Cancer services need to be inclusive and accessible to everybody, including people with disabilities. However, there is evidence suggesting that people with disabilities experience poorer access to cancer services, compared to people without disabilities.To investigate the barriers and facilitators of access to cancer services for people with physical disabilities and their experiences of cancer care.A mixed-method systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach. We used the Mixed Methods Appraisal Tool (MMAT -Version 11) to assess the quality of the included studies. We employed thematic synthesis to bring together data from across both qualitative and quantitative studies and we assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach.Seven quantitative studies and 10 qualitative studies (across 18 publications) were included. The findings highlighted a dearth of research on the experiences of men with disabilities. Furthermore, only one study explored experiences of cancer treatment, with all other studies focusing on cancer screening. Five synthesised findings were identified that reflected barriers and facilitators, highlighting both what makes access to services difficult and what are the strategies that could improve it.Knowing what works for people with disabilities can enable the delivery of appropriate services. The findings of this review suggest that the mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible, and offered in a respectful manner.

Objectives: The purposes of this study were to (1) assess receptiveness of families to violence prevention interventions initiated after an assault injury and (2) assess the effectiveness of a case management program on increasing service utilization and reducing risk factors for reinjury among assault-injured youth presenting to the emergency department. Design/Methods: A randomized controlled trial of youth, aged 12 to 17 years, presenting to a large urban hospital with peer assault injury was conducted. Youth and parents were interviewed at baseline and 6 months to measure service utilization, risk behavior, attitudes about violence, mental health, and injury history. Intervention: Intervention families received case management services by telephone or in person during 4 months by a counselor who discussed sequelae of assault injury and assessed family needs and facilitated service use. Controls received a list of community resources. Results: Eighty-eight families were enrolled; 50 (57%) completed both youth and parent follow-up interviews. Intervention and control groups were not significantly different at baseline on demographics, service utilization, and risk factors. Fighting was common in both groups. Most parents and youth identified service needs at baseline, with recreational programs, educational services, mentoring, and counseling as most frequently desired. There was no significant program effect on service utilization or risk factors for injury. Although intervention families were satisfied with case management services, there was no significant increase in service utilization compared with controls. Conclusions: Youth and parents were receptive to this violence prevention intervention initiated after an emergency department visit. This pilot case management program, however, did not increase service utilization or significantly reduce risk factors for injury. More intensive violence prevention strategies are needed to address the needs of assault-injured youths and their families.

BACKGROUND:We compare two new software packages for linkage analysis, LODPAL and GENEFINDER. Both allow for covariate adjustment. Replicates 1 to 3 of Genetic Analysis Workshop 13 simulated data sets were used for the analyses. We described the results of searching for evidence of loci contributing to a simulated quantitative trait related to systolic blood pressure (SBP). Individuals with SBP greater than 130 mm Hg were defined as affected individuals, and all others as unaffected. Total cholesterol was treated as a covariate.RESULTS:Using LODPAL, the power of detecting one of the three major genes related to SBP is 44.4% when a LOD score of 1 is used as the cut-off point. The power of GENEFINDER is lower than that of LODPAL. It is 22.2%.CONCLUSIONS:Based on the limited comparison, LODPAL provided the more reasonable power to detect linkage compared to GENEFINDER. After adjusting for the total cholesterol covariate, the current version of both programs appeared to give a high number of false positives.

Background HIV-1 surveys in defined populations identify underlying risks and trends useful to mount interventions. Goal The goal of the study was to determine HIV-1 prevalence and risk factors among men working at a Malawian sugar estate. Study Design Three independent surveys were conducted in 1994, 1997, and 1998. Procedures included obtaining informed consent, interviewing, and drawing blood for HIV and syphilis testing. Analyses determined prevalence of HIV and associated risk factors. Results HIV prevalence was 24.3% in 1994 (n = 1691), 22.8% in 1997 (n = 615), and 20.9% in 1998 (n = 1354;P < 0.03). From 1994 to 1998, the percentage of subjects with a history of sexually transmitted disease (STD) decreased from 43.6% to 29.5% (P < 0.0001), accompanied by a substantial rise in STDs confirmed by physical examination (from 7.5% to 16.8%;P < 0.0001) and by laboratory testing for syphilis (from 6.5% to 10.4%;P < 0.0001). The percentage with multiple sex partners declined (from 62.0% to 35.2%;P < 0.0001), and condom use rose (from 10.9% to 18.9%;P < 0.0001). STDs were significantly associated with prevalent HIV infection each year. Conclusions The prevalence of HIV has remained relatively stable and high in this cohort.

