This research project aims to examine the family burden of people living with AIDS receiving treatment at BPKIHS. It will use an exploratory research design and survey 30 primary caregiver family members using interviews and assessments of family burden. The study hypothesizes that there will be no association between family burden and caregiver characteristics or social stigma. It seeks to understand the demographic profiles of PLWAs and their families, problems faced by caregivers, and the relationship between family burden and demographics. The results could help develop strategies to better support patients and reduce caregiver burden through education and policy changes.
This document discusses the evaluation of national health programmes, specifically focusing on the evaluation of India's Revised National Tuberculosis Control Programme (RNTCP). It begins by defining evaluation and describing its purposes and types. It then provides details about the RNTCP, including its history, structure, processes for monitoring and evaluation at various levels, and external funding sources. Key aspects of evaluating the RNTCP involve assessing performance indicators, conducting internal and external evaluations, and repeating surveys to measure disease prevalence and drug resistance over time.
This document contains a SWOT analysis for NVBDCP (National Vector Borne Disease Control Programme) in Gadchiroli, India. It identifies strengths like existing healthcare infrastructure with PHCs, SDHs, and hospitals operating 24/7 along with over 1,400 ASHA workers. Weaknesses include jungles and water bodies that breed mosquitos, inaccessibility, and poor socioeconomic conditions. Opportunities listed are support from national government and presence of ASHA workers. Threats include slow execution, lack of supervision/monitoring in rainy seasons, self-medication, and vacancies in healthcare staff. Actions proposed are strengthening facilities, improving communication, ensuring access to education/water, and
Descriptive epidemiological studies are used to:
1. Document the distribution and determinants of health-related events in populations without attempting to infer causality.
2. Describe patterns of disease by person, place, and time to identify potential risk factors and generate hypotheses.
3. Provide baseline data on diseases, health conditions, and their risk factors that can be used to plan interventions and evaluate control programs.
Proposal Sample for research Armatures/beginnersSamuel Trinity
This document provides an introduction and literature review on HIV/AIDS knowledge and awareness among adolescents. It discusses how HIV attacks the immune system, leading to AIDS. Rates of HIV are increasing among youth due to risk behaviors like unprotected sex and needle sharing. Adolescents often lack sexual education and engagement in risky acts. The study aims to assess HIV/AIDS knowledge, attitudes, and behaviors among high school students in Baguio City, Philippines to inform policy. A survey will be administered to students to understand their awareness and identify information gaps. The Health Belief Model will guide the research. The literature review covers topics like adolescent development, sexual and reproductive health challenges faced by youth, and parent-child relationships.
ROLE OF PRIVATE SECTORS IN HEALTH SERVICES AND MANAGEMENT.pptxPrasharamBC
The private sector plays a major role in delivering healthcare services in Nepal. Private sectors provide direct health services, medicines, medical products, training, and support activities. Local health programs provide essential services like immunization, family planning and maternal/child health, nutrition, and HIV/AIDS programs through primary health centers, health posts, and other local facilities. The involvement of private sectors in healthcare delivery has increased over time due to policies encouraging private sector participation in health development.
The document outlines the National Programme for Health Care of Elderly (NPHCE) in India. It discusses the growing elderly population globally and in India. It then summarizes the key components of the NPHCE, which include establishing geriatric departments in regional medical institutions, dedicating health care facilities for the elderly in 100 districts, and providing services across various levels from the community to regional centers. The program aims to provide accessible and high-quality long-term care for the elderly through prevention, management of health issues, and rehabilitation services.
Health Technology Assessments in Indiashashi sinha
The document provides an overview of health technology assessment (HTA) in India. It discusses how HTA can help optimize resource allocation and ensure affordable access to essential healthcare as part of India's universal health coverage agenda. The HTAIn was established to conduct HTA studies to inform decision making. HTAIn's objectives include maximizing health outcomes while reducing costs and inequality. It has completed several studies that have informed policies on topics like safety engineered syringes, intraocular lenses for cataracts, and long acting contraceptives. Ongoing studies cover additional health technologies. HTAIn aims to support evidence-based policies to expand coverage and financial risk protection.
National framework for malaria elimination in indiaAparna Chaudhary
outlines India’s strategy for elimination of the disease by 2030. The framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty.
This document discusses the evaluation of national health programmes, specifically focusing on the evaluation of India's Revised National Tuberculosis Control Programme (RNTCP). It begins by defining evaluation and describing its purposes and types. It then provides details about the RNTCP, including its history, structure, processes for monitoring and evaluation at various levels, and external funding sources. Key aspects of evaluating the RNTCP involve assessing performance indicators, conducting internal and external evaluations, and repeating surveys to measure disease prevalence and drug resistance over time.
This document contains a SWOT analysis for NVBDCP (National Vector Borne Disease Control Programme) in Gadchiroli, India. It identifies strengths like existing healthcare infrastructure with PHCs, SDHs, and hospitals operating 24/7 along with over 1,400 ASHA workers. Weaknesses include jungles and water bodies that breed mosquitos, inaccessibility, and poor socioeconomic conditions. Opportunities listed are support from national government and presence of ASHA workers. Threats include slow execution, lack of supervision/monitoring in rainy seasons, self-medication, and vacancies in healthcare staff. Actions proposed are strengthening facilities, improving communication, ensuring access to education/water, and
Descriptive epidemiological studies are used to:
1. Document the distribution and determinants of health-related events in populations without attempting to infer causality.
2. Describe patterns of disease by person, place, and time to identify potential risk factors and generate hypotheses.
3. Provide baseline data on diseases, health conditions, and their risk factors that can be used to plan interventions and evaluate control programs.
Proposal Sample for research Armatures/beginnersSamuel Trinity
This document provides an introduction and literature review on HIV/AIDS knowledge and awareness among adolescents. It discusses how HIV attacks the immune system, leading to AIDS. Rates of HIV are increasing among youth due to risk behaviors like unprotected sex and needle sharing. Adolescents often lack sexual education and engagement in risky acts. The study aims to assess HIV/AIDS knowledge, attitudes, and behaviors among high school students in Baguio City, Philippines to inform policy. A survey will be administered to students to understand their awareness and identify information gaps. The Health Belief Model will guide the research. The literature review covers topics like adolescent development, sexual and reproductive health challenges faced by youth, and parent-child relationships.
ROLE OF PRIVATE SECTORS IN HEALTH SERVICES AND MANAGEMENT.pptxPrasharamBC
The private sector plays a major role in delivering healthcare services in Nepal. Private sectors provide direct health services, medicines, medical products, training, and support activities. Local health programs provide essential services like immunization, family planning and maternal/child health, nutrition, and HIV/AIDS programs through primary health centers, health posts, and other local facilities. The involvement of private sectors in healthcare delivery has increased over time due to policies encouraging private sector participation in health development.
The document outlines the National Programme for Health Care of Elderly (NPHCE) in India. It discusses the growing elderly population globally and in India. It then summarizes the key components of the NPHCE, which include establishing geriatric departments in regional medical institutions, dedicating health care facilities for the elderly in 100 districts, and providing services across various levels from the community to regional centers. The program aims to provide accessible and high-quality long-term care for the elderly through prevention, management of health issues, and rehabilitation services.
Health Technology Assessments in Indiashashi sinha
The document provides an overview of health technology assessment (HTA) in India. It discusses how HTA can help optimize resource allocation and ensure affordable access to essential healthcare as part of India's universal health coverage agenda. The HTAIn was established to conduct HTA studies to inform decision making. HTAIn's objectives include maximizing health outcomes while reducing costs and inequality. It has completed several studies that have informed policies on topics like safety engineered syringes, intraocular lenses for cataracts, and long acting contraceptives. Ongoing studies cover additional health technologies. HTAIn aims to support evidence-based policies to expand coverage and financial risk protection.
National framework for malaria elimination in indiaAparna Chaudhary
outlines India’s strategy for elimination of the disease by 2030. The framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty.
Evolution of public health- Dr Subraham PanySubraham Pany
This document provides a summary of the history and evolution of public health and medicine across various civilizations and eras. It discusses early concepts of health and disease from ancient cultures like India, China, Egypt, Greece, and Mesopotamia. It then covers developments in Europe during the Middle Ages and Renaissance period, including the emergence of germ theory and advances during the Industrial Revolution that led to the fields of public health and preventive medicine. The document also introduces several important historical figures who contributed to the understanding and practice of medicine.
steps in epidemic investigation
Prepare for field work
Confirm the existence of an outbreak
Verify the diagnosis and determine the etiology of the disease.
Define the population at risk
Develop case definition, start case finding, and collect information on the cases(after choosing study design)
Describe person, place and time (by questionnaire)
Evaluation of ecological factors
Formulate several possible hypothesis hypotheses.
