article Date: 25 Jul 2013 - 0:00 PDT Current ratings for:
Dance performance improved by 'going through the motions'

Expert ballet dancers seem to glide effortlessly across the stage, but learning the steps is both physically and mentally demanding. New research suggests that dance marking - loosely practicing a routine by "going through the motions" - may improve the quality of dance performance by reducing the mental strain needed to perfect the movements.

The new findings, published in Psychological Science, a journal of the Association for Psychological Science, suggest that marking may alleviate the conflict between the cognitive and physical aspects of dance practice, allowing dancers to memorize and repeat steps more fluidly.

Researcher Edward Warburton, a former professional ballet dancer, and colleagues were interested in exploring the "thinking behind the doing of dance."

"It is widely assumed that the purpose of marking is to conserve energy," explains Warburton, professor of dance at the University of California, Santa Cruz. "But elite-level dance is not only physically demanding, it's cognitively demanding as well:

Learning and rehearsing a dance piece requires concentration on many aspects of the desired performance."

Marking essentially involves a run-through of the dance routine, but with a focus on the routine itself, rather than making the perfect movements.

"When marking, the dancer often does not leave the floor, and may even substitute hand gestures for movements," Warburton explains. "One common example is using a finger rotation to represent a turn while not actually turning the whole body."

To investigate how marking influences performance, the researchers asked a group of talented dance students to learn two routines: they were asked to practice one routine at performance speed and to practice the other one by marking.

The routines were relatively simple, designed to be learned quickly and to minimize mistakes. Yet differences emerged when the judges looked for quality of performance.

Across many of the different techniques and steps, the dancers were judged more highly on the routine that they had practiced with marking - their movements on the marked routine appeared to be more seamless, their sequences more fluid.

The researchers surmise that practicing at performance speed didn't allow the dancers to memorize and consolidate the steps as a sequence, thus encumbering their performance.

"By reducing the demands on complex control of the body, marking may reduce the multi-layered cognitive load used when learning choreography," Warburton explains.

While marking is often thought of as a necessary evil - allowing dancers a "break" from dancing full out - the large effect sizes observed in the study suggest that it could make a noticeable difference in a dancer's performance:

"Marking could be strategically used by teachers and choreographers to enhance memory and integration of multiple aspects of a piece precisely at those times when dancers are working to master the most demanding material," says Warburton.

It's unclear whether these performance improvements would be seen for other types of dance, Warburton cautions, but it is possible that this area of research could extend to other kinds of activities, perhaps even language acquisition.

"Smaller scale movement systems with low energetic costs such as speech, sign language, and gestures may likewise accrue cognitive benefits, as might be the case in learning new multisyllabic vocabulary or working on one's accent in a foreign language."

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Co-authors on this research include Margaret Wilson, Molly Lynch, and Shannon Cuykendall of the University of California, Irvine.

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