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Article: Changing methods of disclosure. Literature review of disclosure to children with terminal illnesses, including HIV.

Heeren, G Anita

2014 Volume 24, Issue 1-2, Page(s) 199–208

Abstract: More than 30 years after the first discovery of the deadly HIV virus, and in the wake of increased knowledge of transmission, treatment and behavioral intervention development, parents are still faced with the difficult task of whether, when and how to ... ...

Abstract	More than 30 years after the first discovery of the deadly HIV virus, and in the wake of increased knowledge of transmission, treatment and behavioral intervention development, parents are still faced with the difficult task of whether, when and how to inform their child about her or his HIV status. Except for some general ethical considerations, there are no national or international guidelines available for handling HIV status disclosure to a child by parents and health professionals. Most studies on disclosure address the problem of stigma and the barriers to disclosure of HIV-positive status by adults to their sexual partners, caretakers, families and communities, but very few studies focus on disclosure to HIV-positive children. The majority of the studies that address disclosure to children limit themselves to stipulating reasons for barriers to such disclosure instead of the skills and knowledge necessary for effective disclosure to a child. Increasing availability of therapy for HIV across the world presses the issue of disclosure to the child. Even so, disclosure for children who are HIV-positive due to vertical transmission continues to be very difficult. There is a lack of interventions that consider guidelines for healthcare professionals, parents or persons involved with taking care of HIV-positive children. These interventions should be designed in an understanding manner towards the culture where they might be implemented and be as appropriate in the view of integrating different family structures and the child's development.
Language	English
Publishing date	2014-02-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2013215-3
ISSN	1469-8412 ; 1351-1610
ISSN (online)	1469-8412
ISSN	1351-1610
DOI	10.1080/13511610.2011.553506
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Article: Sub-Saharan African University Students' Beliefs about Abstinence, Condom Use, and Limiting the Number of Sexual Partners.

Zhang, Jingwen / Jemmott, John B / Heeren, G Anita

Behavioral medicine (Washington, D.C.)

2017 Volume 43, Issue 1, Page(s) 9–20

Abstract: Given the high risk of HIV infection among university students in sub-Saharan Africa, there is a need for culturally appropriate risk-reduction interventions specifically targeting this population. Efforts to reduce the risk require an understanding of ... ...

Abstract	Given the high risk of HIV infection among university students in sub-Saharan Africa, there is a need for culturally appropriate risk-reduction interventions specifically targeting this population. Efforts to reduce the risk require an understanding of the modifiable antecedents of sexual-risk behaviors. We report the results of a semi-structured elicitation survey based on the reasoned action approach to identify behavioral, normative, and control beliefs regarding abstinence, condom use, and limiting sexual partners. Two coders classified into 64 belief categories the written responses of 96 sub-Saharan African university students. Most students believed each behavior could reduce risk of HIV infection. The students reported that peer pressure and being in a risky environment made it harder to practice abstinence. Good communication made it easier to use condoms and to limit partners; however, unstable relationships made practicing these protective behaviors harder. The identified beliefs help to inform the development of theory-based HIV risk-reduction interventions.
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	623101-9
ISSN	0896-4289
ISSN	0896-4289
DOI	10.1080/08964289.2015.1028321
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Article: Health Promotion: Results of focus groups with African-American men.

Heeren, G Anita / Jemmott, John B

Journal of men's health

2011 Volume 8, Issue 1, Page(s) 50–55

Abstract: BACKGROUND: Almost half (49%) of the people diagnosed with HIV/AIDS in the United States (US) are African-Americans. Although African-Americans represent only about 13% of the overall population, they continue to account for a higher proportion of cases ... ...

