[Barriers to Accessing HIV Testing Services - A Systematic Literature Review].

Gesundheitswesen. 2018 Oct 15;:

Authors: Wurm M, Neumann A, Wasem J, Biermann-Stallwitz J

Abstract
OBJECTIVE: In Germany there are 3,100 new HIV infections per year (2016), mainly homosexual men and intravenous drug users. According to experts from Robert Koch Institute, about 30 % of people with HIV are diagnosed late, well past the optimal moment to start the antiretroviral therapy. The high rate of late presenters seems to be a strong argument for an intensification of voluntary counseling and testing services. The main objective of this literature analysis was to describe the barriers to HIV testing.
METHODS: A systematic literature search was done to evaluate current knowledge on theory and practice regarding barriers that keep vulnerable groups from getting tested. The analysis includes all publications between 2000 and 2014 from western industrial states.
RESULTS: 132 publications have been included in a full text analysis. Most of these publications present the result of surveys of clients attending counseling and testing services. Hence, we have a clear idea of the elements that are relevant for clients when they decide whether or where to get tested for HIV. First, the individual risk perception influences the decision on getting tested or not. The risk perception can be influenced through public relations and outreach services. All processes within the counseling and testing service should be adapted to assure confidentiality and anonymity. In addition, clients want to have counseling that is accepting and free of prejudices. These elements are therefore important since HIV is often associated with getting stigmatized. Similar concerns regarding stigmatization occur if clie nts have sexual preferences that can be considered as deviant. The clients' fear of stigmatization, judgment and social exclusion requires a high sensitivity for the situation of the clients and acceptance of their lifestyle.
CONCLUSION: We have a clear insight into how clients decide on getting tested or not. The factor with the greatest influence in the decision-making process is the individual risk perception and anxiety regarding stigmatization. Stigmatization is suspected as a societal reaction to deviant sexual behavior or to being infected with HIV. Public relations should inform about risk factors and risk perception as well as on confidentiality and anonymity of the service. The use of social media and social networks is highly recommended. New approaches such as home testing could eliminate the concerns regarding confidentiality and anonymity.

PMID: 30321880 [PubMed - as supplied by publisher]

Virtual Reality Tool Simulates MRI Experience.

Tomography. 2018 Sep;4(3):95-98

Authors: Brown RKJ, Petty S, O'Malley S, Stojanovska J, Davenport MS, Kazerooni EA, Fessahazion D

Abstract
Magnetic resonance imaging (MRI) is an extremely useful tool for the detection and characterization of numerous pathologic processes. Although patients can benefit from the use of MRI, claustrophobia is a major issue in some cases. This fear alone can lead to cancellation of the scanning procedure in some cases and the need for conscious sedation in others. Patient anxiety during the scan can also lead to increased motion-related artifacts on the images with associated degradation of the diagnostic quality of the study. To alleviate these problems, our team developed a virtual reality (VR) tool (app) to educate patients about MRI and simulate the experience of actually being scanned. The app is totally immersive and incorporates both the visual and auditory sensations that patients encounter during an MRI scan. Patients also learn about potential conditions and implanted devices that may preclude the safe performance of the examination. This VR tool not only educates patients about MRI and its importance in their care, but also allows them to virtually experience what it is like to have a MRI scan. This technology has the potential to decrease both claustrophobic cancellations and patient anxiety before a MRI scan.

PMID: 30320208 [PubMed]

Height Simulation in a Virtual Reality CAVE System: Validity of Fear Responses and Effects of an Immersion Manipulation.

