scholarly journals Survival and predictors of death in tuberculosis/HIV coinfection cases in Porto Alegre, Brazil: A historical cohort from 2009 to 2013

2021 ◽  
Vol 1 (11) ◽  
pp. e0000051
Author(s):  
Évelin Maria Brand ◽  
Maíra Rossetto ◽  
Bruna Hentges ◽  
Gerson Barreto Winkler ◽  
Erica Rosalba Mallmann Duarte ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Protective Factor ◽  
People Living With Hiv ◽  
Porto Alegre ◽  
Historical Cohort ◽  
Adjusted Risk ◽  
Probability Of Survival ◽  
Hiv Coinfection ◽  
Adjusted Risk Ratio ◽  
Directly Observed Treatment

Background Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. Methods We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. Results The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14–18.4), 4.51 for recurrence (95% CI: 1.11–18.4) and 4.53 for return after abandonment (95% CI: 1.12–18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. Conclusions Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.

scholarly journals Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort

PLoS ONE ◽  
2019 ◽  
Vol 14 (10) ◽  
pp. e0222786 ◽  
Author(s):  
Évelin Maria Brand ◽  
Maíra Rossetto ◽  
Karen da Silva Calvo ◽  
Gerson Barreto Winkler ◽  
Daila Alena Raenck da Silva ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Porto Alegre ◽  
Factors Associated ◽  
Hiv Coinfection ◽  
Directly Observed Treatment

Glycaemic responses to glucose and rice in people of Chinese and European ethnicity

2020 ◽  
Author(s):  
M Kataoka ◽  
BJ Venn ◽  
SM Williams ◽  
Lisa Te Morenga ◽  
IM Heemels ◽  
...  
Keyword(s):  
Ethnic Differences ◽  
Rice Variety ◽  
Glycaemic Index ◽  
Activity Levels ◽  
Glycaemic Response ◽  
Rice Varieties ◽  
Adjusted Risk ◽  
Postprandial Glycaemia ◽  
Adjusted Risk Ratio ◽  
Glucose Curve

Aims: Diabetes rates are especially high in China. Risk of Type 2 diabetes increases with high intakes of white rice, a staple food of Chinese people. Ethnic differences in postprandial glycaemia have been reported. We compared glycaemic responses to glucose and five rice varieties in people of European and Chinese ethnicity and examined possible determinants of ethnic differences in postprandial glycaemia. Methods: Self-identified Chinese (n = 32) and European (n = 31) healthy volunteers attended on eight occasions for studies following ingestion of glucose and jasmine, basmati, brown, Doongara® and parboiled rice. In addition to measuring glycaemic response, we investigated physical activity levels, extent of chewing of rice and salivary α-amylase activity to determine whether these measures explained any differences in postprandial glycaemia. Results: Glycaemic response, measured by incremental area under the glucose curve, was over 60% greater for the five rice varieties (P < 0.001) and 39% greater for glucose (P < 0.004) amongst Chinese compared with Europeans. The calculated glycaemic index was approximately 20% greater for rice varieties other than basmati (P = 0.01 to 0.05). Ethnicity [adjusted risk ratio 1.4 (1.2-1.8) P < 0.001] and rice variety were the only important determinants of incremental area under the glucose curve. Conclusions: Glycaemic responses following ingestion of glucose and several rice varieties are appreciably greater in Chinese compared with Europeans, suggesting the need to review recommendations regarding dietary carbohydrate amongst rice-eating populations at high risk of diabetes. © 2012 Diabetes UK.

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

scholarly journals A Tale of Two Viruses: Immunological Insights Into HCV/HIV Coinfection

2021 ◽  
Vol 12 ◽  
Author(s):  
Samaa T. Gobran ◽  
Petronela Ancuta ◽  
Naglaa H. Shoukry
Keyword(s):  
Disease Progression ◽  
Immune Reconstitution ◽  
Acute Infection ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Hiv Reservoir ◽  
Cell Counts ◽  
Hiv Coinfection ◽  
Hcv Coinfection ◽  
The Impact

Nearly 2.3 million individuals worldwide are coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Odds of HCV infection are six times higher in people living with HIV (PLWH) compared to their HIV-negative counterparts, with the highest prevalence among people who inject drugs (PWID) and men who have sex with men (MSM). HIV coinfection has a detrimental impact on the natural history of HCV, including higher rates of HCV persistence following acute infection, higher viral loads, and accelerated progression of liver fibrosis and development of end-stage liver disease compared to HCV monoinfection. Similarly, it has been reported that HCV coinfection impacts HIV disease progression in PLWH receiving anti-retroviral therapies (ART) where HCV coinfection negatively affects the homeostasis of CD4+ T cell counts and facilitates HIV replication and viral reservoir persistence. While ART does not cure HIV, direct acting antivirals (DAA) can now achieve HCV cure in nearly 95% of coinfected individuals. However, little is known about how HCV cure and the subsequent resolution of liver inflammation influence systemic immune activation, immune reconstitution and the latent HIV reservoir. In this review, we will summarize the current knowledge regarding the pathogenesis of HIV/HCV coinfection, the effects of HCV coinfection on HIV disease progression in the context of ART, the impact of HIV on HCV-associated liver morbidity, and the consequences of DAA-mediated HCV cure on immune reconstitution and HIV reservoir persistence in coinfected patients.