Test hypotheses using analytical study
Refine hypotheses and carry out additional studies
Draw conclusions to explain the causes or determinants of outbreak based on clinical, laboratory, epidemiological & environmental evidence
Report and recommend appropriate control measures to concerned authorities at the local/national, and if appropriate at international levels
Communication of the findings
Follow up of the recommendation to assure implementation of control measures
Swot analysis of safe motherhood program of Nepalsirjana Tiwari
The document provides an overview of Nepal's Safe Motherhood and Newborn Health Program, including its goals, strategies, activities and management. Some key points:
- The program aims to reduce maternal and neonatal morbidity and mortality through preventative activities and addressing factors that cause death during pregnancy, childbirth and postpartum.
- Major strategies include promoting birth preparedness, the Aama program to promote antenatal checkups and institutional delivery, and expanding emergency obstetric services.
- Key activities include distribution of birth preparedness packages, rural ultrasound programs, expansion of birthing centers and emergency obstetric care sites, and training of skilled birth attendants.
- The program is managed through planning
National health programs and policies for prevention and control of ncds in n...Pawan Dhami
This document summarizes several national health programs and policies in Nepal related to the prevention and control of non-communicable diseases (NCDs). It outlines policies such as the Integrated NCD Prevention and Control Policy, the Multi-Sectoral Action Plan for NCD Prevention and Control (2014-2020), and the National Policy and Plan for NCD Prevention and Control (2013-2017). It also discusses the Health Education, Information and Communication Program and policies within the Second Long Term Health Plan, Nepal Health Sector Strategy, and other documents. The document analyzes some of the systematic challenges facing NCD prevention in Nepal, such as limited funding for primary prevention and a lack of coordination between sectors.
Current Policy, Strategies and Program of Preventing, Protecting and Control ...Mohammad Aslam Shaiekh
The document summarizes the history and development of tuberculosis control policies and programs in Nepal over several decades. It begins with the establishment of the first sanatorium in 1937 and traces the establishment of additional clinics, hospitals, and tuberculosis control initiatives through partnerships with international organizations. It describes Nepal adopting the DOTS strategy in 1995 and details the current goals, strategies and components of Nepal's National Tuberculosis Control Program, including the adoption of the End TB Strategy.
This presentation is compiled from several sources and summarizes the health care system in Europe. Some of the information could be outdated and readers are encouraged to follow recent updates as well.
The Nepal health information system uses various forms and registers to collect health data from public and private providers. This data is integrated into the national Health Management Information System (HMIS) managed by the Department of Health Services. Currently, an integrated Health Information System using the District Health Information System (DHIS) collects major health data electronically. Facilities have access to enter data, while the Health Office receives monthly reports and can process, represent, and analyze the data.
The 10-step approach to outbreak investigations involves:
1) Identifying an investigation team and resources.
2) Establishing the existence of an outbreak.
3) Verifying the diagnosis, constructing a case definition, and finding cases systematically.
Descriptive epidemiology is then used to develop hypotheses, which are evaluated through additional studies if needed, before implementing control measures, communicating findings, and maintaining surveillance to confirm the outbreak has ended. Being systematic and following these steps is key to determining the source and controlling outbreaks.
Incidence and prevalence measures provide information about disease frequency and burden in populations. Prevalence describes the proportion of people with a disease at a point in time, while incidence refers to the number of new cases that develop over time. Both measures can be stratified by person, place, and time to gain insights into a disease's pathogenesis and development.
1) The document discusses several zoonotic diseases including West Nile virus, rabies, and brucellosis. It describes the pathogens, transmission cycles between animals and humans, clinical manifestations in humans, and national surveillance efforts.
2) For diseases like rabies and brucellosis, the national surveillance involves mandatory reporting of human cases, monitoring of infected animals, and collaboration between human and veterinary agencies.
3) One health approaches discussed include integrating epidemiological data between human and veterinary fields to more rapidly detect and respond to zoonotic outbreaks.
Dr. Salma Burton's presentation outlines the six key building blocks of an effective health system: 1) service delivery, 2) health workforce, 3) health information systems, 4) medical products/vaccines/technologies, 5) health financing, and 6) governance. Each building block plays an important role in ensuring people have access to safe, effective, and quality health services. Strong leadership and coordination across these areas through a systems thinking approach can help improve overall population health outcomes.
This document discusses rapid epidemiological assessment methods. It introduces various sampling techniques used for rapid health assessments including WHO EPI 30x7 cluster sampling, Lot Quality Assurance Sampling (LQAS), and case-control methodology. It describes how to conduct LQAS surveys including identifying target populations, setting assessment criteria, calculating sample sizes, counting lots, setting thresholds, and selecting decision values. The document compares different rapid assessment methods and explains which technique would be most appropriate based on factors like whether inferences need to be made about individual populations, population heterogeneity, ability to obtain a full population list, and desired precision levels.
Selective Vs Comprehensive Primary Health Care in NepalManik Rajbhandari
The document discusses selective primary health care (SPHC) versus comprehensive primary health care (CPHC). SPHC focuses on specific interventions like immunizations, while CPHC aims to improve overall population health through multisectoral coordination. Nepal has achieved success with SPHC but still struggles with CPHC indicators. While SPHC can reduce disease burdens quickly, CPHC is needed long-term to increase life expectancy. The recommendation is that Nepal should continue SPHC while gradually implementing more CPHC through improved coordination.
This document discusses the history and concepts of international health. It begins by outlining the field's origins in the early 20th century with international sanitation conferences and the 1907 establishment of the Office International d'Hygiene Publique. Key organizations discussed include the Pan American Sanitary Bureau (1902), the Health Organization of the League of Nations (1923), and the World Health Organization. The document also examines definitions and perspectives of international health, components that define its scope, and methods of collaboration between countries.
This document provides an overview of cohort studies. It defines a cohort study as observing a group of people who share a common characteristic or experience over time to study the frequency of disease. The key features discussed include: identifying cohorts prior to disease, observing cohorts prospectively to study cause-effect relationships, minimizing attrition, and comparing exposed and non-exposed groups. The document also covers types of cohort studies, elements of cohort studies like follow-up, and strengths such as establishing causation but also weaknesses like loss to follow-up.
AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner
Early Warning And Reporting System (EWARS) in NepalPublic Health
The Early Warning and Reporting System (EWARS) is a hospital-based sentinel surveillance system in Nepal that monitors six priority infectious diseases. EWARS was established in 1997 with 8 sentinel sites and has since expanded to 118 sites including central, provincial, and district hospitals. The main objectives of EWARS are to strengthen disease information flow and facilitate prompt outbreak response. Sentinel sites report disease data weekly or immediately to the Epidemiology and Disease Control Division, which analyzes trends, provides feedback, and coordinates rapid response teams if an outbreak is detected.
The document discusses Hill's criteria for causation, which are six principles established by epidemiologist Austin Bradford Hill in 1965 to help establish a causal relationship between a presumed cause and observed effect. The criteria are: 1) temporal relationship, 2) dose-response relationship, 3) consistency of association, 4) biological plausibility, 5) coherence of association, and 6) experimental evidence. Meeting these criteria helps strengthen the evidence that a causal relationship exists.
INTRO HIV SURVEILLANCE PROF DR SANJEV DAVE.pptxSanjeevDavey1
The document provides an overview of HIV Sentinel Surveillance (HSS) and outlines the roles and responsibilities of personnel involved. It defines HSS as a system that monitors HIV prevalence among specified populations through consistent methodology at designated sites over time. The key objectives are to monitor trends, distribution, and spread of HIV prevalence to identify pockets of the epidemic and measure prevention progress. Personnel roles include implementing HSS according to guidelines, coordinating activities, conducting trainings, monitoring sites, and linking reactive participants to care. HSS is conducted among populations like antenatal clinic attendees, high-risk groups, and prisoners to estimate HIV burden and guide programming.
Austin Journal of Nursing & Health Care is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts to practicing nurses, nurses in leadership roles, and other health care professionals with in the branch of health care sector focused on the care of individuals, families, and communities in order to attain, maintain, or recover optimal health and quality of life. This journal focus to work collaboratively with physicians, therapists, the patient, the patient's family and other related team members, on treating illness to improve quality of life.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Nursing & Health Care accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of nursing and care.
A Matter Of Professional Status The Impact Of Medical Hierarchies On Child M...Alicia Edwards
The study explored differences between physicians, nurses, nurse assistants, and hospital social workers in their work addressing child maltreatment at children's hospitals in Sweden.