Abstract	BACKGROUND: Almost half (49%) of the people diagnosed with HIV/AIDS in the United States (US) are African-Americans. Although African-Americans represent only about 13% of the overall population, they continue to account for a higher proportion of cases at all stages of HIV/AIDS. Most documented interventions targeting the African-American population have focused on women, children, men who have sex with men or drug addicts. METHODS: Six focus group sessions with African-American men (39) and women (15) were conducted in a heterogeneously populated American city. We used a pre-focus group questionnaire to collect data about the socio-economic background of the participants. In our focus group sessions we examined the feasibility of instituting a health promotion program for African-American men. RESULTS: The men who participated in the sessions showed great interest in attending the health promotion program. They had no prior knowledge of positive behavioral practices that could promote their individual health and well-being. HIV infection rates in the African-American population remain the highest in the US. CONCLUSION: The results of our focus group sessions showed that the heterosexual African-American men were eager to learn how to protect themselves against communicable and non-communicable diseases in health promotion programs.
Language	English
Publishing date	2011-05-12
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	2428850-0
ISSN	1875-6859 ; 1875-6867
ISSN (online)	1875-6859
ISSN	1875-6867
DOI	10.1016/j.jomh.2010.11.002
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Article ; Online: Predictors and psychological pathways for binge drinking among South African men.

Zhang, Jingwen / Jemmott, John B / Icard, Larry D / Heeren, G Anita / Ngwane, Zolani / Makiwane, Monde / O'Leary, Ann

Psychology & health

2018 Volume 33, Issue 6, Page(s) 810–826

Abstract: Objective: To develop targeted interventions for high-risk drinkers among South African men, we assessed whether sociodemographic factors and history of childhood sexual abuse predicted binge drinking at six-month follow-up assessment and their ... ...

Abstract	Objective: To develop targeted interventions for high-risk drinkers among South African men, we assessed whether sociodemographic factors and history of childhood sexual abuse predicted binge drinking at six-month follow-up assessment and their psychological pathways according to the extended Theory of Reasoned Action (TRA). Design: Survey responses with a sample of 1181 South African men from randomly selected neighbourhoods in Eastern Cape Province were collected at baseline and six-month follow-up. Multiple logistic regression analysis examined the baseline predictors of binge drinking. Serial multiple mediation analysis examined the psychological pathways. Main outcome measurements: Binge drinking at six-month follow-up. Results: Age (OR = 1.03, 95% CI: 1.01, 1.05), religious participation (OR = .73, CI: .65, .82) and history of childhood sexual abuse (OR = 1.82, CI: 1.32, 2.51) were significant predictors of binge drinking. Predictions of religious participation and history of childhood sexual abuse were partially mediated through attitude, subjective norm, descriptive norm and intention to binge drinking. Conclusion: South African men with childhood sexual abuse experience and low religious participation were at higher risk for binge drinking. The extended TRA model explains the associations of these factors to binge drinking and can contribute to the design and evaluation of interventions.
MeSH term(s)	Adolescent ; Adult ; Binge Drinking/epidemiology ; Binge Drinking/psychology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Risk Factors ; South Africa/epidemiology ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2018-02-07
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	625255-2
ISSN	1476-8321 ; 0887-0446
ISSN (online)	1476-8321
ISSN	0887-0446
DOI	10.1080/08870446.2018.1429613
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Article: Sexual attitudes and behaviour of university students at a rural South African University: Results of a Pilot Survey.

Heeren, G Anita / Jemmott, John B / Mandeya, Andrew / Tyler, Joanne C

Journal Of Human Behavior In The Social Environment

2014 Volume 22, Issue 8, Page(s) 1021–1032

Abstract: A cross sectional qualitative and quantitative pilot survey, using self administered questionnaire and focus group discussions, was conducted to assess the need for, and feasibility of, a health promotion programme for university students at a South ... ...

