The population of women aged 50 years and older living with HIV is increasing. Older women face unique challenges in the prevention and management of HIV; however, they are often under engaged in ...HIV/AIDS research. One such challenge is gender-based stigma, which can be manifested through harmful gendered stereotypes, discrimination, prejudice, and sexism that could potentially hinder HIV care engagement among this population. We propose a scoping review to identify and synthesize evidence pertaining to how experiences of gender-based stigma impacts HIV prevention and care among older women.
We will use the framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) to conduct this scoping review. We will search MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus for empirical literature published between January 1981 and the date of search commencement. Supplementary screening will be conducted using backwards citation chaining of the final list of included full-text articles. Two reviewers will independently screen all titles and abstracts for articles that meet the predetermined inclusion criteria. Two reviewers will also screen full-text articles and chart data using a standardized data collection form.
We will synthesize the findings through tables, charts, and narrative summaries. We will also identify gaps in the current literature and provide recommendations for future research. Findings will be shared at conferences and submitted to a peer-reviewed publication.
To our knowledge, this will be the first scoping review to examine gender-based stigma in relation to HIV prevention and care among older women. We anticipate that our results will be of interest to older women living with HIV, healthcare providers, policy makers, and community activists working to improve quality of life and care experiences for older women living with HIV.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
High prevalence, unreliable risk discrimination and poor clinical outcomes are observed in malignant and benign breast diseases (BD). The involvement of microbial communities in the development of BD ...has become topical, and distal influences of microbial dysregulation in the breast have been well established. Despite advances, the role of the breast skin microbiota in BD remains unclear. Interactions between the skin microbiota and the underlying mucosal immune system are complex. In homeostasis, the skin offers a physical barrier protecting underlying breast tissue from skin commensals and noxious environmental triggers. Our review aims to illuminate the role of the skin microbiota in the development of BD.
Adhering to the PRISMA protocol, a systematic review was conducted utilising the Medline and Embase search engines.
Through a comprehensive search of the last ten years, twenty-two studies satisfied the inclusion criteria. Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were identified as the most prevalent phyla of both breast tissue and skin in healthy controls and BD. High abundance of skin commensals, specifically some species of Staphylococcus, have been linked in breast cancer and metastases. Similarly, dysregulated microbial abundance is also seen in inflammatory and implant-associated BD. These findings raise the hypothesis that the skin microbiota plays a role in tissue homeostasis and may contribute to a range of breast pathologies. Several mechanisms of microbial transfer to underlying tissue have been proposed, including retrograde transfer through ductal systems, breakdown of the skin barrier, and migration through nipple-aspirate fluid.
Our review provides preliminary insights into the skin microbiota as a modifiable risk factor for BD. This raises opportunities for future studies in antimicrobials/probiotics as an adjunct to, or replacement of surgery; a diagnostic and/or prognostic tool for BD; and the possibility of conditioning the microbiota to manage BD.
•The breast skin microbiota as a modifiable risk factor in breast disease.•The utilisation of antimicrobial or probiotic treatments in breast disease.•The role of the breast skin microbiota as a diagnostic or prognostic tool in breast disease.
The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project ...adapted the World Health Organization's Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training's impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement.
Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project's barriers, facilitators, and opportunities.
Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees' diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future.
This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Purified CYP27A1 can hydroxylate the side chain of lumisterol at C25 and C27.•Both (25R)- and (25S)-27‐hydroxylumisterol are products of CYP27A1.•CYP27A1 hydroxylates lumisterol with greater ...catalytic efficiency than vitamin D3.•CYP27A1 in liver mitochondria shows similar action on lumisterol to purified CYP27A1.•CYP27A1-derived hydroxylumisterols inhibit melanoma cell proliferation.