The results showed that nurses and nurse assistants had less experience and training than physicians and social workers. Nurses and nurse assistants were also less familiar with reporting guidelines and organizational support. It was rare for nurses and nurse assistants to have reported child maltreatment cases, compared to physicians and social workers. The analysis found that differences between professional groups were influenced by medical hierarchies within hospitals. The study concluded that all staff would benefit from additional training to improve assessments and feel more supported in the reporting process. Strengthening multidisciplinary collaboration at clinical levels could also help protect children
Evolution of public health- Dr Subraham PanySubraham Pany
This document provides a summary of the history and evolution of public health and medicine across various civilizations and eras. It discusses early concepts of health and disease from ancient cultures like India, China, Egypt, Greece, and Mesopotamia. It then covers developments in Europe during the Middle Ages and Renaissance period, including the emergence of germ theory and advances during the Industrial Revolution that led to the fields of public health and preventive medicine. The document also introduces several important historical figures who contributed to the understanding and practice of medicine.
steps in epidemic investigation
Prepare for field work
Confirm the existence of an outbreak
Verify the diagnosis and determine the etiology of the disease.
Define the population at risk
Develop case definition, start case finding, and collect information on the cases(after choosing study design)
Describe person, place and time (by questionnaire)
Evaluation of ecological factors
Formulate several possible hypothesis hypotheses.
Test hypotheses using analytical study
Refine hypotheses and carry out additional studies
Draw conclusions to explain the causes or determinants of outbreak based on clinical, laboratory, epidemiological & environmental evidence
Report and recommend appropriate control measures to concerned authorities at the local/national, and if appropriate at international levels
Communication of the findings
Follow up of the recommendation to assure implementation of control measures
Swot analysis of safe motherhood program of Nepalsirjana Tiwari
The document provides an overview of Nepal's Safe Motherhood and Newborn Health Program, including its goals, strategies, activities and management. Some key points:
- The program aims to reduce maternal and neonatal morbidity and mortality through preventative activities and addressing factors that cause death during pregnancy, childbirth and postpartum.
- Major strategies include promoting birth preparedness, the Aama program to promote antenatal checkups and institutional delivery, and expanding emergency obstetric services.
- Key activities include distribution of birth preparedness packages, rural ultrasound programs, expansion of birthing centers and emergency obstetric care sites, and training of skilled birth attendants.
- The program is managed through planning
National health programs and policies for prevention and control of ncds in n...Pawan Dhami
This document summarizes several national health programs and policies in Nepal related to the prevention and control of non-communicable diseases (NCDs). It outlines policies such as the Integrated NCD Prevention and Control Policy, the Multi-Sectoral Action Plan for NCD Prevention and Control (2014-2020), and the National Policy and Plan for NCD Prevention and Control (2013-2017). It also discusses the Health Education, Information and Communication Program and policies within the Second Long Term Health Plan, Nepal Health Sector Strategy, and other documents. The document analyzes some of the systematic challenges facing NCD prevention in Nepal, such as limited funding for primary prevention and a lack of coordination between sectors.
Current Policy, Strategies and Program of Preventing, Protecting and Control ...Mohammad Aslam Shaiekh
The document summarizes the history and development of tuberculosis control policies and programs in Nepal over several decades. It begins with the establishment of the first sanatorium in 1937 and traces the establishment of additional clinics, hospitals, and tuberculosis control initiatives through partnerships with international organizations. It describes Nepal adopting the DOTS strategy in 1995 and details the current goals, strategies and components of Nepal's National Tuberculosis Control Program, including the adoption of the End TB Strategy.
This presentation is compiled from several sources and summarizes the health care system in Europe. Some of the information could be outdated and readers are encouraged to follow recent updates as well.
The Nepal health information system uses various forms and registers to collect health data from public and private providers. This data is integrated into the national Health Management Information System (HMIS) managed by the Department of Health Services. Currently, an integrated Health Information System using the District Health Information System (DHIS) collects major health data electronically. Facilities have access to enter data, while the Health Office receives monthly reports and can process, represent, and analyze the data.
The 10-step approach to outbreak investigations involves:
1) Identifying an investigation team and resources.
2) Establishing the existence of an outbreak.
3) Verifying the diagnosis, constructing a case definition, and finding cases systematically.
Descriptive epidemiology is then used to develop hypotheses, which are evaluated through additional studies if needed, before implementing control measures, communicating findings, and maintaining surveillance to confirm the outbreak has ended. Being systematic and following these steps is key to determining the source and controlling outbreaks.
Incidence and prevalence measures provide information about disease frequency and burden in populations. Prevalence describes the proportion of people with a disease at a point in time, while incidence refers to the number of new cases that develop over time. Both measures can be stratified by person, place, and time to gain insights into a disease's pathogenesis and development.
1) The document discusses several zoonotic diseases including West Nile virus, rabies, and brucellosis. It describes the pathogens, transmission cycles between animals and humans, clinical manifestations in humans, and national surveillance efforts.
2) For diseases like rabies and brucellosis, the national surveillance involves mandatory reporting of human cases, monitoring of infected animals, and collaboration between human and veterinary agencies.
3) One health approaches discussed include integrating epidemiological data between human and veterinary fields to more rapidly detect and respond to zoonotic outbreaks.
Dr. Salma Burton's presentation outlines the six key building blocks of an effective health system: 1) service delivery, 2) health workforce, 3) health information systems, 4) medical products/vaccines/technologies, 5) health financing, and 6) governance. Each building block plays an important role in ensuring people have access to safe, effective, and quality health services. Strong leadership and coordination across these areas through a systems thinking approach can help improve overall population health outcomes.
This document discusses rapid epidemiological assessment methods. It introduces various sampling techniques used for rapid health assessments including WHO EPI 30x7 cluster sampling, Lot Quality Assurance Sampling (LQAS), and case-control methodology. It describes how to conduct LQAS surveys including identifying target populations, setting assessment criteria, calculating sample sizes, counting lots, setting thresholds, and selecting decision values. The document compares different rapid assessment methods and explains which technique would be most appropriate based on factors like whether inferences need to be made about individual populations, population heterogeneity, ability to obtain a full population list, and desired precision levels.
Selective Vs Comprehensive Primary Health Care in NepalManik Rajbhandari
The document discusses selective primary health care (SPHC) versus comprehensive primary health care (CPHC). SPHC focuses on specific interventions like immunizations, while CPHC aims to improve overall population health through multisectoral coordination. Nepal has achieved success with SPHC but still struggles with CPHC indicators. While SPHC can reduce disease burdens quickly, CPHC is needed long-term to increase life expectancy. The recommendation is that Nepal should continue SPHC while gradually implementing more CPHC through improved coordination.
This document discusses the history and concepts of international health. It begins by outlining the field's origins in the early 20th century with international sanitation conferences and the 1907 establishment of the Office International d'Hygiene Publique. Key organizations discussed include the Pan American Sanitary Bureau (1902), the Health Organization of the League of Nations (1923), and the World Health Organization. The document also examines definitions and perspectives of international health, components that define its scope, and methods of collaboration between countries.
This document provides an overview of cohort studies. It defines a cohort study as observing a group of people who share a common characteristic or experience over time to study the frequency of disease. The key features discussed include: identifying cohorts prior to disease, observing cohorts prospectively to study cause-effect relationships, minimizing attrition, and comparing exposed and non-exposed groups. The document also covers types of cohort studies, elements of cohort studies like follow-up, and strengths such as establishing causation but also weaknesses like loss to follow-up.
AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner
Early Warning And Reporting System (EWARS) in NepalPublic Health
The Early Warning and Reporting System (EWARS) is a hospital-based sentinel surveillance system in Nepal that monitors six priority infectious diseases. EWARS was established in 1997 with 8 sentinel sites and has since expanded to 118 sites including central, provincial, and district hospitals. The main objectives of EWARS are to strengthen disease information flow and facilitate prompt outbreak response. Sentinel sites report disease data weekly or immediately to the Epidemiology and Disease Control Division, which analyzes trends, provides feedback, and coordinates rapid response teams if an outbreak is detected.
The document discusses Hill's criteria for causation, which are six principles established by epidemiologist Austin Bradford Hill in 1965 to help establish a causal relationship between a presumed cause and observed effect. The criteria are: 1) temporal relationship, 2) dose-response relationship, 3) consistency of association, 4) biological plausibility, 5) coherence of association, and 6) experimental evidence. Meeting these criteria helps strengthen the evidence that a causal relationship exists.
