Objective. To employ the behavioral model of health services use in examining the extent to which predisposing, enabling, and need factors explain the treatment of the HIV-positive population in the ...United States with highly active antiretroviral therapy (HAART). Data Source. A national probability sample of 2,776 adults under treatment for human immunodeficiency virus (HIV) infection. Study Design. The article uses data from the baseline and six-month follow-up surveys. The key independent variables describe vulnerable population groups including women, drug users, ethnic minorities, and the less educated. The dependent variable is whether or not a respondent received HAART by December 1996. Data Collection. All interviews were conducted using computer-assisted personal interview instruments designed for this study. Ninety-two percent of the baseline interviews were conducted in person and the remainder over the telephone. Principal Findings. A multistage logit regression shows that the predisposing factors that have previously described vulnerable groups in the general population with limited access to medical care also define HIV-positive groups who are less likely to gain early access to HAART including women, injection drug users, African Americans, and the least educated (odds ratios, controlling for need, ranged from 0.35 to 0.59). Conclusions. Those HIV-positive persons with the greatest need (defined by a low CD4 count) are most likely to have early access to HAART, which suggests equitable access. However, some predisposing and enabling variables continue to be important as well, suggesting inequitable access, especially for African Americans and lower-income groups. Policymakers and clinicians need to be sensitized to the continued problems of African Americans and other vulnerable populations in gaining access to such potentially beneficial therapies. Higher income, anonymous test sites, and same-day appointments are important enabling resources. Key Words. Antiretroviral therapy, HIV, vulnerable groups, African Americans, access, equitable
Systemic instigation is a process by which endocrine signals sent from certain tumors (instigators) stimulate BM cells (BMCs), which are mobilized into the circulation and subsequently foster the ...growth of otherwise indolent carcinoma cells (responders) residing at distant anatomical sites. The identity of the BMCs and their specific contribution or contributions to responder tumor growth have been elusive. Here, we have demonstrated that Sca1.sup.+cKit.sup.- hematopoietic BMCs of mouse hosts bearing instigating tumors promote the growth of responding tumors that form with a myofibroblast-rich, desmoplastic stroma. Such stroma is almost always observed in malignant human adenocarcinomas and is an indicator of poor prognosis. We then identified granulin (GRN) as the most upregulated gene in instigating Sca1.sup.+cKit.sup.- BMCs relative to counterpart control cells. The GRN.sup.+ BMCs that were recruited to the responding tumors induced resident tissue fibroblasts to express genes that promoted malignant tumor progression; indeed, treatment with recombinant GRN alone was sufficient to promote desmoplastic responding tumor growth. Further, analysis of tumor tissues from a cohort of breast cancer patients revealed that high GRN expression correlated with the most aggressive triple-negative, basal-like tumor subtype and reduced patient survival. Our data suggest that GRN and the unique hematopoietic BMCs that produce it might serve as novel therapeutic targets.
Hepatitis C is Australia's most commonly notified infectious disease. Health education and support strategies that are gender- specific are key components of effective management of chronic illness, ...yet almost no information exists about gender-specific needs of those with hepatitis C. This paper reports on a qualitative study of the experiences of diagnosis, support and discrimination among men and women living with hepatitis C in Melbourne. Content analysis of in- depth interviews conducted with 20 women and 12 men revealed gender related differences in relation to symptom recognition, health seeking attitudes and notions of social support, with men tending to dismiss the impact of their illness and their needs for education and support in comparison to women. Results highlight the need to take gender into account when addressing primary health care issues for people living with hepatitis C. (author abstract)
Cultural beliefs, norms and values regarding sexuality and gender roles forge people's sexual behaviour and understanding of sexual health risk. Acknowledging a person's cultural background is a key ...challenge for the promotion of sexual health programs and strategies for the prevention of sexually transmitted diseases (STDs) and HIV/AIDS. This challenge acquires larger dimensions when health promotion programs are directed towards migrant communities. This article examines narratives about past and present life experiences of Chilean women living in Australia and Chilean women in Chile. We inquire about social changes and exposure to education women experienced in their own country and in Australia and the ways in which migrant women define and articulate their experiences in relation to sexual health prevention. In comparing these experiences, we raise a number of questions about sexual health promotion and programs, including the prevention of STDs and HIV/AIDS targeted to specific migrant communities in Australia. Very few sexual health policies and strategies in Australia take into account the impact that the social and cultural background of migrants, social changes and the 'settlement process' has on the cultural construction of gender identity of migrants in the new country. We propose that these cultural constructs are key in the formulation of migrants' beliefs and attitudes towards sexuality and sexual health. We suggest that there is a need to build effective and culturally appropriate sexual health promotion and prevention strategies that build upon the social and cultural background and the present and past life experiences of migrant women and men.
Various combinations of calcium (4.94 mmol), zinc (0.0071 mmol) and phytate (0.284 mmol) were added either to soy concentrate, casein or torula yeast to determine effects of their interaction on in ...vitro solubility of protein, calcium, zinc, and phytate (PA). Two Ca sources, calcium carbonate (CaCO3) and calcium-citrate-malate complex (CCM) were used. Two pH levels, 2.0 and 5.5, were used to simulate gastrointestinal pH conditions. An increase in pH significantly reduced (P less than 0.01) Zn solubility in all treatments with all protein sources. The solubility of Ca and PA were significantly decreased (P less than 0.01) when both components were present probably due to formation of insoluble Ca-PA complexes. At pH 5.5, with casein and yeast proteins, Zn was significantly more (P less than 0.01) soluble in samples with CCM, in the absence of PA, than in those with CaCO3.
The phytate X Ca:Zn millimolar ratio was varied in a number of soy protein concentrates and subjected to a sequential pH treatment to simulate gastrointestinal conditions. In two independent studies, ...calcium was either decreased incrementally from 4.94 to 0.25 mmol or zinc was increased from 0.0036 to 0.55 mmol. At the lowest level of calcium, a significant increase (P 0.01) in soluble zinc and soluble phytate was observed at pH 5.5, due to the possible formation of a soluble calcium-phytate-zinc complex. Soluble zinc significantly increased (P 0.01) only when the level of zinc was raised to 0.55 mmol. Neither soluble calcium nor soluble phytate was altered at this level
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