Abstract	A cross sectional qualitative and quantitative pilot survey, using self administered questionnaire and focus group discussions, was conducted to assess the need for, and feasibility of, a health promotion programme for university students at a South African University. We examined the gender and cultural effects on sexual attitudes and behaviour, as well as condom use. A total of 73 students, age's between 18 and 30 years, participated in the pilot survey. The results suggest that females compared to the males are more likely to abstain until they find a partner with whom they intend to settle. There was a strong belief that unprotected sex can lead to pregnancy and STIs. Overall participants were not sure if condom use had any negative effects, although female respondents felt that condoms affect the pleasure of sexual intercourse. The results suggest that there is a clear need for health promotion programmes aimed at young adults, who attend university. The programme would need to aim at improving general health knowledge, targeting health promotion and sexual risk behaviour among university students. Such a programme would have to consider gender, socio-economic circumstances as well as national and cultural background of the target population.
Language	English
Publishing date	2014-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2093202-9
ISSN	1540-3556 ; 1091-1359
ISSN (online)	1540-3556
ISSN	1091-1359
DOI	10.1080/10911359.2012.720909
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Article ; Online: Adenocarcinoma of the Uterine Cervix Shows Impaired Recruitment of cDC1 and CD8

Rotman, Jossie / Heeren, A Marijne / Gassama, Awa A / Lougheed, Sinead M / Pocorni, Noëlle / Stam, Anita G M / Bleeker, Maaike C G / Zijlmans, Henry J M A A / Mom, Constantijne H / Kenter, Gemma G / Jordanova, Ekaterina S / de Gruijl, Tanja D

Clinical cancer research : an official journal of the American Association for Cancer Research

2020 Volume 26, Issue 14, Page(s) 3791–3802

Abstract: Purpose: Adenocarcinoma of the uterine cervix is the second most common type of cervical cancer after squamous cell carcinoma (SCC). Although both subtypes are treated similarly, patients with adenocarcinoma have a worse prognosis. In this study, ... ...

Abstract	Purpose: Adenocarcinoma of the uterine cervix is the second most common type of cervical cancer after squamous cell carcinoma (SCC). Although both subtypes are treated similarly, patients with adenocarcinoma have a worse prognosis. In this study, immunologic features of the tumor microenvironment in these two subsets were pursued with potential therapeutic implications. Experimental design: The immune microenvironment of primary tumors and nonmetastatic tumor-draining lymph nodes (TDLN) was compared between patients with cervical adenocarcinoma ( Results: Flow cytometric analyses revealed intact T-cell differentiation in TDLNs, but hampered effector T-cell trafficking to the primary tumors in adenocarcinoma, as compared with SCC. TCGA analysis demonstrated higher expression of chemokines involved in effector T-cell homing (CXCL9/10/11) in SCC primary tumors as compared with adenocarcinoma primary tumors, which was highly correlated to a transcriptional signature for type I conventional dendritic cells (cDC1). This was consistent with elevated frequencies of CD141/BDCA3 Conclusions: Our data have identified an opportunity for the investigation of potentially novel therapeutic interventions in adenocarcinoma of the cervix, that is, β-catenin inhibition and cDC1 mobilization.
MeSH term(s)	Adenocarcinoma/drug therapy ; Adenocarcinoma/immunology ; Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adult ; Antineoplastic Combined Chemotherapy Protocols/pharmacology ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; CD8-Positive T-Lymphocytes/immunology ; Carcinoma, Squamous Cell/drug therapy ; Carcinoma, Squamous Cell/immunology ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/pathology ; Cervix Uteri/immunology ; Cervix Uteri/pathology ; Datasets as Topic ; Dendritic Cells/drug effects ; Dendritic Cells/immunology ; Drug Resistance, Neoplasm/drug effects ; Drug Resistance, Neoplasm/immunology ; Female ; Gene Expression Profiling ; Humans ; Immune Checkpoint Inhibitors/pharmacology ; Immune Checkpoint Inhibitors/therapeutic use ; Lymphocyte Activation ; Lymphocytes, Tumor-Infiltrating/immunology ; Middle Aged ; Tumor Microenvironment/immunology ; Uterine Cervical Neoplasms/drug therapy ; Uterine Cervical Neoplasms/immunology ; Uterine Cervical Neoplasms/mortality ; Uterine Cervical Neoplasms/pathology ; beta Catenin/antagonists & inhibitors ; beta Catenin/metabolism
Chemical Substances	CTNNB1 protein, human ; Immune Checkpoint Inhibitors ; beta Catenin
Language	English
Publishing date	2020-03-27
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1225457-5
ISSN	1557-3265 ; 1078-0432
ISSN (online)	1557-3265
ISSN	1078-0432
DOI	10.1158/1078-0432.CCR-19-3826
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Article: Health-Promotion Intervention Increases Self-Reported Physical Activity in Sub-Saharan African University Students: A Randomized Controlled Pilot Study.