Prolonged exposure of the skin to UV radiation causes previtamin D3, the initial photoproduct formed by opening of the B ring of 7-dehydrocholesterol, to undergo a second photochemical reaction where the B-ring is reformed giving lumisterol3 (L3), a stereoisomer of 7-dehydrocholesterol. L3 was believed to be an inactive photoproduct of excessive UV radiation whose formation prevents excessive vitamin D production. Recently, we reported that L3 is present in serum and that CYP11A1 can act on L3 producing monohydroxy- and dihydroxy-metabolites which inhibit skin cell proliferation similarly to 1α,25-dihydroxyvitamin D3. In this study we tested the ability of human CYP27A1 to hydroxylate L3. L3 was metabolized by purified CYP27A1 to 3 major products identified as 25-hydroxyL3, (25R)-27-hydroxyL3 and (25S)-27-hydroxyL3, by NMR. These three products were also seen when mouse liver mitochondria containing CYP27A1 were incubated with L3. The requirement for CYP27A1 for their formation by mitochondria was confirmed by the inhibition of their synthesis by 5β-cholestane-3α,7α,12α-triol, an intermediate in bile acid synthesis which serves as an efficient competitive substrate for CYP27A1. CYP27A1 displayed a high kcat for the metabolism of L3 (76 mol product/min/mol CYP27A1) and a catalytic efficiency (kcat/Km) that was 260-fold higher than that for vitamin D3. The CYP27A1-derived hydroxy-derivatives inhibited the proliferation of cultured human melanoma cells and colony formation with IC50 values in the nM range. Thus, L3 is metabolized efficiently by CYP27A1 with hydroxylation at C25 or C27 producing metabolites potent in their ability to inhibit melanoma cell proliferation, supporting that L3 is a prohormone which can be activated by CYP-dependent hydroxylations.
Febrile neutropenia (FN) is a common side effect of cytotoxic chemotherapy that may result in poor treatment outcomes. The short acting granulocyte colony stimulating factors (G-CSF) act to stimulate ...granulocytes to increase production of white blood cells. The filgrastim biosimilar is useful, as it may provide a cheaper and equally effective treatment to FN. This study explored the usage of the filgrastim biosimilar (Grastofil
) and the reference biologic (Neupogen
) in breast cancer and lymphoma patients. A retrospective chart review of patients receiving Grastofil
from January 2017 to June 2019 or Neupogen
for primary prophylaxis of FN from January 2013 to December 2017 was conducted. The endpoints included the incidence of FN and the occurrence of dose reduction (DR) and dose delay (DD). One hundred and fifty-three Grastofil
patients were matched to 153 Neupogen
patients. This cohort was further split into breast cancer (
= 275) and non-Hodgkin's lymphoma (
= 31) cohorts. After adjusting for chemotherapy cycles, the biosimilar filgrastim was non-inferior to the reference biologic based on FN incidence in addition to related outcomes including DR and DD.
Background and Aim
Open‐access (OA) colonoscopies are defined as those scheduled without a gastrointestinal (GI) office visit. Past research has not focused on split preparation use and patient ...perception within OA. We aim to identify differences in bowel preparation (BP) adequacy, adenoma detection rate (ADR), self‐reported compliance, and patient perception between OA and GI providers using split prep.
Methods
This was a cross‐sectional study using split BP for colonoscopies. Patients completed a survey, and demographics, BP adequacy, and ADR were recorded. BP compliance was self‐reported. Patients were asked three questions qualifying the BP instructions. Data were analyzed using chi square and Mann–Whitney tests by SPSS.
Results
BP adequacy was reported for 56 of 60 patients. Twenty‐one participants (38%) were scheduled on OA, and 35 participants (62%) were scheduled after a GI office visit. Adequate BP was more frequent in 86% (18/21) of OA patients compared to 60% (21/35) in the GI group (P = 0.043). OA patients reported better review and explanation of the BP instructions compared to GI patients. There was no statistical difference between the demographics of the OA and GI groups or self‐reported compliance and patient understanding of instructions.
Conclusion
OA scheduled colonoscopies were associated with more adequate BP. This could be explained by patients' self‐motivation or an explanation of the importance of completing BP. This study supports the use of OA procedures as a standard of care.
We aim to identify differences in bowel preparation adequacy, adenoma detection rate, self‐reported compliance, and patient perception between open‐access (OA) and gastrointestinal (GI) providers using split preparation. OA patients reported better bowel preparation, review, and explanation of the bowel preparation instructions compared to GI patients. This study supports the use of OA procedures as a standard of care, possibly during the Coronavirus disease pandemic, which is causing a disruption in office operations.
Objective quantitative measurements of facial motion for the assessment of outcomes in patients with facial paralysis have been elusive. This paper will reintroduce an objective computerized program ...for measurement of facial motion and present data on symmetry in healthy subjects and test-retest reliability in patients with facial paralysis.
