A previous analysis of the impact of drought in Africa on HIV demonstrated an 11% greater prevalence in HIV-endemic rural areas attributable to local rainfall shocks. The Lesotho Population-Based HIV ...Impact Assessment (LePHIA) was conducted after the severe drought of 2014-2016, allowing for reevaluation of this relationship in a setting of expanded antiretroviral coverage.
LePHIA selected a nationally representative sample between November 2016 and May 2017. All adults aged 15-59 years in randomly selected households were invited to complete an interview and HIV testing, with one woman per household eligible to answer questions on their experience of sexual violence. Deviations in rainfall for May 2014-June 2016 were estimated using precipitation data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS), with drought defined as <15% of the average rainfall from 1981 to 2016. The association between drought and risk behaviors as well as HIV-related outcomes was assessed using logistic regression, incorporating complex survey weights. Analyses were stratified by age, sex, and geography (urban versus rural). All of Lesotho suffered from reduced rainfall, with regions receiving 1%-36% of their historical rainfall. Of the 12,887 interviewed participants, 93.5% (12,052) lived in areas that experienced drought, with the majority in rural areas (7,281 versus 4,771 in urban areas). Of the 835 adults living in areas without drought, 520 were in rural areas and 315 in urban. Among females 15-19 years old, living in a rural drought area was associated with early sexual debut (odds ratio OR 3.11, 95% confidence interval CI 1.43-6.74, p = 0.004), and higher HIV prevalence (OR 2.77, 95% CI 1.19-6.47, p = 0.02). It was also associated with lower educational attainment in rural females ages 15-24 years (OR 0.44, 95% CI 0.25-0.78, p = 0.005). Multivariable analysis adjusting for household wealth and sexual behavior showed that experiencing drought increased the odds of HIV infection among females 15-24 years old (adjusted OR aOR 1.80, 95% CI 0.96-3.39, p = 0.07), although this was not statistically significant. Migration was associated with 2-fold higher odds of HIV infection in young people (aOR 2.06, 95% CI 1.25-3.40, p = 0.006). The study was limited by the extensiveness of the drought and the small number of participants in the comparison group.
Drought in Lesotho was associated with higher HIV prevalence in girls 15-19 years old in rural areas and with lower educational attainment and riskier sexual behavior in rural females 15-24 years old. Policy-makers may consider adopting potential mechanisms to mitigate the impact of income shock from natural disasters on populations vulnerable to HIV transmission.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Nailfold capillaroscopy (NFC) is increasingly used in the early identification of systemic sclerosis (SSc)-related disorders. A consensus "Fast Track algorithm" was developed by the European Alliance ...of Associations for Rheumatology to aid differentiation of scleroderma from nonscleroderma pattern on NFC. Our objective was to evaluate the online training of NFC using the Fast Track algorithm in the assessment of scleroderma vs nonscleroderma NFC pattern.
Participants attended the NFC online training workshop and were taught the Fast Track algorithm. Following the training, participants independently evaluated 45 NFC images in the same session, and then 2 to 4 weeks later, through the online platform. Participants had to differentiate between scleroderma vs nonscleroderma pattern, and additionally nonscleroderma pattern (normal) vs nonscleroderma pattern (nonspecific). The inter- and intrarater Cohen Formula: see text agreement was calculated.
Ninety-eight participants took part in the baseline evaluation, and 61 in the reevaluation session. For identification of scleroderma vs nonscleroderma pattern, the mean (95% CI) inter- and intrarater Formula: see text were 0.86 (0.83-0.88) and 0.83 (0.79-0.87), respectively. The overall inter- and intrarater Formula: see text in the identification of scleroderma, nonscleroderma (normal), and nonscleroderma (nonspecific) patterns were 0.71 (0.69-0.74) and 0.71 (0.67-0.75), respectively. For nonscleroderma (normal) vs nonscleroderma (nonspecific) pattern, the inter- and intrarater Formula: see text were 0.59 (0.55-0.63) and 0.59 (0.54-0.65), respectively.
In this first study evaluating NFC online training using the Fast Track algorithm, we showed very good inter- and intrarater agreement for the identification of scleroderma and nonscleroderma NFC pattern, supporting the feasibility of online NFC standardized training workshops.
Background. To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on ...incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)–infected adults in low- and middle-income countries (LMICs). Methods. Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count ≥200 cells/μL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. Results. We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%–91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval CI, 828 032–874 853), with cost savings of $46.7 million (95% CI, $43.8–$49.4 million). Conclusions. There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted.
Background. Human immunodeficiency virus (HIV)–infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have ...suggested that opioid substitution therapy (OST) could facilitate PWID's engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID. Methods. We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic. Results. We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio HR, 1.69; 95% confidence interval CI, 1.32–2.15), a 54% increase in ART coverage (odds ratio OR, 1.54; 95% CI, 1.17–2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41–3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63–.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21–1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65–1.25). Conclusions. These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID.