INTRO HIV SURVEILLANCE PROF DR SANJEV DAVE.pptxSanjeevDavey1
The document provides an overview of HIV Sentinel Surveillance (HSS) and outlines the roles and responsibilities of personnel involved. It defines HSS as a system that monitors HIV prevalence among specified populations through consistent methodology at designated sites over time. The key objectives are to monitor trends, distribution, and spread of HIV prevalence to identify pockets of the epidemic and measure prevention progress. Personnel roles include implementing HSS according to guidelines, coordinating activities, conducting trainings, monitoring sites, and linking reactive participants to care. HSS is conducted among populations like antenatal clinic attendees, high-risk groups, and prisoners to estimate HIV burden and guide programming.
Austin Journal of Nursing & Health Care is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts to practicing nurses, nurses in leadership roles, and other health care professionals with in the branch of health care sector focused on the care of individuals, families, and communities in order to attain, maintain, or recover optimal health and quality of life. This journal focus to work collaboratively with physicians, therapists, the patient, the patient's family and other related team members, on treating illness to improve quality of life.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Nursing & Health Care accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of nursing and care.
A Matter Of Professional Status The Impact Of Medical Hierarchies On Child M...Alicia Edwards
The study explored differences between physicians, nurses, nurse assistants, and hospital social workers in their work addressing child maltreatment at children's hospitals in Sweden.
The results showed that nurses and nurse assistants had less experience and training than physicians and social workers. Nurses and nurse assistants were also less familiar with reporting guidelines and organizational support. It was rare for nurses and nurse assistants to have reported child maltreatment cases, compared to physicians and social workers. The analysis found that differences between professional groups were influenced by medical hierarchies within hospitals. The study concluded that all staff would benefit from additional training to improve assessments and feel more supported in the reporting process. Strengthening multidisciplinary collaboration at clinical levels could also help protect children
This study examined the mental health of 341 caregivers of 134 perinatally HIV-exposed adolescents ages 9-16 in New York City. Biological parents had significantly higher depression and anxiety scores than relative or adoptive caregivers. Higher depression scores were associated with being HIV+, Latino, higher stress, and more health problems. Higher anxiety scores were also associated with being HIV+, Latino, lower education, poorer communication with the child, and health problems. The researchers concluded that caregivers of HIV-infected or affected children experience higher than average mental health issues and recommend family-centered intervention programs to support all caregivers.
AIDS And Stigma A Conceptual Framework And Research Agenda Final Report From...Brittany Brown
This document provides a conceptual framework for understanding AIDS-related stigma and proposes a research agenda on the topic. It discusses AIDS stigma at both the cultural and individual levels. At the cultural level, stigma is manifested through discriminatory laws/policies and negative portrayals. At the individual level, people with HIV experience primary stigma while their friends/family experience secondary stigma. Stigma stems from both a fear of HIV (instrumental stigma) and negative attitudes towards associated groups (symbolic stigma). Stigma interferes with HIV prevention and takes a psychological toll on those infected. More research is needed to inform policies that reduce stigma and its negative impacts.
This document is a cover page and abstract for a culminating experience paper by Lindsey Garrison at Boston University School of Public Health. The paper analyzes adherence to antiretroviral therapy (ART) among adolescents in South Africa. It examines determinants of poor adherence, reviews best practices to improve adherence, and analyzes the ST-AMP program from the US. The paper identifies gaps in research and makes recommendations to improve data collection and gender-stratified statistics on HIV among adolescents in South Africa.
This document summarizes a study on systems-level barriers that contribute to secondary conditions in individuals with fetal alcohol spectrum disorders (FASD). The study involved interviews and focus groups with parents of children with FASD and service providers.
The key findings were:
1) A pervasive lack of knowledge about FASD exists throughout multiple systems, including healthcare, education, and social services. This lack of knowledge contributes to barriers across different systems.
2) Systems-level barriers that interfere with preventing secondary conditions include delayed diagnosis of FASD, difficulty qualifying for and accessing services, poor implementation of services, and challenges maintaining services long-term.
3) Broad system changes are needed using a public
This document discusses disease surveillance research. It explains that disease surveillance involves the ongoing collection, analysis, interpretation, and dissemination of health data to monitor disease trends and improve public health. A reductionist approach looks at isolating variables to find cause-and-effect relationships, while a complex systems approach considers adaptive and multilevel systems in context. The document also discusses the roles and competencies needed for nurses to participate in surveillance and investigation activities.
This study assessed the knowledge and attitudes regarding care of patients with HIV/AIDS among 207 nurses working at BPKIHS, Nepal. The study found that the majority (92.3%) of nurses had moderately adequate knowledge of HIV/AIDS patient care. Over half (50.7%) of nurses reported having a favorable attitude toward caring for HIV/AIDS patients. No significant associations were found between knowledge, attitude, and socio-demographic or training variables. Knowledge was found to have a significant positive correlation with attitude. The study concluded that nurses generally have adequate knowledge and favorable attitudes, but continuous education is still needed to ensure non-stigmatizing, high-quality care of HIV/AIDS patients.
The Effectiveness of HIV/Aids Education in Promoting Interventions for A Supp...QUESTJOURNAL
ABSTRACT: HIV/AIDS education is supposed to not only be a medium of creating awareness but also most importantly promote practices and skills to enable HIV prevention among youth in schools. This article reports on a study whose purpose was to assess the effectiveness of HIV/AIDS education in promoting interventions for a supportive environment in secondary schools. Specifically, the study sought to find out the extent to which interventions for a supportive environment for HIV/AIDS prevention were emphasized to youth; and explore the factors that influenced the promotion of the interventions. The study focused on youth involvement, parental involvement and HIV/AIDS prevention friendly school policies. The findings of the study established that the potential of the youth in enabling HIV/AIDS prevention among their fellow peers was not fully exploited. Parental involvement was low especially among the fathers. Parents rarely engaged in discussions on topics that dealt with sexuality. HIV/AIDS prevention friendly policies were ineffectively promoted in schools. Factors that influenced the promotion of the interventions were explored.
Peer Navigation Program for people newly diagnosed with HIVCBRC
This document describes new services for people newly diagnosed with HIV (ND/HIV) including a workshop series and peer navigators program. The goals are to educate ND/HIV individuals about treatment, prevent disease progression and transmission, and engage people when they are highly infectious. The workshop series provides education and empowerment to ND/HIV individuals, while peer navigators meet one-on-one to assess needs and guide individuals in gaining self-care knowledge and skills. Lessons learned found the lag time before workshops was too long and workshops outside cities had logistical challenges, while peer navigators needed to build trust quickly and provide support tailored to individual needs.
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
The defence of teaching philosophy as the noble discipline to the teachersAkashSharma618775
As students of philosophy there has always been a wonder about what the work of philosophers is and
what do they teach their students. The wonder of this nature becomes manifest when one has to become one of the
philosophers himself. Having heard it as a saying that “to err is human”, it then becomes inevitable to wonder
humans are really what they perceive themselves as or something else. One of the crucial things to note is that if
humans get deceived in the perception of themselves then all what they engage in will not be authentically of
service to humanity. This speaks to the issue of the way in which human interactions are guided by their will or, if
true, something in a form of a supernatural being outside themselves. Exploring such mindboggling issues around
human existence might guide a philosopher of education to understand what really makes a person be, and at what
point do philosophical teachings make guided students. In most cases students want to receive fair and just
education. But without teachings of critical thinking that philosophers of education emphasize, teachers will
always delve into matters of morality and forget the thought aspect that forms the basis of teaching itself. Although
morality in any form of education is paramount, but it is most important to at least know the fundamental
underpinnings of that morality. When teachers do not study philosophy their understanding of the applied
curriculum remains shallow and proper application of it might be hindered. Without saying that morality
education and curriculum knowledge is non-profiting, the argument here is that it is always most beneficial to
know the foundations of those things from their philosophical beginnings. It is in that backdrop that usage of
analytic theoretical framework will be employed in this paper to explore errors and other accurate uncertainties
that make life and its experiences almost certain
Madridge Journal of AIDS (ISSN: 2638-1958); As a result of the increased availability of antiretroviral treatment, children infected with HIV can expect to live to adulthood and even to have long, productive lives.
The document provides a report on the "Ladder to Safety" project implemented from January to November 2015 in Zimbabwe. The project aimed to address the gap in support for HIV positive children transitioning from infant ART treatment to adolescence. It created support groups and education programs to help children and their caregivers understand HIV/AIDS, disclose statuses appropriately, and adhere to lifelong ART treatment. Knowledge gained showed few children/adolescents knew their own or others' statuses due to stigma. The project trained stakeholders on disclosure strategies to empower children and build a supportive community.
This document summarizes research on the meaning of "family" for adolescents living with HIV in Swaziland. It is based on interviews with 13 adolescents between the ages of 12-19 living with HIV. The research found that the meaning of family is fluid and dynamic, referring to nuclear families, the Swazi nation, and HIV support groups. While policies emphasize the role of families in HIV care, the realities of adolescents' lives are more complex. The study explores how adolescents understand the concept of family in the context of their daily experiences with HIV.