Cross-sectional analysis of archived images.
Tertiary referral center.
Good quality video-recordings of 38 healthy subjects and 30 facial paralysis subjects with a wide range of paralysis that had been tested twice were selected.
Using image subtraction techniques of digital video recordings, computer-generated strength-duration curves of prescribed facial movements were automatically constructed.
The areas under the curve for specific regions of each side of the face were compared as a proportion described as a percentage (left/right in healthy subjects, abnormal/normal side in paralysis) in which 100% would be perfect symmetry.
Thirty-eight healthy subjects had the following left/right symmetry means (95% confidence interval): brow, 98.95 (93.94-103.95); eye, 99.18 (96.31-102.06); and mouth, 96.87 (93.10-100.63).Thirty patients with varying degrees of facial paralysis, tested twice, were evaluated to determine the degree of agreement between trials as measured by the intraclass correlation coefficient. The results showed the intraclass correlation coefficient (95% confidence interval) for brow was 0.972 (0.943-0.987), eye 0.950 (0.898-0.976), and mouth 0.951 (0.901-0.976).
These results demonstrate no substantial side bias in healthy subjects and excellent test-retest reliability in patients with facial paralysis. This program may be made available for interested investigators upon request.
Optical coherence tomography (OCT) has emerged as a novel noninvasive imaging device that allows for the real-time, in vivo, cross-sectional imaging of skin morphology. OCT has increased imaging ...depth and field of view compared with reflectance confocal microscopy, at the cost of decreased cellular resolution. Frequency domain OCT, dynamic OCT (D-OCT), and high-definition OCT (HD-OCT) are useful in the diagnosis, treatment planning, and treatment monitoring of nonmelanoma skin cancers. Research is currently underway to assess the utilization of these devices in distinguishing between malignant and benign melanocytic lesions based on vascular patterns on D-OCT and cellular information on HD-OCT.
Palliative care aims to improve quality of life (QoL) for patients and families and does so by addressing issues not limited to pathology, but other symptoms that may be debilitating to patient ...experience and QoL. Despite sexual health being an important aspect of life for many patients, it is often omitted in clinical practice. This review summarizes published primary studies to explore the prevalence and importance of incorporating sexual health in the symptom screening and assessments of palliative patients, to identify current interventions that are implemented to address sexual health issues, and identify the barriers that health care professionals (HCPs) and patients may encounter which may prevent sexual health discussions. A literature review was conducted on Medline and Embase databases using keywords including "cancer", "sexual health", "intimacy", and "palliative care". Eleven papers focusing on the sexual health and intimacy of terminally ill patients in hospice, palliative or terminal care settings were identified for inclusion. Discussions about sexual health, functioning, and intimacy were not common in patient care, despite being a service that both patients and their partners desired. Referrals to sexologists, or discussions with patients and partners about intimacy and sexuality over the course of the disease trajectory were shown to improve QoL as well as alleviate some of the stress of receiving palliative care services. HCPs cited a lack of training, their own life experiences, or discomfort with the topic as barriers to initiating conversations with patients. In conclusion, sexuality and intimacy remain important parts of many people's lives regardless of their health, and should be incorporated into the care of all patients including those in palliative care. There is a need for further research to evaluate different methods or procedures for educating and counselling patients and their partners on sexual health issues. HCPs should have specific training and education in sexual health care to enable them to initiate and direct these discussions.
Sexual orientation health disparities are rooted in sexual minorities’ exposure to stress and challenges to effective coping. This article reviews the “toolkit” of psychosocial interventions ...available to reduce sexual minority stress effects. A systematic search uncovered 44 interventions that both seek to reduce sexual minority stress at its source in unjust and discriminatory social structures as well as bolster sexual minorities’ stigma‐coping abilities. These interventions were implemented in a variety of contexts (e.g., education, health care delivery) and utilized heterogeneous modalities to create change (e.g., policy implementation, role‐playing activities). They were designed to affect change across structural, interpersonal, and individual levels. The interventions reviewed here, while in early stages of efficacy testing, possess potential for meeting the needs and resources of mental and medical health care providers, policy makers, and other stakeholders who aim to lessen the burden of sexual minority stress and the health disparities it generates.
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