Objective
Patients with pulmonary arterial hypertension (PAH) may be stratified as low, intermediate, or high risk of 1‐year mortality. In 2022, the European Society of Cardiology (ESC) updated and ...simplified its risk stratification tool, based on three variables: World Health Organization functional class, serum N‐terminal pro‐brain type natriuretic peptide and six‐minute walk distance, applied at follow‐up visits, intended to guide therapy over time.
Methods
We applied the 2022 ESC risk assessment tool at baseline and follow‐up (within 2 years) to a multinational incident cohort of systemic sclerosis‐associated PAH (SSc‐PAH). Kaplan‐Meier curves, Cox hazards regression, and accelerated failure time models were used to evaluate survival by risk score.
Results
At baseline (n = 260), the majority of SSc‐PAH (72.2%) were graded as intermediate risk of death according to the 2022 tool. At follow‐up, according to 2022 tool, half (55.5%) of the cohort were classified as low or intermediate‐low risk. The 2022 risk model at follow‐up was able to differentiate survival between risk strata. All three individual parameters (World Health Organization functional class, N‐terminal pro‐brain type natriuretic peptide, six‐minute walk distance) were significantly associated with mortality at baseline and/or follow‐up.
Conclusion
The 2022 ESC risk assessment strategy applied at baseline and follow‐up predicts survival in SSc‐PAH. Treatment decisions for SSc‐PAH should include risk assessments, aiming to achieve low‐risk status according to the 2022 ESC guidelines.
Objective
To assess work productivity, identify associated factors and evaluate the economic burden of systemic sclerosis (SSc) in a multiethnic Asian population.
Methods
Data on employment status ...and work productivity loss were collected. Associations between demographic and disease characteristics and unemployment status, work productivity loss, and activity impairment were examined using logistic and linear regression analyses, as appropriate. Costs of unemployment and work productivity loss were estimated using the human capital approach.
Results
Of 111 patients with a mean disease duration of 9.1 years, 33 (29.7%) were unemployed. Their mean age at unemployment was 44.2 years, equating to 22.8 years of lost employment. No demographic and disease characteristics were significantly associated with unemployment status in multivariable analysis. Of 73 employed patients, 39 (53.4%) reported work productivity loss, accounting for 45.9% of the working week. The presence of hyperlipidemia (coefficient –19.01, P = 0.03) was associated with work productivity loss in multivariable analysis. In total, 37 of 78 employed patients (47.4%) and 19 of 33 unemployed patients (57.6%) reported activity impairment, accounting for 42.2% and 50.0%, respectively, of the preceding week. The presence of hyperlipidemia (coefficient –18.56, P < 0.01) was associated with activity impairment in multivariable analysis. Annual cost of unemployment and work productivity loss were estimated to be $53,244 and $13,045 (Singapore dollar) per patient, respectively.
Conclusion
SSc imposes significant unemployment and work productivity loss and causes a substantial economic burden to both affected individuals and society. Modifying the identified factors associated with unemployment and work productivity loss may reduce the burden of SSc.
ObjectivesPoor symptom appraisal (detection, interpretation and response to symptoms) plays a major role in prolonged prediagnosis interval in various health conditions. Theories and models have been ...proposed to study the symptom appraisal process but how they could be employed to improve symptom appraisal remains unclear. We therefore aimed to review approaches to improving symptom appraisal in the literature and to develop a theoretical framework that could guide the development of approaches to improving symptom appraisal among individuals in the general population.DesignSystematic review.Data sourcesMedline, Web of Science, PsycINFO, Embase, CINAHL and Scopus were searched from inception to 30 March 2021.Eligibility criteriaWe included original articles in English in which approaches to improve the detection, interpretation or response to symptoms for symptomatic individuals were described. We excluded articles in which approaches were developed to improve symptom appraisal among healthcare professionals.Data extraction and synthesisA predefined data extraction form was used to extract the development, characteristics and evaluation of approaches to improving symptom appraisal. This formed the basis for the narrative synthesis.ResultsOf 19 046 publications identified from the literature search, 112 were selected for full-text review and 29 approaches comprising provision of knowledge of symptoms/signs and additional components (eg, symptom self-examination and comparison) for symptom appraisal were included in the synthesis. Less than half (41.4%) of these approaches were developed based on theories/models. Interestingly, despite the variety of theories/models adopted in developing these approaches, the components of these approaches were similar.ConclusionSymptom appraisal is an essential process in a patient’s journey that can be targeted to facilitate early diagnosis but is largely unstudied. Building on the literature, we proposed a theoretical framework and approaches to improving symptom appraisal. This could facilitate early identification of a variety of health conditions in the general population.Trial registration numberCRD42021279500.
Abstract
Background
Population-level research evaluating HIV-related stigma among countries with varied national HIV prevalence is scarce. To better understand HIV-related stigma and mitigate its ...potential negative effects, it is necessary to evaluate its relationship with HIV prevalence, as well as the mechanisms that influence it. This study aimed to analyze how HIV-related stigma correlates with subnational HIV prevalence in three African countries with varied HIV epidemics.