Birth outcomes are superior after transfer of fresh versus frozen embryos for donor oocyte recipients

2020 ◽  
Vol 35 (12) ◽  
pp. 2850-2859
Author(s):  
Cassandra Roeca ◽  
Rachel L Johnson ◽  
Tracy Truong ◽  
Nichole E Carlson ◽  
Alex J Polotsky
Keyword(s):  
Birth Weight ◽  
Birth Outcomes ◽  
Live Birth ◽  
Risk Ratio ◽  
Gestational Age ◽  
Embryo Cryopreservation ◽  
Adjusted Risk ◽  
Donor Oocyte ◽  
Adjusted Risk Ratio ◽  
Frozen Embryos

Abstract STUDY QUESTION For donor oocyte recipients, are birth outcomes superior for fresh versus frozen embryos? SUMMARY ANSWER Among fresh donor oocyte recipients, fresh embryos are associated with better birth outcomes when compared with frozen embryos. WHAT IS KNOWN ALREADY Frozen embryo transfer (ET) with vitrification has been associated with improved pregnancy rates, but also increased rates of large for gestational age infants. Donor oocyte recipients represent an attractive biological model to attempt to isolate the impact of embryo cryopreservation on IVF outcomes, yet there is a paucity of studies in this population. STUDY DESIGN, SIZE, DURATION A retrospective cohort of the US national registry, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, of IVF cycles of women using fresh donor oocytes resulting in ET between 2013 and 2015. Thawed oocytes were excluded. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Good obstetric outcome (GBO), defined as a singleton, term, live birth with appropriate for gestational age birth weight, was the primary outcome measure. Secondary outcomes included live birth, clinical pregnancy, spontaneous abortion, preterm birth, multiple births and gestational age-adjusted weight. Outcomes were modeled using the generalized estimating equation approach. MAIN RESULTS AND THE ROLE OF CHANCE Data are from 25 387 donor oocyte cycles, in which 14 289 were fresh and 11 098 were frozen ETs. A GBO was 27% more likely in fresh ETs (26.3%) compared to frozen (20.9%) (adjusted risk ratio 1.27; 95% confidence interval (CI) 1.21–1.35; P &lt; 0.001). Overall, fresh transfer was more likely to result in a live birth (55.7% versus 39.5%; adjusted risk ratio 1.21; 95% CI 1.18–1.26; P &lt; 0.001). Among singleton births, there was no difference in gestational age-adjusted birth weight between groups. LIMITATION, REASONS FOR CAUTION Our cohort findings contrast with data from autologous oocytes. Prospective studies with this population are warranted. WIDER IMPLICATIONS OF THE FINDINGS Among donor oocyte recipients, fresh ETs may be associated with better birth outcomes. Reassuringly, given its prevalent use, modern embryo cryopreservation does not appear to result in phenotypically larger infants. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.

Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

2019 ◽  
Vol 75 (3) ◽  
pp. 709-717 ◽  
Author(s):  
Naouale Maataoui ◽  
Céline Langendorf ◽  
Fatou Berthe ◽  
Jumamurat R Bayjanov ◽  
Willem van Schaik ◽  
...  
Keyword(s):  
Placebo Group ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Double Blind ◽  
Adjusted Risk ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

scholarly journals Strengths-Based Assessment for Suicide Prevention: Reasons for Life as a Protective Factor From Yup’ik Alaska Native Youth Suicide

Assessment ◽  
2019 ◽  
pp. 107319111987578 ◽  
Author(s):  
James Allen ◽  
Stacy M. Rasmus ◽  
Carlotta Ching Ting Fok ◽  
Billy Charles ◽  
Joseph Trimble ◽  
...  
Keyword(s):  
Protective Factors ◽  
American Indian ◽  
Suicide Prevention ◽  
Cause Of Death ◽  
Alaska Native ◽  
Suicide Risk ◽  
Protective Factor ◽  
Well Being ◽  
Health Crisis ◽  
Native Youth

Suicide is the second leading cause of death among American Indian and Alaska Native youth, and within the Alaska Native youth subpopulation, the leading cause of death. In response to this public health crisis, American Indian and Alaska Native communities have created strategies to protect their young people by building resilience using localized Indigenous well-being frameworks and cultural strengths. These approaches to suicide prevention emphasize promotion of protective factors over risk reduction. A measure of culturally based protective factors from suicide risk has potential to assess outcomes from these strengths-based, culturally grounded suicide prevention efforts, and can potentially address several substantive concerns regarding direct assessment of suicide risk. We report on the Reasons for Life (RFL) scale, a measure of protective factors from suicide, testing psychometric properties including internal structure with 302 rural Alaska Native Yup’ik youth. Confirmatory factor analyses revealed the RFL is best described through three distinct first-order factors organized under one higher second-order factor. Item response theory analyses identified 11 satisfactorily functioning items. The RFL correlates with other measures of more general protective factors. Implications of these findings are described, including generalizability to other American Indian and Alaska Native, other Indigenous, and other culturally distinct suicide disparities groups.

