Global surface temperature has increased by 0.2℃per decade in the past 30 years,similar to the warming rate predicted in the 1980s in initial global climate model simulations with transient greenhouse gas changes.War...Global surface temperature has increased by 0.2℃per decade in the past 30 years,similar to the warming rate predicted in the 1980s in initial global climate model simulations with transient greenhouse gas changes.Warming is larger in the Western Equatorial Pacific than in the Eastern Equatorial Pacific over the past century previous research on the economic impacts of a climate-induced sea level rise has been based on the gradual erosion of the shoreline。展开更多
Purpose: Despite high levels of depression among persons living with HIV (PLWHIV), little research has investigated the relationship of depression to work status and income in PLWHIV in sub-Saharan Africa, which was t...Purpose: Despite high levels of depression among persons living with HIV (PLWHIV), little research has investigated the relationship of depression to work status and income in PLWHIV in sub-Saharan Africa, which was the focus of this analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting antiretroviral therapy in Kampala, Uganda were examined. In separate multivariate analyses, we examined whether depressive severity and symptom type [as measured by the Patient Health Questionnaire (PHQ-9)] and major depression [diagnosed with the Mini International Neuropsychiatric Interview (MINI)] were associated with work status and income, controlling for demographics, physical health functioning, work self-efficacy, social support and internalized HIV stigma. Results: 14% of the sample had Major Depression and 66% were currently working. Each measure of depression (PHQ-9 total score, somatic and cognitive subscales;Major Depression diagnosis) was associated with not working and lower average weekly income in bivariate analysis. However, none of the depression measures remained associated with work and income in multivariate analyses that controlled for other variables associated with these economic outcomes. Conclusions: These findings suggest that while depression is related to work and income, its influence may only be indirect through its relationship to other factors such as work self-efficacy and physical health functioning.展开更多
Purpose: There is extensive evidence regarding the relationship between HIV related stigma and disclosure;however, the influence of depression in this relationship is not well understood, and thus is the focus of our ...Purpose: There is extensive evidence regarding the relationship between HIV related stigma and disclosure;however, the influence of depression in this relationship is not well understood, and thus is the focus of our analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting ART in Kampala, Uganda were examined. A staged-approach regression analysis was used to examine variables associated with HIV disclosure to most people (general disclosure) and disclosure to primary sex partner. Internalized HIV stigma plus demographic and background covariates were first entered into the model;the binary indicator of clinical depression was added on step two, followed by the addition of the interaction of stigma and depression in step three. Separate analyses were conducted for each of the two disclosure outcomes. Results: 39% indicated that they kept their HIV status as a secret from most people, while 19% of respondents with a regular sex partner had not disclosed their HIV status to the partner. In bivariate analysis, respondents who preferred to keep their HIV status as a secret from most people had higher internalized HIV stigma (p < 0.001) and depression (p < 0.01), and were more likely to be clinically depressed (p < 0.01) compared with others in the sample. Similarly, participants who had not disclosed their HIV status to their main sex partner had higher internalized HIV stigma (p < 0.01) and depression (p < 0.05), and were more likely to be clinically depressed (p < 0.01) compared with those who had informed their partner of their HIV status. The regression analysis revealed that internalized HIV stigma was strongly negatively correlated with disclosure to primary partner, while depression was not associated. In the regression analysis for general disclosure, both stigma and depression were negatively correlated with disclosure when the interaction term was included in the model. Further analysis showed that internalized HIV stigma was more strongly associated with general disclosure among participants who were not depressed. Conclusions: Although there was clearly a strong and consistent association between internalized HIV stigma and depression symptoms, the strong association between internalized HIV stigma and general disclosure among respondents who were not depressed indicated that HIV stigma was in itself remained a strong barrier to HIV disclosure. Therefore, interventions to reduce internalized HIV stigma may aid in efforts to decrease secondary transmission of HIV.展开更多
Objective: To determine if increased psychosocial risks are associated with ea ch increase in birth multiplicity (i.e., singleton, twin, triplet) resulting fro m assisted reproduction. Design: Stratified random sample...Objective: To determine if increased psychosocial risks are associated with ea ch increase in birth multiplicity (i.e., singleton, twin, triplet) resulting fro m assisted reproduction. Design: Stratified random sample (n = 249). Setting: An academic teaching hospital and private practice infertility center. Patient(s): Mothers raising 1-to 4-year-old children (n = 128 singletons, n = 111 twins, and n = 10 triplets) conceived through assisted reproduction. Intervention(s): Self-administered, mailed survey. Main Outcome Measure(s): Scales measuring mat erial needs, quality of life, social stigma, depression, stress, and marital sat isfaction. Result(s): Using multivariate logistic regression models, for each ad ditional multiple birth child, the odds of having difficulty meeting basic mater ial needs more than tripled and the odds of lower quality of life and increased social stigma more than doubled. Each increase in multiplicity was also associat ed with increased risks of maternal depression. Conclusion(s): To increase patie nts’informed decision-making, assisted reproduction providers might consider i ncorporating a discussion of these risks with all patients before they begin fer tility treatment, and holding the discussion again if the treatment results in a multiple gestation. These data may also help providers to identify appropriate counseling, depression screening, and supports for patients with multiple births .展开更多