Three key barriers to the diagnosis and treatment of depression in Jordan were identified from focus groups with primary health care providers:
1) Lack of education about depression among providers which hinders proper identification, diagnosis, and treatment.
2) Limited availability of appropriate therapies like counseling services and antidepressant medications at primary care clinics.
3) Social stigma surrounding mental illness that prevents patients from accepting depression diagnoses due to beliefs that it reflects poorly on themselves or their families.
Addressing these barriers through provider education, expanding mental health services, and destigmatizing depression could improve rates of recognizing and treating depression in Jordan's primary care system according to the researchers.
Parents perceptions of autism and theirhealth-seeking behavemelyvalg9
Parents' perceptions of autism and their
health-seeking behaviors
Maria Isabel O. Quilendrino a,*, Mary Anne R. Castor a,
Nenacia Ranali Nirena P. Mendoza b, Jacqueline R. Vea c,
Nina T. Castillo-Carandang c
a Department of Clinical Epidemiology and Department of Pediatrics, College of Medicine, University of the Philippines,
Manila, Philippines
b Department of Clinical Epidemiology and Department of Family and Community Medicine, College of Medicine,
University of the Philippines, Manila, Philippines
c Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 3 ( 2 0 1 5 ) s 1 0 – s 1 5
a r t i c l e i n f o
Article history:
Received 15 September 2015
Accepted 13 November 2015
Available online 7 December 2015
Keywords:
Autism
Autistic disorder
Behavior
Perception
a b s t r a c t
Background: Parents' health-seeking behaviors, which in turn may be related to their per-
ceptions, are hypothesized to be the major determinant of the timing of diagnosis and
subsequent intervention for children with autism.
Objective: The primary objective of this study was to describe parental perceptions of autism
and health-seeking behaviors for urban Filipino children aged 2–6 years.
Methods: This was a cross-sectional study conducted in several phases. The first phase
involved collection of qualitative data from key informant interviews and small group
discussions. The second phase involved the development of a validated and reliable ques-
tionnaire, which was administered to 41 parents of children with autism, aged 2–6 years.
Results: Parents had varying perceptions of autism. They were generally undecided with
regard to the etiology of autism, but were in agreement that psychosocial factors, such as
parental sins and curses, were unlikely to be associated with autism. The most common
presenting symptom noted by parents was a qualitative impairment in social interaction.
There was a noted trend towards earlier age of symptom recognition (mean of 24 months)
and diagnosis of autism (mean of 39 months) among parents with younger children.
Conclusion: The results of this study showed some trends: There is improved awareness
regarding autism and the needs of children with autism. Parents tend to disagree with
previous myths about autism. There was an observable trend toward earlier diagnosis for
this group.
# 2015 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All
rights reserved.
* Corresponding author. Tel.: +63 9178033888; fax: +63 27311631.
E-mail address: [email protected] (M.I.O. Quilendrino).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/cegh
http://dx.doi.org/10.1016/j.cegh.2015.11.003
2213-3984/# 2015 INDIACLEN. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
http://crossmar ...
The new public health and std hiv preventionSpringer
This document discusses social determinants of sexually transmitted infections. It explores how social factors like education, occupation, neighborhoods, and media can influence sexual behaviors and networks, thereby affecting STI spread. Key determinants of STI transmission include likelihood of transmission during sex, number of sexual partners, and partnership patterns. Factors like consistent condom use, access to healthcare, sex education, sexual network patterns, and timing of partnerships all influence STI rates at a population level.
The Risk Lies in Not Knowing HIV AIDS Awareness and Acceptance towards PLWHAijtsrd
This document summarizes a study that assessed HIV/AIDS awareness and acceptance of people living with HIV/AIDS (PLWHA) among senior high school students in Toledo City, Cebu, Philippines. The study found that respondents had a high level of HIV/AIDS awareness and acceptance of PLWHA. It also found statistically significant correlations between gender and levels of awareness/acceptance, as well as a strong correlation between overall awareness and acceptance levels. The study concluded higher awareness is linked to greater acceptance of PLWHA.
Similar to Proposal hiv aids family burden old (20)
This document discusses the need for a paradigm shift in nursing research. It notes that while efforts have been made to promote evidence-based nursing, there remains a gap between research findings and clinical practice. The document outlines different research paradigms and factors that can drive paradigm shifts, such as technological advances. It argues that paradigm shifts are important for developing up-to-date knowledge and meeting human and social needs. Some examples of potential paradigm shifts in clinical nursing after COVID-19 include increased telehealth, home-based care, and focus on infection prevention and digital health technologies.
This document provides an overview of an autobiographical book written by Dr. Rordzor Dhital describing his life journey from childhood to the present. The book details his upbringing, family background, educational experiences, career struggles and successes as a medical professional. It is intended to inspire youth by sharing his challenges and perseverance in achieving his goals through hard work and dedication.
This dissertation examines home-based care for people living with AIDS in rural Nepal. The study had two parts: 1) Analyzing aspects of home-based care through interviews with 125 caregivers of people with AIDS, case studies of 14 people with AIDS, and focus groups/key informant interviews. 2) Implementing an 8-week education intervention program on home-based care and evaluating its impact using pre- and post-testing. The study found many caregivers lacked training and knowledge. Caregiving was burdensome and affected caregivers' health, social life, and finances. The education program significantly improved caregivers' knowledge and outcomes related to caregiving.
The document discusses the benefits of exercise for both physical and mental health. Regular exercise can improve cardiovascular health, reduce stress and anxiety, boost mood, and enhance cognitive function. Staying physically active for at least 30 minutes each day is recommended for significant health benefits.
This dissertation examines home-based care for people living with AIDS in rural Nepal. The study had two parts: 1) Analyzing aspects of home-based care for 125 caregivers of people with AIDS through interviews, case studies, and focus groups. 2) Implementing an 8-week education intervention program on home-based care and evaluating its impact using pre- and post-testing. The study found many caregivers lacked training and knowledge about HIV/AIDS. Caregivers reported high burdens and many faced health issues, social problems, and financial difficulties due to caregiving. The education program significantly improved caregivers' knowledge and preparedness for home-based care.
This document provides an overview of pancreatitis including:
- Defining pancreatitis and describing the types as acute or chronic.
- Stating the common causes as biliary disease, alcohol, ERCP, trauma, and drugs.
- Explaining the pathophysiology as premature activation of digestive enzymes in the pancreas causing autodigestion.
- Identifying clinical manifestations such as abdominal pain, nausea, fever, and diagnostic tests including blood tests and imaging.
- Describing the management of fluid resuscitation, pain control, nutritional support, and antibiotics as well as surgical interventions for complications.
This document provides an overview of 12-lead EKG interpretation. It describes the normal P wave, QRS complex, ST segment, T wave, and QT interval. It discusses abnormalities such as bundle branch blocks and signs of myocardial infarction including ST elevation, T wave inversion, and Q waves. Lead placement and determining the cardiac axis are also covered. The document outlines coronary anatomy and describes common infarction locations such as inferior, anterior, and lateral walls.
This document discusses patients' rights and advocacy in nursing. It outlines various patients' bills of rights which guarantee patients access to information, treatment, and medical decision making. Specific rights mentioned include the right to privacy, informed consent, and making complaints. The role of nurses as advocates who help patients understand and exercise their rights is described. Nurses act as advocates by developing relationships with patients and making decisions with them. They may also be whistleblowers by calling attention to unethical or illegal actions. The document is authored by Prof. Dr. Ram Sharan Mehta on the topics of patient rights and advocacy in nursing.
This document discusses various legal aspects related to nursing practice, including medico-legal issues, terminology, common medico-legal cases, torts, and legal safeguards for nurses. It provides definitions for terms like bill, law, constitution, negligence, and malpractice. It also outlines legal provisions in Nepal, common medico-legal cases seen in hospitals, intentional and unintentional torts, the functions of law in nursing, potential legal issues nurses may face, and the legal processes followed for medico-legal cases in hospitals.
This document discusses ethics and values in nursing. It defines ethics as concerning right and wrong based on knowledge rather than just principles. It also defines morals as private standards of right and wrong, while ethics reflect commitments beyond personal preferences. The document outlines ethical principles like autonomy, non-maleficence, beneficence, and justice. It discusses how a code of ethics provides guidance for decision making and lists primary nursing values. Finally, it provides steps for processing an ethical dilemma in nursing practice.