scholarly journals The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Morgan M. Millar ◽  
Joanne W. Elena ◽  
Lisa Gallicchio ◽  
Sandra L. Edwards ◽  
Marjorie E. Carter ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cancer Survivors ◽  
Cancer Registry ◽  
Patient Reported Outcomes ◽  
Web Surveys ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Patient Reported ◽  
Paper Survey ◽  
Survey Modes

Abstract Background Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. Methods Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. Results The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. Conclusions Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.

scholarly journals 2377. Social Determinants Impact Readmission Following Clostridioides difficile-Related Index Hospital Stay in Medicare Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S820-S820
Author(s):  
Elizabeth Scaria ◽  
Ryan Powell ◽  
Jen Birstler ◽  
Oguzhan Alagoz ◽  
Daniel Shirley ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Risk Ratio ◽  
Disadvantaged Neighborhood ◽  
Adjusted Risk ◽  
Clostridioides Difficile ◽  
Disadvantaged Neighborhoods ◽  
Adjusted Risk Ratio ◽  
Index Hospital ◽  
The Relationship ◽  
Readmission Risk

Abstract Background Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea and recurs in up to 30% of patients, often requiring readmission. Socioeconomic factors, such as living in a disadvantaged neighborhood may impact readmission but have not been studied. Methods We examined the relationship between neighborhood disadvantage, as measured by the Singh validated area deprivation index (ADI), and 30-day all-cause readmission risk in patients with an index hospital stay with CDI. We analyzed a random 20% sample of national Medicare claims for patients’ initial index hospitalization with a CDI diagnosis in 2014 (n = 19,528) that included each patient’s neighborhood ADI national percentile. The most disadvantaged neighborhoods were categorized as those in the upper 35 percentile, while the least disadvantaged was defined as those in the bottom 65% of national ADI rankings. We evaluated the relationship between ADI percentile and 30-day readmission risk using multivariate logistic regression, controlling for key patient demographics, comorbidities, and hospital/stay characteristics. Results A total of 19,528 patients had an index stay with CDI, 4,899 were readmitted within 30 days. Patients from the most disadvantaged neighborhoods had a higher average rate of readmission compared with those living in the least disadvantaged neighborhoods (28% vs. 24% rate; unadjusted risk ratio = 1.16 [1.10, 1.21]). This relationship held after controlling for confounders. After adjustment, being a resident in the most disadvantaged neighborhoods was associated with a 10% increased risk of readmission (adjusted risk ratio = 1.10 [1.05, 1.16]), which was similar to the effect sizes associated with dual Medicaid-Medicare enrollment status (adjusted risk ratio = 1.09 [1.03, 1.15]) and renal failure (adjusted risk ratio = 1.14 [1.08, 1.21]). Conclusion Living in a disadvantaged neighborhood is associated with an increased 30-day readmission risk similar in magnitude to Medicaid status and renal failure in patients with index hospitalizations of CDI. Future studies should examine whether interventions such as post discharge support and care coordination for patients in disadvantaged neighborhoods may reduce readmissions in this patient population. Disclosures All authors: No reported disclosures.

scholarly journals Periconceptional Folic Acid Supplementation and the Risk of Spontaneous Abortion among Women Who Prepared to Conceive: Impact of Supplementation Initiation Timing

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2264
Author(s):  
Yan-Yan Mao ◽  
Liu Yang ◽  
Min Li ◽  
Jun Liu ◽  
Qian-Xi Zhu ◽  
...  
Keyword(s):  
Folic Acid ◽  
Spontaneous Abortion ◽  
Lower Risk ◽  
Folic Acid Supplementation ◽  
Health Examination ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Periconceptional Period ◽  
Utilization Of Healthcare ◽  
The Impact

It is unclear whether periconceptional folic acid (FA) supplementation decreases the risk of spontaneous abortion (SA). The impact of supplementation initiation timing has not been ascertained. This cohort study aimed to investigate the association between maternal periconceptional FA supplementation and risk of SA, with due consideration of the supplementation initiation timing. Through the National Free Pre-conception Health Examination Project (NFPHEP), we identified 65,643 pregnancies on FA supplementation in Chongqing, China between 2010 and 2015. After adjusting for covariates, maternal periconceptional FA supplementation was associated with a lower risk of SA (adjusted risk ratio [aRR]: 0.52; 95% confidence interval [CI]: 0.48–0.56). Pregnant women with FA supplementation initiated at least 3 months before conception had a 10% lower risk of SA (aRR: 0.46; 95% CI: 0.42–0.50) than those with FA supplementation initiated 1–2 months before conception (aRR: 0.56; 95% CI: 0.50–0.62) or after conception (aRR: 0.56; 95% CI: 0.51–0.61). These associations might not thoroughly account for FA supplementation, and to some extent our findings confirm the role of the utilization of healthcare in preventing SAs. Women who initiated healthcare, including taking FA earlier during the periconceptional period, could have a lower risk of SA.

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