Lawler, Kathy

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Now showing 1 - 4 of 4
  • Publication
    Validation of the Pediatric Symptom Checklist in HIV-Infected Batswana
    (2011-08-22) Lowenthal, Elizabeth D; Lawler, Kathy; Harari, Nurit; Moamogwe, Lesedi; Masunge, Japhter; Masedi, Motshodi; Matome, Bolefela; Seloilwe, Esther; Gross, Robert; Jellinek, Michael; Murphy, Michael
    Objective—To determine the validity of the Pediatric Symptom Checklist (PSC), a brief measure of psychosocial health, for screening HIV+ Batswana children. Method—Setswana versions of the parent and child PSC were administered to 509 HIV+ Batswana children (age 8–16) and their parents/guardians. Test properties were evaluated and cutoff scores were derived using receiver operating characteristic curve analysis. Scores on the parent-completed PSC and the child-completed PSC-Y were compared to parental and clinic staff reports of concern about the child’s psychosocial health and to scores on the Children’s Depression Inventory and the Revised Children’s Manifest Anxiety Scale. Results—The Setswana PSC has high internal consistency (Cronbach’s alpha 0.87 for the parent-completed version). Comparing PSC scores to parental reports of concern and childreported depression symptoms, a cut-off score of 20 on the PSC and PSC-Y maximised the sensitivity and specificity. Conclusions—The PSC performed well in Setswana-speaking children and is a promising screening tool for paediatric psychosocial problems in busy clinical settings. Screening with the PSC may allow for early detection and treatment of psychosocial problems. This is likely to be of particular value for HIV+ children for whom HIV treatment non-adherence may result from untreated psychosocial dysfunction.
  • Publication
    Neurobehavioral Effects in HIV-Positive Individuals Receiving Highly Active Antiretroviral Therapy (HAART) in Gaborone, Botswana
    (2011-02-18) Lawler, Kathy A; Ratcliffe, Sarah; Jeremiah, Kealeboga; Mosepele, Mosepele; Steenhoff, Andrew P; Cherry, Catherine; Seloilwe, Esther
    Objective To explore the prevalence and features of HIV-associated neurocognitive disorders (HANDS) in Botswana, a sub-Saharan country at the center of the HIV epidemic. Design and Methods A cross sectional study of 60 HIV-positive individuals, all receiving highly active antiretroviral therapy (HAART), and 80 demographically matched HIV-seronegative control subjects. We administered a comprehensive neuropsychological test battery and structured psychiatric interview. The lowest 10th percentile of results achieved by control subjects was used to define the lower limit of normal performance on cognitive measures. Subjects who scored abnormal on three or more measures were classified as cognitively impaired. To determine the clinical significance of any cognitive impairment, we assessed medication adherence, employment, and independence in activities of daily living (ADL). Results HIV+ subjects were impaired for all cognitive-motor ability areas compared with matched, uninfected control subjects. Thirty seven percent of HIV+ patients met criteria for cognitive impairment. Conclusion These findings indicate that neurocognitive impairment is likely to be an important feature of HIV infection in resource-limited countries; underscoring the need to develop effective treatments for subjects with, or at risk of developing, cognitive impairment.
  • Publication
    Cognitive Health among Older Adults: Evidence from Rural Sub-Saharan Africa
    (2016-07-26) Payne, Collin F.; Kohler, Iliana V.; Bandawe, Chiwoza; Lawler, Kathy A.; Kohler, Hans-Peter
    Cognitive health is an important dimension of well-being in older ages, but few studies have investigated cognitive health in sub-Saharan Africa’s (SSA) growing population of mature adults (= persons age 45+). We use data from the Malawi Longitudinal Study of Families and Health (MLSFH) to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age-pattern of decline in cognitive health for both men and women is similar to that observed in the U.S. We also find that women have substantially worse cognitive health than men, and experience a steeper decline of cognitive ability with age. Strong social ties and exposure to socially complex environments are associated with higher cognitive health, as is higher socioeconomic status. Poor cognitive health is associated with adverse social and economic well-being outcomes such as less nutrition intake, lower income, and reduced work efforts even in this subsistence agriculture context. Lower levels of cognitive health are also strongly associated with increased levels of depression and anxiety, and are associated with worse physical health measured through both self-reports and physical performance.
  • Publication
    Neurocognitive Impairment Among HIV-Positive Individuals in Botswana: A Pilot Study
    (2010-04-20) Lawler, Kathy; Ratcliffe, Sarah; Mosepele, Mosepele; Seloilwe, Esther; Steenhoff, Andrew P; Steele, Katherine; Nthobatsang, Rudo
    Background The primary objective of this study was to determine the prevalence of neurocognitive impairment among HIV-positive individuals in Botswana, using the International HIV Dementia Scale (IHDS). We also compared performance on the IHDS with performance on tests of verbal learning/memory and processing speed, and investigated the association between performance on the IHDS and such variables as depression, age, level of education and CD4 count. Methods We conducted a cross-sectional study of 120 HIV-positive individuals randomly selected from an outpatient HIV clinic in Gaborone, Botswana. Patients provided a detailed clinical history and underwent neuropsychological testing; measures of depression, daily activities and subjective cognitive complaints were recorded. Results Despite the fact that 97.5% of subjects were receiving highly active antiretroviral therapy (HAART), 38% met criteria for dementia on the IHDS, and 24% were diagnosed with major depressive disorder. There was a significant association between neurocognitive impairment as measured by the IHDS and performance on the other two cognitive measures of verbal learning/memory and processing speed. Level of education significantly affected performance on all three cognitive measures, and age affected processing speed and performance on the IHDS. Depression and current CD4 count did not affect performance on any of the cognitive measures. Conclusions The prevalence of neurocognitive impairment in HIV-positive individuals in Botswana is higher than expected, especially since almost all of the subjects in this study were prescribed HAART. This suggests the need to reconsider the timing of introduction of antiretroviral therapy in developing countries where HAART is generally not administered until the CD4 cell count has dropped to 200/mm3 or below. The contribution of other factors should also be considered, such as poor central nervous system penetration of some antiretrovirals, drug resistance, potential neurotoxicity, and co-morbidities. Memory impairment and poor judgment may be underlying causes for behaviours that contribute to the spread of HIV and to poor adherence. It is important to identify these neurobehavioural complications of HIV so that effective treatments can be developed.