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Search Results: 1 - 10 of 1219 matches for " Sonja Merten "
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Corrigendum for Individual and contextual factors influencing patient attrition from antiretroviral therapy care in an urban community of Lusaka, Zambia
Maurice Musheke,Virginia Bond,Sonja Merten
Journal of the International AIDS Society , 2013, DOI: 10.7448/ias.16.1.18590
Individual and contextual factors influencing patient attrition from antiretroviral therapy care in an urban community of Lusaka, Zambia
Maurice Musheke,Virginia Bond,Sonja Merten
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.3.17366
Abstract: Background: Despite the relatively effective roll-out of free life-prolonging antiretroviral therapy (ART) in public sector clinics in Zambia since 2005, and the proven efficacy of ART, some people living with HIV (PLHIV) are abandoning the treatment. Drawing on a wider ethnographic study in a predominantly low-income, high-density residential area of Lusaka, this paper reports the reasons why PLHIV opted to discontinue their HIV treatment. Methods: Opened-ended, in-depth interviews were held with PLHIV who had stopped ART (n = 25), ART clinic staff (n = 5), religious leaders (n = 5), herbal medicine providers (n = 5) and lay home-based caregivers (n = 5). In addition, participant observations were conducted in the study setting for 18 months. Interview data were analysed using open coding first, and then interpreted using latent content analysis. The presentation of the results is guided by a social-ecological framework. Findings: Patient attrition from ART care is influenced by an interplay of personal, social, health system and structural-level factors. While improved corporeal health, side effects and need for normalcy diminished motivation to continue with treatment, individuals also weighed the social and economic costs of continued uptake of treatment. Long waiting times for medical care and placing “defaulters” on intensive adherence counselling in the context of insecure labour conditions and livelihood constraints not only imposed opportunity costs which patients were not willing to forego, but also forced individuals to balance physical health with social integrity, which sometimes forced them to opt for faith healing and traditional medicine. Conclusions: Complex and dynamic interplay of personal, social, health system and structural-level factors coalesces to influence patient attrition from ART care. Consequently, while patient-centred interventions are required, efforts should be made to improve ART care by extending and establishing flexible ART clinic hours, improving patient-provider dialogue about treatment experiences and being mindful of the way intensive adherence counselling is being enforced. In the context of insecure labour conditions and fragile livelihoods, this would enable individuals to more easily balance time for treatment and their livelihoods. As a corollary, the perceived efficacy of alternative treatment and faith healing needs to be challenged through sensitizations targeting patients, religious leaders/faith healers and herbal medicine providers.
HIV Testing and Tolerance to Gender Based Violence: A Cross-Sectional Study in Zambia
Sara Gari, Jacob R. S. Malungo, Adriane Martin-Hilber, Maurice Musheke, Christian Schindler, Sonja Merten
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0071922
Abstract: This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR = 2.48 95% CI = 1.00–6.19); tolerance to gender-based violence (OR = 2.10 95% CI = 1.05–4.32) and fear of social rejection (OR = 1.48 95% CI = 1.23–1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families.
Patient-Related Factors Influencing Adherence to ART, A Case of Chivuna, Southern Province of Zambia  [PDF]
Harriet Ntalasha, Jacob R. S. Malungo, Sonja Merten, Annie N. Phiri, Simona J. Simona
World Journal of AIDS (WJA) , 2019, DOI: 10.4236/wja.2019.92005
Despite the roll out of free life prolonging HIV and AIDS drugs in many public clinics in Zambia and the well documented effects of Anti Retrovirals (ARVs) in reducing mortality among people living with HIV, some people living with HIV still abandon treatment. This study explores patient-related factors that influence adherence to the life prolonging drugs. It is hoped that such information would be useful in enhancing adherence so as to achieve the goal of ART. This information is critical considering irrefutable evidence that non-adherence to Anti-Retroviral Therapy (ART) can lead to drug resistance and consequently, transmission of drug resistant HIV. Drug resistant HIV is not only expensive to handle, but can lead to increased morbidity, mortality and increased incidence of HIV cases particularly, for a low income country like Zambia. Methods: This paper uses data from a large mixed method study which was conducted in a rural setting. The study explored how patient-related factors influence people living with HIV in continuing taking of medication. The paper, therefore, discusses the major reasons reported by HIV infected people on ART for either being able to consistently take their medication or failing to do so. Results: Both limiting and facilitating factors were identified as influencing adherence. Among the facilitators identified were one having a reminder, feeling better after being on ART, seeing someone on ART recover, desire to live longer and disclosure of one’s positive status. The limiting factors included forgetting to take medication, non-recovery while on treatment for some time and drug fatigue. A significant association was found between adherence treatment and one having a reminder, desire to live longer and seeing someone on ART get better. Conclusion: While facilitators enhanced adherence, the barriers prevented or discouraged people on ART from continuing taking AIDS medicines as prescribed by their health care providers. In order to avoid drug resistance and other public health implications, such as transmission of drug resistant HIV virus and deaths, there is need to address these patient-related barriers.