Heeren, G Anita / Jemmott, John B / Marange, C Show / Rumosa Gwaze, Arnold / Batidzirai, Jesca Mercy / Ngwane, Zolani / Mandeya, Andrew / Tyler, Joanne C

Behavioral medicine (Washington, D.C.)

2017 Volume 44, Issue 4, Page(s) 297–305

Abstract: To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an ... ...

Abstract	To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33-8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43-2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01-1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091-2.07). The intervention reduced self-reported servings of fried foods (mean difference = -0.31; 95% CI: -0.60, -0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa.
MeSH term(s)	Africa South of the Sahara ; Exercise/psychology ; Female ; Health Promotion/methods ; Humans ; Male ; Pilot Projects ; Self Report ; Students/psychology ; Universities ; Young Adult
Language	English
Publishing date	2017-08-04
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	623101-9
ISSN	0896-4289
ISSN	0896-4289
DOI	10.1080/08964289.2017.1350134
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Article ; Online: Self-management program improves participation in patients with neuromuscular disease: A randomized controlled trial.

Veenhuizen, Yvonne / Cup, Edith H C / Jonker, Marianne A / Voet, Nicoline B M / van Keulen, Bianca J / Maas, Daphne M / Heeren, Anita / Groothuis, Jan T / van Engelen, Baziel G M / Geurts, Alexander C H

Neurology

2019 Volume 93, Issue 18, Page(s) e1720–e1731

Abstract: Objective: To investigate the effectiveness of Energetic, a self-management group program combining aerobic training, energy conservation management, and relapse prevention to improve social participation in patients with neuromuscular disease (NMD) and ...

Abstract	Objective: To investigate the effectiveness of Energetic, a self-management group program combining aerobic training, energy conservation management, and relapse prevention to improve social participation in patients with neuromuscular disease (NMD) and chronic fatigue. Methods: In this multicenter, assessor-blinded, 2-armed randomized controlled trial with repeated measurements, 53 patients with various types of NMD and chronic fatigue were randomly allocated to Energetic, a 4-month group intervention, or to usual care. The primary endpoint was social participation assessed with the Canadian Occupational Performance Measure (COPM) performance scale immediately postintervention. Secondary outcomes included COPM satisfaction scale, 6-Minute Walk Test (6MWT), and Checklist Individual Strength-subscale fatigue. Participants were followed for 11 months postintervention. Data were analyzed with linear models that account for repeated measurements. Results: Directly after intervention, the mean group difference for COPM-performance was 1.7 (95% confidence interval [CI] 1.0-2.4; Conclusion: Energetic led to sustainable improvements in social participation and functional endurance compared to usual care in patients with NMD and chronic fatigue.Clinicaltrials.gov IDENTIFIER: NCT02208687. Classification of evidence: This study provides Class III evidence that a combination of aerobic training, energy conservation management, and relapse prevention improves social participation in patients with NMD and chronic fatigue.
MeSH term(s)	Adult ; Affect ; Anxiety ; Exercise Therapy/methods ; Fatigue/physiopathology ; Fatigue/rehabilitation ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Mitochondrial Myopathies/physiopathology ; Mitochondrial Myopathies/rehabilitation ; Muscular Dystrophy, Facioscapulohumeral/physiopathology ; Muscular Dystrophy, Facioscapulohumeral/rehabilitation ; Myasthenia Gravis/physiopathology ; Myasthenia Gravis/rehabilitation ; Myositis, Inclusion Body/physiopathology ; Myositis, Inclusion Body/rehabilitation ; Neuromuscular Diseases/physiopathology ; Neuromuscular Diseases/rehabilitation ; Occupational Therapy/methods ; Patient Education as Topic ; Physical Endurance ; Secondary Prevention ; Self Efficacy ; Self-Management/education ; Self-Management/methods ; Single-Blind Method ; Social Participation ; Walk Test
Language	English
Publishing date	2019-09-30
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000008393
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Article: Disclosure of HIV Diagnosis to HIV-Infected Children in South Africa: Focus Groups for Intervention Development.