Front Hum Neurosci. 2018;12:372

Authors: Gromer D, Madeira O, Gast P, Nehfischer M, Jost M, Müller M, Mühlberger A, Pauli P

Abstract
Acrophobia is characterized by intense fear in height situations. Virtual reality (VR) can be used to trigger such phobic fear, and VR exposure therapy (VRET) has proven effective for treatment of phobias, although it remains important to further elucidate factors that modulate and mediate the fear responses triggered in VR. The present study assessed verbal and behavioral fear responses triggered by a height simulation in a 5-sided cave automatic virtual environment (CAVE) with visual and acoustic simulation and further investigated how fear responses are modulated by immersion, i.e., an additional wind simulation, and presence, i.e., the feeling to be present in the VE. Results revealed a high validity for the CAVE and VE in provoking height related self-reported fear and avoidance behavior in accordance with a trait measure of acrophobic fear. Increasing immersion significantly increased fear responses in high height anxious (HHA) participants, but did not affect presence. Nevertheless, presence was found to be an important predictor of fear responses. We conclude that a CAVE system can be used to elicit valid fear responses, which might be further enhanced by immersion manipulations independent from presence. These results may help to improve VRET efficacy and its transfer to real situations.

PMID: 30319376 [PubMed]

Subtypes of aggression and their relation to anxiety in Barbary macaques.

Aggress Behav. 2018 Oct 14;:

Authors: Paschek N, Müller N, Heistermann M, Ostner J, Schülke O

Abstract
Human aggression can be differentiated into reactive aggression (RA), displayed in face of a real or perceived threat and associated with high levels of anxiety, and proactive aggression (PA), displayed to achieve a certain goal and linked to lower anxiety levels. To study the origins of these aggression subtypes and their relation to anxiety, we tested if both subtypes can be distinguished in a nonhuman primate species, characterized their occurrence within the study group, and examined the link between aggression subtype and anxiety. Data were collected on 29 individuals of a semi-free ranging group of Barbary macaques (Macaca sylvanus) at Affenberg Salem, Germany, via focal animal (303 hr) and event sampling (1,222 agonistic events). Using a priori definitions, each aggressive event was classified as either reactive or proactive. We found both aggression types in our study population as well as individual differences in the proportion at which they occurred. The predominant use of one subtype of aggression was linked to the individual's dominance rank, age and sex, but not related to standard behavioral and physiological measures of anxiety. Our results suggest that reactive and proactive subtypes of aggression also exist in Barbary macaques, indicating a deeper evolutionary history of these aggression types observed in humans.

PMID: 30318602 [PubMed - as supplied by publisher]

Related Articles

Fear of birth in clinical practice: A structured review of current measurement tools.

Sex Reprod Healthc. 2018 Jun;16:98-112

Authors: Richens Y, Smith DM, Lavender DT

Abstract
To identify measurement tools which screen for the presence of fear of birth (FOB) and to determine the most effective tool/s for use in clinical practice. Fear or birth (FOB) is internationally recognised as a cause for increasing concern, despite a lack of consensus on a definition or optimal measure of assessment. There is a wide array of FOB measurement tools, however little clarity on which tool should be used to screen for FOB in clinical practice. This review explores the use of tools that are used to screen for FOB and discusses the perceived effectiveness of such tools. A structured literature review was undertaken. Electronic databases were searched in July 2017 and manuscripts reviewed for quality. The review included 46 papers. The majority of studies were undertaken in Scandinavia (n = 29) and a range of tools were used to measure FOB. The most widely used tool was the Wijma Delivery Expectancy Experience Questionnaire' (W-DEQ). Inconsistencies were found in the way this tool was used, including variations in assessment cut-off points, implementation and use across a range of cultural settings and women of varying gestations. Moreover, the tool may be too lengthy to use in clinical practice. The Fear of Birth Scale (FOBS) has been shown to be as effective as W-DEQ but has the advantage of being short and easy to administer. The inconsistencies in tools reflect the difficulties in defining FOB. A clear consensus definition of FOB would aid comparisons across practice and research. The W-DEQ is not used in clinical practice; this may be due to its length and complexity. The FOBS is likely to be a more versatile tool that can be used in clinical practice.

PMID: 29804785 [PubMed - indexed for MEDLINE]