Becker, Stephen*; Fisher, Alvan†; Flexner, Charles‡; Gerber, John G.§; Haubrich, Richard∥; Kashuba, Angela D. M.¶; Luber, Andrew D.#; Piscitelli, Stephen C.** Author Information

OBJECTIVE:To assess patterns of morbidity and associated factors in late infancy and early childhood among human immunodeficiency virus (HIV)-infected and -uninfected African children.DESIGN:Prospective study.SETTING:The Queen Elizabeth Central Hospital, Blantyre, Malawi.PARTICIPANTS:Children with known HIV status from an earlier perinatal intervention trial were enrolled during the first year of life and followed to approximately 36 months of age.OUTCOME MEASURES:Morbidity and mortality information was collected every 3 months by a questionnaire. A physical examination was conducted every 6 months. Blood to determine CD4(+) values was also collected. Age-adjusted and Kaplan-Meier analyses were performed to compare rates of morbidity and mortality among infected and uninfected children.RESULTS:Overall, 808 children (190 HIV-infected, 499 HIV-uninfected but born to infected mothers, and 119 born to HIV-uninfected mothers) were included in this study. Of these, 109 died during a median follow-up of 18 months. Rates of childhood immunizations were high among all children (eg, lowest was measles vaccination [87%] among HIV-infected children). Age-adjusted morbidity rates were significantly higher among HIV-infected than among HIV-uninfected children. HIV-infected children were more immunosuppressed than were uninfected children. By 3 years of age, 89% of the infected children died, 10% were in HIV disease category B or C, and only approximately 1% were without HIV symptoms. Among HIV-infected children, median survival after the first occurrence of acquired immunodeficiency syndrome-related conditions, such as splenomegaly, oral thrush, and developmental delay, was <10 months. These same conditions, in addition to frequent bouts of fever, were the main morbidity predictors of mortality.CONCLUSIONS:The frequency of diseases was high, and progression from asymptomatic or symptomatic HIV disease to death was rapid. Management strategies that effectively reduce morbidity for HIV-infected children are needed.

ObjectiveTo examine the association of viral load and CD4 lymphocyte count with mortality among HIV-infected children over one year of age. DesignA prospective study. HIV-infected children were enrolled during the first year of life and followed for more than 2 years at the Queen Elizabeth Central Hospital in Blantyre, Malawi (southeast Africa). MethodsMorbidity and mortality information was collected every 3 months, and physical examination and blood testing (for viral level and CD4 cell percentage) were performed every 6 months. Kaplan–Meier analyses and proportional hazards models were used to estimate survival and to examine the association of primary predictors with mortality. ResultsOf 155 HIV-infected children originally enrolled, 115 (74%) had viral load testing and 82 (53%) had both viral load and CD4 cell percentage testing after their first year. Among children over one year of age, significant associations were found between mortality and the log10 viral load and CD4 cell percentage in both univariate and multivariate models. Independent of the CD4 cell value, a one unit log10 increase in HIV RNA level increased the hazard of child mortality by more than twofold. Children with low CD4 cell counts (< 15%) and high viral loads (⩾ 250 000 copies/ml median value) had the worst survival; children with high CD4 cell counts (⩾ 15%) and low viral loads (< 250 000 copies/ml) had the best survival. ConclusionAs in developed countries, viral load and CD4 cell count are the main predictors of mortality among African children. Making these tests available adds to the challenges to be considered if antiviral therapies were to be adopted in these countries.

Background. HIV-infected and uninfected children who survived their first year of life were prospectively followed in Malawi to assess levels of mortality and related risk factors during the second and third years of life. Methods. Children with known HIV status from an earlier perinatal intervention trial were enrolled. These children [HIV-infected (Group A); HIV-uninfected but born to HIV-seropositive mothers (Group B); and children born to HIV-seronegative mothers (Group C)] were followed every 3 months until age 36 months. Mortality data were collected at each visit. Immunologic data (CD4+ percent) were collected at or immediately after enrollment. Results. Overall 702 children were enrolled and 83 children died during follow-up. The mortality rate per 1000 person years of observation was 339.3 among Group A children, 46.3 among Group B children and 35.7 among Group C children. Among HIV-infected children the cumulative proportion surviving to age 24 months was 70% and those surviving to age 36 months was 55%. By age 32 months none of the severely immunosuppressed (CD4% <15%) children had survived. The mortality differentials between HIV-infected and uninfected children persisted after adjusting for several risk factors. The major causes of death among infected children (n = 52) were wasting and respiratory conditions. Conclusions. Although all HIV-infected children had received childhood immunizations, mortality was high. Management of these children should include aggressive antimicrobial treatment, and evaluation of prophylactic regimens should be considered.