Barriers and facilitators to HIV testing in people age 50 and above: a systematic review

Background: Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people ≥50 years is increasing. Unique factors may be associated with testing in this group. This review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged ≥50 years. Methods: A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and number of times reported was noted. Due to considerable heterogeneity, a narrative approach has been undertaken to synthesise data. Findings: 17 studies were included. Main barriers to testing were low perceived risk, and clinicians’ preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider. Interpretation: Although being encouraged to test was a common facilitator, clinicians’ preconceptions about older people was the biggest barrier, showing a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates. This review is an important first step to identify potential barriers/facilitators for further study or to be addressed in the design of future interventions

Late diagnosis among our ageing HIV population: a cohort study

INTRODUCTION: With the advent of combined antiretroviral therapy (cART), more people infected with HIV are living into older age; 22% of adults receiving care in the UK are aged over 50 years [1]. Age influences HIV infection; the likelihood of seroconversion illness, mean CD4 count and time from infection to development of AIDs defining illnesses decreases with increasing age. A UK study estimates that half of HIV infections in persons over 50 years are acquired at an age over 50 [2]. Studies exploring sexual practices in older persons have repeatedly shown that we cannot assume there is no risk of STI and HIV infection [3,4]. Physicians should be alert to risk of HIV even in the older cohort, where nearly half diagnoses are made late [2]. Local audit has demonstrated poor testing rates in the over 50's on the Acute Medical Unit. Late diagnosis (CD4<350) results in poorer outcomes and age confounds further; older late presenters are 2.4 times more likely to die within the first year of diagnosis than younger counterparts [2]. MATERIALS AND METHODS: A retrospective case notes review was conducted of all patients aged 60 years and over attending HIV clinic in the last 2 years. Outcomes audited included features around diagnosis; age, presentation, missed testing opportunities and CD4 count at diagnosis. RESULTS: Of the current cohort of 442 patients, 34 were over 60 years old (8%). Age at diagnosis in this group ranged from 36 to 80 years, mean 56.6 years. Presentation triggers included opportunistic infections or malignancies (n=10), constitutional symptoms (n=6), diagnosis of another STI (n=4), seroconversion illness (n=2), partner status (n=3). Eight patients were diagnosed through asymptomatic screening at Sexual Health. We identified missed opportunities in five patients who were not tested despite diagnoses or symptoms defined as clinical indicators for HIV. Half of older patients had a CD4 count of <200 at diagnosis. CONCLUSIONS: It is imperative that general medical physicians and geriatricians are alert to enquiring about risk and testing for HIV where clinical indicators are present, irrespective of age. The oldest patient in the cohort was diagnosed with HIV aged 80 years. All patients with missed opportunities for testing were over 47 years old

Hydrological consequences of Eucalyptus afforestation in the Argentine Pampas

The impacts of a 40 ha stand of Eucalyptus camaldulensis in the Pampas grasslands of Argentina were explored for 2 years using a novel combination of sap flow, groundwater data, soil moisture measurements, and modeling. Sap flow measurements showed transpiration rates of 2–3.7 mm d−1, lowering groundwater levels by more than 0.5 m with respect to the surrounding grassland. This hydraulic gradient induced flow from the grassland areas into the plantation and resulted in a rising of the plantation water table at night. Groundwater use estimated from diurnal water table fluctuations correlated well with sap flow (p &lt; 0.001, r2 = 0.78). Differences between daily sap flow and the estimates of groundwater use were proportional to changes in surface soil moisture content (p &lt; 0.001, r2 = 0.75). E. camaldulensis therefore used both groundwater and vadose zone moisture sources, depending on soil water availability. Model results suggest that groundwater sources represented ∼67% of total annual water use

Catalytic and conductivity studies in two dimensional coordination polymers built with a thiazole based ligand

The employment of the commercial availiable organic ligand 2-mercapto-4-methyl-5-thiazoleacetic acid (H2L) in Zn and Cd chemistry yields two-dimensional (2D) coordation polymers (CPs) with pseudopolymorphic character. Thermal, catalytic and conductivity studies are discussed

Illuminating hydrological processes at the soil-vegetation-atmosphere interface with water stable isotopes

Funded by DFG research project “From Catchments as Organised Systems to Models based on Functional Units” (FOR 1Peer reviewedPublisher PDFPublisher PD

Estimating age of mature adults from the degeneration of the sternal end of the clavicle

