This book explores the challenges involved in conducting research with members of minoritized communities. Through reflective accounts, contributors explore community-based collaborative work, and ...suggest important implications for applied linguistics, educational research and anthropological investigations of language, literacy and culture.
Fracture rates have been reported to be higher among older women living with HIV (WLWH) than HIV- women. Hormone therapy with estrogen can reduce vasomotor symptoms (VMS) associated with menopause ...and prevent fractures. As data are limited on the benefits of hormone therapy use in WLWH, we examined associations of hormone therapy, use and fractures.
A prospective study of 1765 (1350 WLWH and 415 HIV-) postmenopausal Women's Interagency HIV Study (WIHS) participants was performed, including self-reported hormone therapy, use and fracture data from 2003 to 2017. Proportional hazard models determined predictors of new fractures at any site or at typical fragility fracture sites (hip, spine, wrist).
At the first postmenopausal visit, the median (IQR) age of WLWH was slightly younger than HIV- women 49.8 (46.4-53) vs. 50.7 (47.5-54), P = 0.0002 and a smaller proportion of WLWH reported presence of VMS (17% vs. 26%, P < 0.0001). A greater proportion of WLWH than HIV- women reported hormone therapy use (8% vs. 4%, P = 0.007) at the first postmenopausal visit. In multivariate analyses, white race and smoking were significant predictors of incident fracture at any site but hormone therapy ( P = 0.69) and HIV status ( P = 0.53) were not.
Our study did not find evidence of benefit or harm with regards to fracture outcomes in postmenopausal WLWH receiving hormone therapy. Further research is needed to determine whether hormone therapy has benefits beyond treatment of VMS, such as prevention of adverse aging-associated outcomes.
Predictors of adverse events (AE) associated with nevirapine use are needed to better understand reports of severe rash or liver enzyme elevation (LEE) in HIV+ women.
AE rates following ART ...initiation were retrospectively assessed in a multi-site cohort of 612 women. Predictors of onset of rash or LEE were determined using univariate and multivariate analyses.
Of 612 subjects, 152 (24.8%) initiated NVP-based regimens with 86 (56.6%) pregnant; 460 (75.2%) initiated non-NVP regimens with 67 (14.6%) pregnant. LEE: No significant difference was found between regimens in the development of new grade ≥2 LEE (p = 0.885). Multivariate logistic regression demonstrated an increased likelihood of LEE with HCV co-infection (OR 2.502, 95% CI: 1.04 to 6, p = 0.040); pregnancy, NVP-based regimen, and baseline CD4 >250 cells/mm(3) were not associated with this toxicity. RASH: NVP initiation was associated with rash after controlling for CD4 and pregnancy (OR 2.78; 95%CI: 1.14-6.76), as was baseline CD4 >250 cells/mm(3) when controlling for pregnancy and type of regimen (OR 2.68; 95% CI: 1.19-6.02 p = 0.017).
CD4 at initiation of therapy was a predictor of rash but not LEE with NVP use in HIV+ women. Pregnancy was not an independent risk factor for the development of AEs assessed. The findings from this study have significant implications for women of child-bearing age initiating NVP-based ART particularly in resource limited settings. This study sheds more confidence on the lack of LEE risk and the need to monitor rash with the use of this medication.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Pragmatic clinical trials (PCTs) seek to improve the generalizability and increase the statistical power of traditional explanatory trials. They are a major tenet of comparative ...effectiveness research. While a powerful study design, PCTs have been limited by high cost, modest efficiency, and limited ability to fill relevant evidence gaps. Based on an American Reinvestment and Recovery Act (ARRA) supported meeting of national stakeholders, we propose several innovations and future research that could improve the efficiency and effectiveness of such studies focused in the U.S. Innovations discussed include optimizing the use of community based practices through partnership with Practice Based Research Networks (PBRNs), using information technology to simplify PCT subject recruitment, consent and randomization processes, and utilizing linkages to large administrative databases, such as Medicare, as a mechanism to capture outcomes and other important PCT variables with lower subject and research team burden. Testing and adaptation of such innovations to PCT are anticipated to improve the public health value of these increasingly important studies.
Osteoporosis Saag, Kenneth G.; Morgan, Sarah L.; Warriner, Amy H.
A Clinician's Pearls and Myths in Rheumatology
Book Chapter
Bone continually undergoes a process of renewal called remodeling. In the normal adult skeleton, bone formation and bone resorption are closely coupled: new bone laid down by osteoblasts exactly ...matches osteoclastic bone resorption. The bone mass of an individual in later life is a consequence of the peak bone mass accrued in utero and during childhood and puberty, as well as the subsequent rate of bone loss. Genetic factors strongly contribute in determining the peak bone mass. However, hormonal, nutritional, and environmental influences modulate the genetically determined pattern of skeletal growth. More than 1.5 million fractures related to osteoporosis occur in the United States every year. Ninety percent of all hip and spine fractures are related to osteoporosis. Most osteoporotic fractures involve the femoral neck, the vertebral bodies, or the wrist. Two types of scores have been used traditionally to quantify bone mineral density (BMD): —The T score is the number of standard deviations of the patient's BMD above or below the young-normal mean BMD. —The Z score is the number of standard deviations of the measurement above or below the age-matched mean BMD. The World Health Organization (WHO) defines osteoporosis with a T score ≤ −2.5.
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