Local perceptions of cholera and anticipated vaccine acceptance in Katanga province, democratic republic of Congo
Sonja Merten, Christian Schaetti, Cele Manianga, Bruno Lapika, Claire-Lise Chaignat, Raymond Hutubessy, Mitchell G Weiss
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-60
Abstract: In a cross-sectional study in Katanga province, Democratic Republic of Congo (DRC), local perceptions of cholera and anticipated acceptance of an OCV were investigated. A random sample of 360 unaffected adults from a rural town and a remote fishing island was interviewed in 2010. In-depth interviews with a purposive sample of key informants and focus-group discussions provided contextual information. Socio-cultural determinants of anticipated OCV acceptance were assessed with logistic regression.Most respondents perceived contaminated water (63%) and food (61%) as main causes of cholera. Vaccines (28%), health education (18%) and the provision of clean water (15%) were considered the most effective measures of cholera control. Anticipated acceptance reached 97% if an OCV would be provided for free. Cholera-specific knowledge of hygiene and self-help in form of praying for healing were positively associated with anticipated OCV acceptance if costs of USD 5 were assumed. Conversely, respondents who feared negative social implications of cholera were less likely to anticipate acceptance of OCVs. These fears were especially prominent among respondents who generated their income through fishing. With an increase of assumed costs to USD 10.5, fear of financial constraints was negatively associated as well.Results suggest a high motivation to use an OCV as long as it seems affordable. The needs of socially marginalized groups such as fishermen may have to be explicitly addressed when preparing for a mass vaccination campaign.
Einfluss kognitiver Lernstrategien und motivationaler Aspekte auf den Lernerfolg im Medizinstudium []
Merten, Kathleen
GMS Zeitschrift für Medizinische Ausbildung , 2008,
An analysis of the VOSP Silhouettes Test with neurological patients
Psychology Science , 2006,
Abstract: An item analysis of the Silhouettes, part of the Visual Object and Space Perception Battery, was performed using the test protocols of 266 German-speaking neurological patients with a mean age of 54.8 years, all of them presenting some sort of brain pathology. The sample yielded a mean test score of 17.0 (SD = 4.6). The two subsets of 15 animals and 15 objects were only moderately correlated (0.45), so the inclusion into a single scale is questionable. Other reliability estimates were also rather low (0.62 to 0.77). Moreover, gross deviations in item difficulty were obtained with this sample; scoring rules were found to be insufficiently explicit. Despite moderate rank correlations with other instruments (Hooper VOT: 0.65; WAIS-R Block Design: 0.57; neuropsychological screening battery SKT: -0.45), the psychometric properties obtained with this sample must be considered to be insufficient.
Nucleon Decay and Neutrino Properties in a Mass Model based on an SO(10) Grand Unified Theory
Carsten Merten
Physics , 2000,
Abstract: In this work a mass model based on a SO(10) GUT with a global U(1) family symmetry is discussed which leads to an asymmetric Nearest Neighbour Interaction structure for the fermionic mass matrices. As a result of the analysis one gets three solutions of the model which include several large left- and right-handed fermion mixings. Those mixings are not observable in the SM where only the CKM quark mixing matrix can be measured, but they have testable effects on the branching ratios of nucleon decays in theories beyond the SM. One finds that decay channels with positrons in the final state are suppressed while channels with antimuons and antineutrinos are enhanced compared to models with small mixings. The total nucleon lifetimes obtained should be observable by future experiments. The SO(10) model also predicts the masses and mixings of the light neutrinos. They are in the right range to explain the anomalies of solar and atmospheric neutrinos by means of oscillations, preferring the small angle MSW solution for the solar neutrino deficit.
Weak lensing detection of intra-cluster filaments with ground based data
Matteo Maturi,Julian Merten
Physics , 2013, DOI: 10.1051/0004-6361/201322007
Abstract: According to the current standard model of Cosmology, matter in the Universe arranges itself along a network of filamentary structure. These filaments connect the main nodes of this so-called 'Cosmic Web', which are clusters of galaxies. Although its large-scale distribution is clearly characterized by numerical simulations, constraining the dark matter content of the cosmic web in reality turns out to be difficult. The natural method of choice is gravitational lensing. However, the direct detection and mapping of the elusive filament signal is challenging and in this work we present two methods,specifically tailored to achieve this task. A linear matched filter aims at the detection of the smooth mass component of filaments and is optimized to perform a shear decomposition that follows the anisotropic component of the lensing signal. Filaments clearly inherit this property due to their morphology. At the same time, the contamination arising from the central massive cluster is controlled in a natural way. The filament 1 {\sigma} detection is of about {\kappa} ~ 0.01-0.005 according to the filter's template width and length, enabling the detection of structures out of reach with other approaches. The second, complementary method seeks to detect the clumpy component of filaments. The detection is determined by the number density of sub-clump identifications in an area enclosing the potential filament, as it was found within the observed field with the filter approach. We test both methods against Mock observations based on realistic N-Body simulations of filamentary structure and prove the feasibility of detecting filaments with ground-based data.
Large Quark Rotations, Neutrino mixing and Proton Decay
Yoav Achiman,Carsten Merten
Physics , 2000, DOI: 10.1016/S0550-3213(00)00353-9
Abstract: Right-handed (RH) rotations do not play a role in the Standard Model, and only the differences of the LH mixing angles are involved in ${\bf V}_{\scr \textrm{CKM}}$. This leads to the huge freedom in the fermionic mass matrices. However, that is no more true in extensions of the Standard Model. For example in GUTs large RH rotations of the quarks can be related to the observed large neutrino mixing or in particular, all mixing angles are relevant for the proton decay. We present a simple realistic non-SUSY SO(10) GUT with large RH and LH mixing and study the corresponding nucleon decay rates.
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