Methods
This paper used data from the nationally representative Population-based HIV Impact Assessment (PHIA) surveys conducted from 2015–2017 in Malawi, Zambia, and Tanzania. Each country's sub-national geographic divisions were used to categorize them as low (0–5.4%), middle (5.5–11.2%), and high (11.3–17.1%) HIV prevalence regions in the main analysis. Questions from the survey stigma module were used to measure HIV-related stigma. Logistic regression and multilevel models were performed to assess the associations between the level of sub-national HIV prevalence and HIV-related stigma measures among persons living with, and without, HIV.
Results
The results show that the odds of people living without HIV expressing stigmatizing behavior towards PLWH was significantly lower in regions of middle (OR = 0.80, 90%CI = (0.68–0.96)) and high (OR = 0.65, 90%CI = (0.53–0.80)) HIV prevalence when compared to low prevalence regions. The odds of reporting discriminatory attitudes were also lower for those in middle (OR = 0.87, 90%CI = (0.78–0.98)) and high (OR = 0.64, 90%CI = (0.56–0.73)) HIV prevalence regions compared to others. Living in middle and high HIV prevalence regions was associated with lower odds of expressing prejudice toward PLWH (OR = 0.84, 90%CI = (0.71–0.99) and OR = 0.60, 90%CI = (0.45–0.80), respectively) among people living without HIV. Notably, PLWH living in high prevalence regions had higher odds of reporting internalized stigma (OR = 1.48, 90%CI = (1.02–2.14)) compared to those living in low prevalence regions.
Conclusions
The results indicate that among people not living with HIV, subnational HIV prevalence was negatively associated with discriminatory attitudes and prejudice towards PLWH, but HIV prevalence was positively associated with self-reported internalized stigma among PLWH. These results provide insight on how resources could be invested to reduce HIV related stigma among both PLWH and those not living with HIV.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Aim
Social cognitive theory (SCT) has been successfully employed to improve symptom appraisal and help‐seeking among patients with various conditions but is yet to be applied in the context ...of autoimmune rheumatic diseases (ARDs). This study aimed to explore the applicability of SCT in and possible approaches to improving symptom appraisal and help‐seeking of patients with ARDs, one of the key barriers to earlier diagnosis.
Methods
Semi‐structured interviews were conducted with 33 ARD patients with a prolonged pre‐diagnosis interval (>3 months). We coded the transcripts deductively using SCT as the overarching framework and inductively for approaches identified from the interviews.
Results
All six main concepts of SCT (behavioral capacity, expectations, self‐efficacy, observational learning, reinforcements, and reciprocal determinism) were observed in the three stages of symptom appraisal and help‐seeking (detection, interpretation, and response) of patients with ARDs. While many participants reported that they were able and confident to detect their symptoms, they lacked the behavioral capacity and self‐efficacy to interpret symptoms correctly, which resulted in delayed help‐seeking and diagnosis. Possible approaches to address this suggested by participants (such as education of the general population) could improve behavioral capacity and self‐efficacy in symptom interpretation and enhance expectations, observational learning, reinforcements, and reciprocal determinism in symptom response.
Conclusion
Lack of behavioral capacity and self‐efficacy was observed in symptom interpretation of patients with ARDs, which resulted in delayed help‐seeking. Approaches could target the behavioral capacity and self‐efficacy for symptom interpretation to facilitate early help‐seeking and, in turn, earlier diagnosis among individuals with possible ARDs.
Studies of flares of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination are limited by small sample size, short follow up or at risk of selection bias.
A national ...retrospective cohort study of consecutive AIIRD patients ≥12 years old, across 8 hospitals who received at least one dose of a COVID-19 mRNA vaccine. Patients were included from the date of 1st vaccine dose and censored at the time of flare or on the date of the clinic visit at least 3 months from cohort entry, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis.
4627 patients (73% Chinese, 71% female) of median (IQR) age 61 (48, 70) years were included; 42% Rheumatoid arthritis, 14% Systemic lupus erythematosus and 11% Psoriatic arthritis. 47% were in remission, 41% low disease activity, 10% moderate disease activity and 1% in high disease activity. 18% patients flared, of which 11.7% were within the 3-month period of interest. 11.8% patients improved. Median (IQR) time-to-flare was 60 (30, 114) days. 25% flares were self-limiting, 61% mild-moderate and 14% severe. Older patients (53–65 years and >66 years) had a lower risk of flare HR 0.6 (95% CI 0.5–0.8) and 0.7 (0.6–0.8) respectively. Patients with inflammatory arthritis and with active disease had a higher risk of flare HR 1.5 (1.2–2.0) and 1.4 (1.2–1.6), respectively. Treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), immunosuppression and prednisolone was also associated with an increased risk of flare HR 1.5 (1.1–2), 1.2 (1.1–1.4) and 1.5 (1.2–1.8) for prednisolone ≤7.5 mg respectively.
There was a moderately high rate of AIIRD flares after mRNA vaccination but also improvement in several patients. Severe flares and hospitalisation were rare. Thus, vaccination remains safe and highly recommended.
•Our large inception cohort of consecutively vaccinated AIIRD patients yielded a flare rate of 4.5/100 patient-months.•Predictors of flares were younger age, inflammatory arthritis, active disease and immunosuppressive treatment.•Severe flares were rare; thus vaccination is safe and highly recommended for our vulnerable patients with AIIRD.
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