The document outlines the International Council of Nurses (ICN) Code of Ethics, which provides ethical guidance for nurses. It discusses four main sections - Nurses and Patients/People Requiring Care, Nurses and Practice, Nurses and the Profession, and Nurses and Global Health. Each section contains a number of points that define ethical nursing responsibilities in those areas. For example, section one emphasizes person-centered care and maintaining patient dignity, while section two stresses nurse accountability and maintaining competence through continuous learning. The full code aims to establish standards and accountability for ethical nursing practice globally.
This document appears to be a presentation by Prof. Dr. RS Mehta about his 23 year history working in ERH & BPKIHS from 2048-2071. It includes some pictures from his time there and lists him as a participant and resource person for a Research Methodology Training from March 3-7, 2013. It also mentions an HBC session and thanks Robert from CGH Singapore for an example of innovations and development.
The document discusses Singapore and Chengi General Hospital (CGH). It provides details about Singapore, noting its cleanliness, security, and transportation services. It then summarizes information about CGH, an 800-bed government-funded hospital in Singapore. Key details about CGH include its facilities, staff of 2000 including 1200 nurses, nurse to patient ratio of 1:6, and services like home care teams and celebration of special days for patients. The document also compares CGH to BPKIHS hospital in some aspects like bed numbers and duration of establishment, but notes CGH provides better quality and services.
This document summarizes international visits by Prof. Dr. Ram Sharan Mehta between 2000 and 2022. It lists visits to various cities in India as well as other countries in Asia, Europe, North America, and Australia. The visits involved presentations on healthcare topics. The document concludes by thanking the audience.
This document provides an overview of an autobiographical book written by Dr. Rajendra Dhakal titled "From Birth to Retirement". The book describes key events and experiences from the author's life, from childhood through his professional career as a medical doctor. It covers his upbringing in rural Nepal, education journey, career experiences including hardships faced, professional achievements, and reflections on life lessons learned. The author hopes the book will inspire youth to work hard through perseverance despite challenges.
This document discusses patients' rights in healthcare. It begins by defining a patient's bill of rights as a list of guarantees for those receiving medical care, including the right to information, fair treatment, and autonomy over decisions. The document then outlines specific rights in more detail, such as the right to receive respectful and safe care, provide informed consent, privacy and confidentiality, refuse treatment, and make complaints. It discusses patients' rights during medication and treatment. Overall, the document aims to clearly define the rights and protections that should be afforded to all patients.
This document discusses various legal aspects related to nursing practice, including medico-legal issues and cases. It defines key terminology like tort, negligence, malpractice. Common medico-legal cases involve deliberate self-harm, accidents, and criminal cases. Nurses must properly document and handle medico-legal cases, obtain informed consent, and understand their legal duties and liabilities to practice safely and avoid litigation. Maintaining standards of care, competence, and keeping accurate records are important legal safeguards for nurses.
The document outlines the International Council of Nurses' (ICN) Code of Ethics for nurses. It discusses four main sections of the code: 1) Nurses and patients or other people requiring care or services, 2) Nurses and practice, 3) Nurses and the profession, and 4) Nurses and global health. For each section, it lists the guiding principles that nurses should uphold in their relationships with patients, in their nursing practice and professional responsibilities, and in promoting global health as a human right. The code aims to define ethical nursing practice and decision-making to meet high professional standards.
1. The document discusses ethics and values in nursing, defining key terms like ethics, morals, and values. It outlines ethical principles like autonomy, non-maleficence, and beneficence.
2. Six standards of nursing practice are discussed, including accountability, continuing competence, and professional relationships. Methods of ethical decision making and processing ethical dilemmas are also presented.
3. Primary values for ethical nursing practice are outlined, including providing safe care, maintaining privacy, and promoting justice. The relationship between ethics, values, and the nursing code of ethics is explored.
More from BP KOIRALA INSTITUTE OF HELATH SCIENCS,, NEPAL (20)
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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• Building trust with communities online and offline
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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1. Title of the research project:
Family Burden of the People Living with AIDS
Getting Treatment in BPKIHS
Details of the research project
1. Title of the research project
Family Burden of the People Living with AIDS Getting Treatment in BPKIHS
2. Objectives.
General Objectives:
To find out the family burden of the people living with AIDS getting treatment in BKIHS
Specific Objectives:
1. To find out the demographic profile of the people living with AIDS (PLWA) and
their family members.
2. To explore the principal care providers problems of the people living with AIDS.
3. To find out the association between demographic variables and family burden.
4. To suggest the ways and means to develop and Implement the strategies for better
patient care.
Null Hypothesis:
There will be no association between family burden and caregiver characteristics and
social stigma.
3. Summary of the research project.
The Family: The concept of family need not be limited to ties of blood, marriage, sexual
partnership or adaptation. Any group whose bonds are based on trust, mutual support and
a common density may be regarded as a family. All families, traditional or nontraditional, can help stop AIDS spreading by making sure that their members understand
and action the facts about HIV and safer behavior and if on of their members does fall ill
with AIDS, families are often the best sources of compassionate care and support.
It will be exploratory research study design, conducted among the caregivers’ family
members of AISDS clients getting treatment at BPKIHS, selecting 30 subjects using
continent sampling technique. The data will be collected using interview schedule and
2. focus group discussion along with he use of Family Burden Assessment Scale and the
collected data will be analysed using SPSS-10.5 and STATA software package,
conclusion will be drawn.
4. Review of the literature pertaining to the project.
Burden is one of the most commonly used variables in care giving research both as a
predictor and as an outcome. However, much published research has identified the
determinants in the effort to predict or explain caregiver burden. Several definitions of
caregiver burden have been defined in the literature. Zarit and colleagues 1 defined
caregiver burden, an outcome measure, as 'the extent to which caregivers perceive their
emotional or physical, social life, and financial status as suffering as a result of caring for
their relative'.
Caregiver burden might be defined as a predictor such as 'an external demand or potential
threat that has been appraised as stressor'. Furthermore, caregiver burden might be
defined as 'the consequences of the activities involved with providing necessary direct
care to an ill relative or friend that result in observable and perceived costs to the
caregiver2.
Caregiver burden is a multidimensional phenomenon reflecting the physical,
psychoemotional, social and financial consequences of caring for an impaired family
member. Based on Donabedian3, who originally proposed the structure, process, outcome
framework for the purpose of quality assessment, and the Outcome Model for Health
Care Research that extended the work of Donabedian, burden of care of PLWHA can be
linked to an outcome of care. Structure, which equals 'input' of care, related to nonclinical influences on outcomes is composed of two categories: (i) characteristics of the
caregiver; and (ii) characteristics of the patient. The latter are being the stronger predictor
of caregiver outcomes. The process of care is patient self-care and self-care burden. The
outcome of care is caregiver burden and quality of life of caregivers. Caregiver
characteristics that might influence caregiver outcomes include age, gender,
socioeconomic status, duration of caregiving and family relationship between the patient
and the caregiver.
Many researchers have reported that caregiver characteristics have inconsistent effects on
caregiver burden. Some studies have found that younger caregivers experience greater
burden than older caregivers4 In contrast, Reinhard did not find any associations between
caregivers' age and overall burden.5
The evidence from cross-sectional studies indicates that female caregivers are more likely
to experience burden than are male caregivers.4 However, researchers also reported that
the caregivers' gender was not associated with burden.5 Family income was not associated
with objective burden,6 subjective burdens or overall burden.8 Moreover, in the study that
investigated caregiver–patient relationships, the findings have shown that spousal
caregivers experienced greater personal burden than adult daughter or son caregivers. 7
The length of time in the caregiving role has yielded various findings as to caregiver
burden. The caregivers' ability to tolerate problem behaviours increased with time as
disease progressed in caregivers of dementia patient. 1 Conversely, Gaynor14 found
2
3. feelings of perceived burden to be higher among women who had been involved in
caregiving for an extended time.
Patient characteristics that have been cited in the literature as having an influence on
caregiver outcome include patient's age, ADL, activity of instrumental tasks and stigma.
Few studies within the caregiving literature have evaluated patient's age and caregiver
burden. No studies were found in the relation of patient characteristics and burden of
HIV/AIDS caregivers in Nepal.
The effects of societal stigmatization, as well as the degree of caregiving demands, might
become overwhelming for the caregivers.9 Stigma attached to HIV/AIDS and the
association of HIV infection with sexual practices, with injection drug use and with death
have placed the disease in societal taboos. In Nepali culture, the perception of AIDS as a
frightful contagious disease, resulting from immoral behaviour, leads to the view that
HIV/AIDS patients are 'bad people'. The family caregivers felt that they are shunned by
people around them, including their family members, relatives, friends and health-care
providers, as well as society. Caregivers of HIV/AIDS patients share some of the burdens
related to a stigmatized person. Mushonga10 found that stigma was associated with
perceived burden in HIV/AIDS caregivers in Zimbabwe.