文摘Global surface temperature has increased by 0.2℃per decade in the past 30 years,similar to the warming rate predicted in the 1980s in initial global climate model simulations with transient greenhouse gas changes.Warming is larger in the Western Equatorial Pacific than in the Eastern Equatorial Pacific over the past century previous research on the economic impacts of a climate-induced sea level rise has been based on the gradual erosion of the shoreline。
文摘Purpose: Despite high levels of depression among persons living with HIV (PLWHIV), little research has investigated the relationship of depression to work status and income in PLWHIV in sub-Saharan Africa, which was the focus of this analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting antiretroviral therapy in Kampala, Uganda were examined. In separate multivariate analyses, we examined whether depressive severity and symptom type [as measured by the Patient Health Questionnaire (PHQ-9)] and major depression [diagnosed with the Mini International Neuropsychiatric Interview (MINI)] were associated with work status and income, controlling for demographics, physical health functioning, work self-efficacy, social support and internalized HIV stigma. Results: 14% of the sample had Major Depression and 66% were currently working. Each measure of depression (PHQ-9 total score, somatic and cognitive subscales;Major Depression diagnosis) was associated with not working and lower average weekly income in bivariate analysis. However, none of the depression measures remained associated with work and income in multivariate analyses that controlled for other variables associated with these economic outcomes. Conclusions: These findings suggest that while depression is related to work and income, its influence may only be indirect through its relationship to other factors such as work self-efficacy and physical health functioning.
文摘Purpose: There is extensive evidence regarding the relationship between HIV related stigma and disclosure;however, the influence of depression in this relationship is not well understood, and thus is the focus of our analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting ART in Kampala, Uganda were examined. A staged-approach regression analysis was used to examine variables associated with HIV disclosure to most people (general disclosure) and disclosure to primary sex partner. Internalized HIV stigma plus demographic and background covariates were first entered into the model;the binary indicator of clinical depression was added on step two, followed by the addition of the interaction of stigma and depression in step three. Separate analyses were conducted for each of the two disclosure outcomes. Results: 39% indicated that they kept their HIV status as a secret from most people, while 19% of respondents with a regular sex partner had not disclosed their HIV status to the partner. In bivariate analysis, respondents who preferred to keep their HIV status as a secret from most people had higher internalized HIV stigma (p < 0.001) and depression (p < 0.01), and were more likely to be clinically depressed (p < 0.01) compared with others in the sample. Similarly, participants who had not disclosed their HIV status to their main sex partner had higher internalized HIV stigma (p < 0.01) and depression (p < 0.05), and were more likely to be clinically depressed (p < 0.01) compared with those who had informed their partner of their HIV status. The regression analysis revealed that internalized HIV stigma was strongly negatively correlated with disclosure to primary partner, while depression was not associated. In the regression analysis for general disclosure, both stigma and depression were negatively correlated with disclosure when the interaction term was included in the model. Further analysis showed that internalized HIV stigma was more strongly associated with general disclosure among participants who were not depressed. Conclusions: Although there was clearly a strong and consistent association between internalized HIV stigma and depression symptoms, the strong association between internalized HIV stigma and general disclosure among respondents who were not depressed indicated that HIV stigma was in itself remained a strong barrier to HIV disclosure. Therefore, interventions to reduce internalized HIV stigma may aid in efforts to decrease secondary transmission of HIV.
文摘Objective: To determine if increased psychosocial risks are associated with ea ch increase in birth multiplicity (i.e., singleton, twin, triplet) resulting fro m assisted reproduction. Design: Stratified random sample (n = 249). Setting: An academic teaching hospital and private practice infertility center. Patient(s): Mothers raising 1-to 4-year-old children (n = 128 singletons, n = 111 twins, and n = 10 triplets) conceived through assisted reproduction. Intervention(s): Self-administered, mailed survey. Main Outcome Measure(s): Scales measuring mat erial needs, quality of life, social stigma, depression, stress, and marital sat isfaction. Result(s): Using multivariate logistic regression models, for each ad ditional multiple birth child, the odds of having difficulty meeting basic mater ial needs more than tripled and the odds of lower quality of life and increased social stigma more than doubled. Each increase in multiplicity was also associat ed with increased risks of maternal depression. Conclusion(s): To increase patie nts’informed decision-making, assisted reproduction providers might consider i ncorporating a discussion of these risks with all patients before they begin fer tility treatment, and holding the discussion again if the treatment results in a multiple gestation. These data may also help providers to identify appropriate counseling, depression screening, and supports for patients with multiple births .