Heeren, G Anita / Jemmott, John B / Sidloyi, Lulama / Ngwane, Zolani

Vulnerable children and youth studies

2012 Volume 7, Issue 1, Page(s) 47–54

Abstract: Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy has reduced mortality among HIV-infected children, and as they survive into ... ...

Abstract	Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy has reduced mortality among HIV-infected children, and as they survive into adolescence, disclosing to them their diagnosis has emerged as a difficult issue, with many adolescents unaware of their diagnosis. There is a need to build an empirical foundation for strategies to appropriately inform infected children of their diagnosis, particularly in South Africa, which has the largest number of HIV-positive people in the world. As a step toward developing such strategies, we conducted a study in Eastern Cape Province, South Africa to identify beliefs about disclosing HIV diagnosis to HIV-infected children among caregivers, health-care providers, and HIV-positive children who knew their diagnosis. We implemented 7 focus groups with 80 participants: 51 caregivers in 4 groups, 24 health-care providers in 2 groups, and 5 HIV-positive children in 1 group. We found that although the participants believed that children from age 5 years should begin to learn about their illness, with full disclosure by age 12, they suggested that many caregivers fail to fully inform their children. The participants said that the primary caregiver was the best person to disclose. The main reasons cited for failing to disclose were (a) lack of knowledge about HIV and its treatment, (b) the concern that the children might react negatively, and (c) the fear that the children might inappropriately disclose to others, which would occasion gossip, stigmatization, and discrimination towards them and the family. We discuss the implications for developing interventions to help caregivers appropriately disclose HIV status to HIV-infected children and, more generally, communicate effectively with the children to improve their health outcomes.
Language	English
Publishing date	2012-02-24
Publishing country	England
Document type	Journal Article
ISSN	1745-0128
ISSN	1745-0128
DOI	10.1080/17450128.2012.656733
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Article: Health Promotion Project for University Students at a South African University: Results of a Pilot Survey.

Heeren, G Anita / Mandeya, Andrew / Marange, C Show / Batidzirai, Jesca M / Tyler, Joanne C

Journal Of Human Behavior In The Social Environment

2013 Volume 23, Issue 8, Page(s) 967–971

Abstract: Globally, chronic diseases place a tremendous burden on health care systems all over the world. The increased prevalence of chronic diseases is mainly influenced by industrialization and decreased levels of physical activity. A cross-sectional ... ...

Abstract	Globally, chronic diseases place a tremendous burden on health care systems all over the world. The increased prevalence of chronic diseases is mainly influenced by industrialization and decreased levels of physical activity. A cross-sectional qualitative and quantitative pilot survey, using a self-administered questionnaire and focus group discussions, was conducted with 73 students to assess the need for and feasibility of a health promotion program for university students at a rural South African university. The results of this survey suggest that there is a need for a health promotion program aimed at young adults who attend university.
Language	English
Publishing date	2013
Publishing country	United States
Document type	Journal Article
ZDB-ID	2093202-9
ISSN	1540-3556 ; 1091-1359
ISSN (online)	1540-3556
ISSN	1091-1359
DOI	10.1080/10911359.2013.831295
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