Caregiving is a demanding responsibility. Research in caregiving seems to be an
accumulation of diverse points of views. Over the past decade, many studies have
emphasized the negative consequences of caregiving, generally referred to as caregiver
burden,17 caregiver stress and caregiver strain. Some studies used positive terms such as
caregiver esteem, caregiver satisfaction and uplifts of caregiving. Other research used
neutral terms including health, mental-health outcomes, caregiver appraisal, caregiver
well being and quality of life.11
The current situation of HIV in Nepal is different from when the first case was diagnosed
in 1988. There are gaps and challenges to be addressed in the fight against HIV and
AIDS. Nepal is low prevalence country for HIV and AIDS (0.5 percent). However, some
of the groups show evidence of a concentrated HIV epidemic e.g. sex workers 19.5
percent, migrant population 4-10 percent, and intravenous drug users (IVDU's), both in
rural and urban areas, 68 percent. Since 1988 when the first case was diagnosed
MoHP/DoHS and different stakeholders came forward to address HIV and AIDS issues.
The main focus was given to preventive aspects. In 1995 MoHP in consultation with
different stakeholders developed a policy for the control of HIV and AIDS. However, the
activities were implemented in a sporadic and disorganized manner.
In Nepal, knowledge about family caregiving of PLWHA is sparse and research in family
caregiving is in the infant stages. Prior studies in Nepal indicate that the most common
place for adult AIDS persons to spend the advanced stage of their illness is in their
parents' homes and the most common caregiver is a parent—particularly a mother—
providing care for almost two-thirds of the Nepali adults who died of AIDS. For married
PLWHA, the spouses, especially wives, often play a major role. As more complex care is
offered at home, mothers and wives will continue to be the main caregivers of PLWAs.12
3
4. Similarly, in other countries, such as Uganda and Zimbabwe, researchers found the same
phenomena of parents as the primary caregivers of PLWHA. PLWHA who are single (or
non-partnered) often have no one on whom they can depend for care and support other
than their parents, siblings or other relatives. Hence, many PLWHA who live away from
their place of origin are likely to return to their family home when they can no longer
earn a living or when they need extensive care because the symptoms worsen.2
The new strategy spotlights the following main areas: Vulnerable groups, Young people,
Treatment, care and support, Epidemiology, research and surveillance and Management
and implementation of an expanded response
Broad political commitment, a multi-sectoral approach, civil society involvement, publicprivate partnership, reduction of stigma and discrimination against people infected and
affected by HIV/AIDS and human rights based approach have been outlined as some of
the guiding principles in the development of the strategy. HIV infection has taken root in
South Asia and poses a threat to development and poverty alleviation efforts in the
region. HIV infection is fueled by risk behaviour, extensive commercial sex, low condom
use and access, injecting drug use, population movements (cross-border/rural-urban
migration), and trafficking13. Social and economic vulnerabilities, including poverty and
illiteracy, highlight the need to act effectively and aggressively to reduce its spread.
South Asia has about 4.2 million of the world’s 36 million people living with HIV/AIDS.
While overall prevalence rates remain relatively low, the region’s large populations mean
that a rise of a mere 0.1percent in the prevalence rate in India, for example, would
increase the national total of adults living with HIV by about half a million persons14.
HIV/AIDS is emerging as a major threat in the socio-economic and health sectors of
Nepal. Their multiple effects have so far been minimal in the country, but their potential
impact is immense. The first AIDS case in Nepal was detected in 1988. Since then the
number of HIV/AIDS cases has been increasing gradually. In Nepal HIV transmission is
mainly heterosexual. Some of the surveys reveal that there is concentrated epidemic
among Injecting Drug Users and Commercial Sex Workers14.
In world More than 40 million people are living with HIV/AIDS, 2.3 million are under 15
yrs , 14,000 new infections each day , 1.7 million human infected with HIV/AIDS 3.1
million deaths from AIDS , Million new HIV cares – 13425/day. In Nepal the estimated
number of PLWHA at end 2005 is 61,000, HIV prevalence in 2005 is 0.5, estimated
number of AIDS cares are 7,800, number of child orphaned by HIV/AIDS is (0-18) is
18000, receiving ART till December 2005 is 210. In south East Asia 6.3 million PLWHA
in 2005 (Source: WHO, UNAIDS).
In Nepal there are 6990 HIV the including AIDS, 1085 leaving with AIDS, New
infection 30/day and 336 death (Source: NCASC June 2006 National statistics)
Cumulative HIV/AIDS situation by category as of Jan, 2005 : Clients of SW/STD –
53.7% , House wives – 12.7% , IDUs – 19.2% , Sex worker (SW) – 12.1% , Perinatal
Transmission – 2.1% and Blood & blood products – 0.2% .
4
5. Stigma is a powerful tool of social control. Stigma can be used to marginalize, exclude
and exercise power over individuals who show certain characteristics. While the societal
rejection of certain social groups (e.g. 'homosexuals, injecting drug users, sex workers')
may predate HIV/AIDS, the disease has, in many cases, reinforced this stigma. By
blaming certain individuals or groups, society can excuse itself from the responsibility of
caring for and looking after such populations. This is seen not only in the manner in
which 'outsider' groups are often blamed for bringing HIV into a country, but also in how
such groups are denied access to the services and treatment they need.
In the majority of developing countries, families are the primary caregivers to sick
members. There is clear evidence of the importance of the role that the family plays in
providing support and care for people living with HIV/AIDS. However, not all-family
response is positive. Infected members of the family can find themselves stigmatized and
discriminated against within the home. There is also mounting evidence that women and
non-heterosexual family members are more likely to be badly treated than children and
men.
The substantial increase in the number of persons living with HIV/AIDS (PLWHA) in
Nepal has important implications for providing care. Because AIDS is a fatal illness,
supportive care continues to be a crucial issue, influencing the government's attempt to
develop appropriate policies to address the care needs of patients with HIV/AIDS. With a
high number of PLWHA, the demands of family caregivers who take responsibility for
the care of these patients at home are escalating. The care of these patients can place a
significant burden on family caregivers. Thus, the degree of burden experienced by
family caregivers is an important concern. The concept of outcome emphasizes the
patient's well being. However, there is a growing body of research related to the
outcomes of family caregiving. Caregiver burden is one of the patient-related outcomes,
which is the most common outcome measure in caregiver research.
The study concerning caregiver burden as an outcome is important to nurses who work
with families in communities. The knowledge of caregiver burden can help nurses
develop specific intervention strategies for family caregivers in order to prevent the
negative burden and enhance quality of life 6. The purpose of this study is to examine the
outcome of family burden among of people living with AIDS getting treatment in BKIHS
5. Rational of the study.
The demands and outcomes on the family caregivers of HIV/AIDS patients are enormous
and need to be addressed in terms of public health policy, health economics and patientcare perspectives. The second perspective highlights health-care economic problems. The
care for HIV/AIDS patients is provided through general and infectious disease hospitals
in Nepal. Finally, the increasing demand of family caregivers involves the patient care.
The studies have shown that HIV/AIDS patients would rather stay with their families at
home than in a hospital15. The necessary emphasis on family caregiving is even more
significant because the family member is given the responsibility of the care of people
living with HIV/AIDS.
5
6. There has been a growing interest over the past 20 years in exploring the caregiving
experience. Over the course of the AIDS epidemic, family caregivers have provided an
essential source of care to PLWHA. The assessment of burden has become a challenging
task for most researchers. The literature suggests that the characteristics of the caregiver,
the characteristics of the patient, stigma and the nature of the caregiving relationship are
the determinants of caregiver burden6. Nurses are in an excellent position to minimize the
burden of care experienced by family members. This information can help nurses'
knowledge so that they can plan innovative, promotional and proactive care strategies to
treat the burden of caregivers. Measure of caregiver burden is one of the components of
the significant quality of care outcome.
Care giver’s took responsibilities for PLWHA including providing physical care,
assisting with activities of daily living (ADLs), cooking, giving medicine, physical
exercise, wound care, providing basic care for general symptoms such as fever, headache,
oral thrush, cough, diarrhea, skin infection and giving emotional support. The families
experienced enormous burdens related to financial limitations, inadequate resources, and
insufficient support4.
AIDS stigma had a profound and negative impact on the lives of informal carvers.
Caregivers were compelled to give care under cover. Most of the caregivers wanted to
keep their experiences secret and not disclose anything to any body. The demands of
caregiving led many caregivers to with draw from friends, family and work place. This
resulted in isolation and loss of productive ventures16.
