1
|
Hall SA, Towe SL, Nadeem MT, Hobkirk AL, Hartley BW, Li R, Huettel SA, Meade CS. Hypoactivation in the precuneus and posterior cingulate cortex during ambiguous decision making in individuals with HIV. J Neurovirol 2021; 27:463-475. [PMID: 33983505 PMCID: PMC8276275 DOI: 10.1007/s13365-021-00981-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
People with human immunodeficiency virus (HIV) often have neurocognitive impairment. People with HIV make riskier decisions when the outcome probabilities are known, and have abnormal neural architecture underlying risky decision making. However, ambiguous decision making, when the outcome probabilities are unknown, is more common in daily life, but the neural architecture underlying ambiguous decision making in people with HIV is unknown. Eighteen people with HIV and 20 controls completed a decision making task while undergoing functional magnetic resonance imaging scanning. Participants chose between a certain reward and uncertain reward with a known (risky) or unknown (ambiguous) probability of winning. There were three levels of risk: high, medium, and low. Ambiguous > risky brain activity was compared between groups. Ambiguous > risky brain activity was correlated with emotional/psychiatric functioning in people with HIV. Both groups were similarly ambiguity-averse. People with HIV were more risk-averse than controls and chose the high-risk uncertain option less often. People with HIV had hypoactivity in the precuneus, posterior cingulate cortex (PCC), and fusiform gyrus during ambiguous > medium risk decision making. Ambiguous > medium risk brain activity was negatively correlated with emotional/psychiatric functioning in individuals with HIV. To make ambiguous decisions, people with HIV underrecruit key regions of the default mode network, which are thought to integrate internally and externally derived information to come to a decision. These regions and related cognitive processes may be candidates for interventions to improve decision-making outcomes in people with HIV.
Collapse
Affiliation(s)
- Shana A Hall
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA.
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - M Tauseef Nadeem
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Sciences, Pennsylvania State University, 500 University Dr. Hershey, PA, 17033, USA
- Department of Public Health Sciences, Pennsylvania State University, 700 HMC Crescent Rd., Hershey, PA, 17033, USA
| | - Bennett W Hartley
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Rosa Li
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Campus Box #3270 235 E. Cameron Ave., Chapel Hill, NC, 27599-3270, USA
| | - Scott A Huettel
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Dr. Campus Box 90086, Durham, NC, 27708-0086, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
- Brain Imaging and Analysis Center, Duke University Medical Center, Campus Box 3918, Durham, NC, 27710, USA
| |
Collapse
|
2
|
Hartley BW, Sinkinson CA. Assessment of the Maya’s Beliefs and Preferences on Bonesetters and Bone Fracture Treatment in the Guatemalan Highlands: A Household Survey. Glob J Health Sci 2021. [DOI: 10.5539/gjhs.v13n3p89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: In the Lake Atitlán region of Guatemala, traditional bonesetters (hueseros) commonly treat bone fractures. The indigenous Kaqchikel population has access to biomedical care, but traditional medicine remains the preferred treatment modality for bone fracture.
METHODS: Households in four villages were surveyed to assess experiences with bone fracture treatment. Of 108 households sampled, 83 met inclusion criteria and completed the survey. Responses were analyzed to assess for group demographics, bone fracture prevalence, and treatment history. Independence testing assessed for subgroup differences.
RESULTS: Mean age: 40 years old. For fracture treatment, 37% (31/83) consulted with a physician/nurse whereas 75% (62/83) consulted with a bonesetter. 19% (16/83) consulted with both. Cast immobilization was utilized by only 16% (13/83) of participants. The services provided by bonesetters included massage, temazcal (sweat lodge), herbal poultice, prayer, and recommended rest. When comparing participants that used a cast (n=13) and those that used a bonesetter exclusively (n=46), the bonesetter group had lower rates of continued pain and movement limitation, higher satisfaction with treatment, and higher interest in seeking the same treatment in the future, though these findings were not statistically significant. Regarding future care, 66% (55/83) would consider consulting a doctor whereas 83% (69/83) would seek services from a bonesetter. 53% (44/83) would utilize both. If recommended, 46% (38/83) would consider using a cast. Only 22% (18/83) of participants reported previous musculoskeletal imaging.
CONCLUSION: These results suggest a high preference of bonesetters for bone injury treatment, reduced acceptance of biomedical care, and limited acceptance of cast immobilization.
Collapse
|