The sternal end of the clavicle has been illustrated to be useful in aging young adults, however, no studies have investigated what age-related changes occur to the sternal end post epiphyseal fusion. In this study, three morphological features (i.e., surface topography, porosity, and osteophyte formation) were examined and scored using 564 clavicles of individuals of European ancestry (n = 318 males; n = 246 females), with known ages of 40+ years, from four documented skeletal collections: Hamann-Todd, Pretoria, St. Bride's, and Coimbra. An ordinal scoring method was developed for each of the three traits. Surface topography showed the strongest correlation with age, and composite scores (formed by summing the three separate trait scores) indicated progressive degeneration of the surface with increasing chronological age. Linear regression analyses were performed on the trait scores to produce pooled-sample age estimation equations. Blind tests of the composite score method and regression formulae on 56 individuals, aged 40+ years, from Christ Church Spitalfields, suggest accuracies of 96.4% for both methods. These preliminary results display the first evidence of the utility of the sternal end of the clavicle in aging older adult individuals. However, in the current format, these criteria should only be applied to individuals already identified as over 40 years in order to refine the age ranges used for advanced age. These findings do suggest the sternal end of the clavicle has potential to aid age estimates beyond the traditional "mature adult" age category (i.e., 46+ years), and provides several suggestions for future research

Enhancing Occupational Therapy Students’ Education in Animal-Assisted Therapy: Students’ Experience

Animal-assisted therapy has been gaining increased attention in occupational therapy practice and research. Yet the topic remains missing from university curricula at an international level. The aim of this study was to describe how animal-assisted therapy might be introduced to occupational therapy curricula and explore the experience of students who were able to implement their knowledge within a student-led clinic. Nine occupational therapy students engaged in individual semistructured interviews, allowing them to describe their experience participating in a student-led canine-assisted therapy clinic. Transcripts were analysed using inductive thematic analysis. Four themes emerged describing the students’ experience: outside my comfort zone, a safe learning environment, opening minds to possibilities by linking theory to practice, and future recommendations. Students explained that they were initially met with a challenge as canine-assisted therapy was an area of practice in which they had limited previous experience. However, they noted that the safe learning environment created by the clinic staff, their peers, and their clients’ parents supported their confidence to overcome these challenges and embrace the unique learning experience. Students identified that they gained a deeper understanding of the occupational therapy profession through this experience. Finally, while describing an overall positive experience, students identified that improvements could be made to further support student learning. To support the increasing involvement of occupational therapists in animal-assisted therapy, methods to establish appropriate education and training are required. Introducing animal-assisted therapy to university curricula as an area of occupational therapy practice, as well as within student-led clinics might be a potential way in which this could be achieved

Molecular and supramolecular chemistry of mono- and di-selenium analogues of metal dithiocarbamates

This bibliographic review summarises the coordination chemistry of mono- and diselenium analogues of metal dithiocarbamate ligands, [RRꞌNCS2]-, as revealed by X-ray crystallography and spectroscopy (77Se NMR and infrared). The Se-ligands are usually chelating but, bridging modes, up to 4, are known. Reflecting the larger size, greater polarisability and presence of a polar-cap (-hole), selenium atoms are more likely to be involved in secondary-bonding (chalcogen-bonding) than sulphur when a competition exists. Isostructural relationships are established across the series in about one-third of the structures

Poundbury Camp in context – a new perspective on the lives of children from urban and rural Roman England

Objectives The current understanding of child morbidity in Roman England is dominated by studies of single sites/regions. Much of the data are derived from third to fifth century AD Poundbury Camp, Dorchester, Dorset, considered an unusual site due to high levels of non-adult morbidity. There is little understanding of children in rural areas, and whether Poundbury Camp was representative of Romano-British childhood. Materials and methods The study provides the first large scale analysis of child health in urban and rural Roman England, adding to the previously published intra-site analysis of non-adult paleopathology at Poundbury Camp. Age-at-death and pathology prevalence rates were reassessed for 953 non-adults (0–17 years) from five major urban, six minor urban, and four rural sites (first to fifth century AD). The data were compared to the results from 364 non-adults from Poundbury Camp. Results Rural sites demonstrated higher levels of infant burials, and greater prevalence of cribra orbitalia in the 1.1–2.5 year (TPR 64.3%), and 6.6–10.5 year cohorts (TPR 66.7%). Endocranial lesions were more frequent in the minor urban sample (TPR 15.9%). Three new cases of tuberculosis were identified in urban contexts. Vitamin D deficiency was most prevalent at Poundbury Camp (CPR 18.8%), vitamin C deficiency was identified more frequently in rural settlements (CPR 5.9%). Discussion The Poundbury Camp data on morbidity and mortality are not representative of patterns in Roman England and other major urban sites. Rural children suffered from a distinct set of pathologies described as diseases of deprivation, prompting reconsideration of how Romano-British land management affected those at the bottom of the social hierarchy