This study will assess problems of caregiver family members of PLWHA, educational
packages can be prepared for caregivers, national policy can be developed to decrease
caregiver burden and aid in providing quality care to AIDS patients, along with AIDS
patient’s various training programme can be arranged for their caregivers, caregiver’s
training can play a vital role in minimizing social stigma; adhere to ARV therapeutic
regimen, and minimizing symptoms. The findings of the study help in quality patient care
by training the caregivers using education package and IEC materials and changing the
government policy.
6. Research design and methodology.
A. Research design: This study will be exploratory research design.
B. Research Setting/Sample Area: The study will be conducted among the family
members of AIDS cases getting treatment in BPKIHS.
C. Target population: The family members of people living with AIDS will
constitute the population of the study.
D. Sample and sample size:
Sample: Family members of people living with AIDS. Who fulfill the set
selection criteria will be sample of this study.
Sample size: About 30 family members of PLWA will be included in the study.
E. Criteria for sample selection/Procedure:
6
7. The principle care provider family member of diagnosed AIDS client’s for
more than 3 months willing to participate in the study will be included. The
family member of PLWA will be interviewed.
F. Criteria for sample exclusion:
a. Those who refuse to participate in the study.
b. Diagnosed cases of HIV positive for less than 3 months will be excluded.
c. Clients living alone will be excluded.
G. Sampling technique:
Using convenient sampling technique the diagnosed cases for more then 3
months, their principle care provider family member will be selected for
interview.
H. Research instrument:
Interview schedule: To find out the demographic profile of client’s and their
primary care giver.
Family Burden Assessment scale: To evaluate the family burden. The family burden
assessment scale for caregivers is taken from the tool used by Kipp 17etal,
Montogomery8, and Zarit1 after some modification in the statements as per our
context. The tools are well practical, tested, reliable, valid, and universally used in
worldwide. Three questions (Q.N. 13, 14, 15) are added in tools used by Kipp 17 etal
from the tools of Zarit1, and Montgomery8, which are appropriate in this context.
Focus group discussion: To evaluate the problems of the family regarding care of
their patients and, social stigma. Two to three focus group discussion sessions will be
arranged.
• Detailed guidelines are prepared for focus, along with Preset questions.
• One interviewer will ask the question and another will document the responses.
• One interviewer will be trained for data collection especially those who are
involved in AIDS care, along with the investigators.
• Focus group will be arranged at BPKIHS or in public places where the caregivers
can attain easily and feel free to express their views.
• The collected information’s will be compiled and analyzed.
I. Validity of the tool:
Content and face validity of the tool will be again established with the experts of
concerned field. Pre-testing of the tool will be done among 3-4 subjects. Nepali
version of the tool will be prepared and again it will be translated to English for
validity.
J. Methods of data collection/Data collection Procedure:
•
A detailed list of all the cases will be prepared before starting the data
collection.
•
Ethical clearance from concerned authorities (BPKIHS ethical review board)
will be obtained.
•
Permission from concerned authorities i.e. HODs, In-charges etc.
7
8. •
•
•
Informed written consent from each subject will be obtained prior to interview.
The family members of PLWA will be separately interviewed.
The interview will be taken from the primary (Main) caregiver of PLWA using
convenient sampling technique. The interview will be also taken at ARV, VCT,
PMTCT centers, and at their home as per feasibility, practicability and
convenient of care giver.
•
2-3 slots of focus group discussion will be arranged among 2-3 family members
group to explore the facts in details, especially social stigma
K. Statistical Analysis of data:
a. Descriptive data analysis: Percentage, Mean and SD will be used for
describing demographic Profile.
b. Inferential data Analysis: Chi-squire, t-test / z-test, ANOVA, Bivariate and
Multivariate linear regression and Correlation will be used to find out
association and draw the conclusions.
L. Limitations of the study:
The HIV/AIDS positive cases getting treatment in BKIHS will be only included in the
study. About 30 subjects will be only included in the study. The people living with AIDS
living alone will be excluded. The People living with HIV positive with symptoms free
and not facing any problems will be excluded.
M. Ethical Issues for the Research:
i. Written permission will be obtained from the concerned authority.
ii. Anonymity of the subjects will be maintained.
iii. The informed written permission will be obtained from subjects.
iv. The subjects will be assured of the confidentiality of the information.
v. Ensure privacy and confidentiality and to hide the patient’s diagnosis from
extended family members. Interview conducted in caregiver in alone, not with
patients and other family members.
5. Results and Discussion: The collected data will be entered in SPSS-10.5 software
package and will be analyzed. The STATA will be also used to analyze the data. The
findings will be presented in table and graphs. Inferential statistics will be used to analyze
and draw the conclusion. The results will be compared with the findings of study
conducted by various investigators on related fields.
6. ORGANIZATION OF THE STUDY: (TIME SCHEDULE)
SN Activities
Duration/Time
1.
Literature review and finalization of the project
2 Months
2.
Pre-testing and finalization of tool
1 Months
3.
Data collection and Focus group discussions
6 Months
4.
Analysis of Data
1 Months
5.
Report writing and Submission
2 Months
8
10. Section-D
Details of the Budget:
SN
1
2
3
Item/Particular
Personnel cost:
Interviewer: 1 persons for 6 monts
Details
1x6x500
Tool: Preparation, Printing & Testing.
Amount (In NP Rs.)
3,000
1,900
Data Collection
a. Focus group discussion:
Arrangement and Refreshments
b. Incentives for Participants
3x1000
200x30
3000
6000
4
Traveling
a. Data collection: traveling
2000
5
Data Processing: coding and entry
800
6
Report preparation and Typing
3000
7
Data Analysis
2000
8
Photocopy, Printing and Binding
1800
9
Miscellaneous
1500
25,000 /-
Grand Total
Rs. Twenty Five Thousand Only
10
11. References.
1. Zarit, S.H., Todd, P.A., & Zarit, J.M. (1986) Subjective burden of husbands and
wives as caregivers: A longitudinal study. Gerontologist; 26: 260–266.
2. Vithayachockitikhum, N. (2006) Family caregiving of persons living with
HIV/AIDS in Thailand. Caregiver burden, an outcome measure. International
Journal of Nursing Practice; 12(3): 123.
3. Donabedian, A. (1980) Explorations in Quality Assessment and Monitoring,
Arbor, MI, USA:
Ann
Health Administration.
4. Fitting, M., Rabins, P.V. (1985) Men and women: Do they give care differently?
Generations; 10: 23–26.
5. Reinhard, S.C. (1994) Living with mental illness: Effects of professional support and
personal control on caregiver burden. Research in Nursing and Health; 17: 79–88.
6. Reinhard, S.C. (1994) living with mental illness: Effects of professional support and
personal control on caregiver burden. Research in Nursing and Health; 17: 79–88 .
7. Grafström, M., Fratiglioni, L., & Sandman, P.O. (1992) Health and social
consequences for relatives of demented and non-demented elderly. A populationbased study. Journal of Clinical Epidemiology; 45: 861–870.
8. Montgomery, R.J.V., Kamo, Y. (1989) Parent care by sons and daughters. In:
Mancini JA (ed.). Aging Parents and Adult Children.
Lexicon, MA, USA:
Lexington
Books, 213–230.
9. Moffatt, B.C. (1986) When Someone You Love Has AIDS. New York: NAL Penguin.
10. Mushonga, R.P. (2001) Social support, coping, and perceived burden of female
caregivers of HIV/AIDS patients in rural Zimbabwe. Unpublished doctoral
dissertation, Case Western Reserve University, Ohio.
11. Hughes, S.L., Giobbie-Hurder, A., & Weaver, F.M. (1999) Relationship between
caregiver burden and health-related quality of life. Gerontologist; 39: 534–545.
12. Burintramart, P., Lerdmaleewong, M., & Nilmanat, K. (1982) Uncertainty in
illness and coping of family caregivers of hospitalized symptomatic HIV patients.
Thai Journal of Nursing Research; 2: 76–90.
13. Hunt, C.K. (2003) Concepts in caregiver Research. Journal of Nursing
Scholarships, 35(1): 27-32.
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12. 14. Bhardwaj, A., Biswas, R., & Shetty, K.J. (2001) HIV in Nepal: Is it rarer or the
tip of an iceberg? . Trop Doct, 31: 211-213.
15. AIDS Division, Ministry of Public Health. (1996). Health Care and Social
Service, Received by HIV/AIDS Patients at Home: Lampang Province. Bangkok.
16. Mwinituo Prudence, Mill JE. Stigma associated with Ghanian Caregivers of AIDS
patients. Western Journal of Nursing Research. 2006; 28(4): 369-382.
17. Kipp W, Tindyebwa D, Karamagi E, Rubaale T.(2006),. Family caregiving to
AIDS patients: The role of Gender in caregiver burden in Uganda. Journal of
International women’s studies. 7(4): 1-13.
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