Expanding pre-exposure prophylaxis (PrEP) among transgender women in the United States is an important strategy to meet national HIV prevention goals, however self-reported use of PrEP is low in this ...group.
This study reports the findings of a cross-sectional analysis of the relationship of barriers as well as facilitators to recent PrEP use among transgender women enrolled in an evaluation of the TransLife Care project (Chicago, Illinois), a structural intervention designed to meet basic needs. We computed multivariable prevalence ratios for barriers, facilitators and recent PrEP use, controlling for demographics.
Findings suggest that psychosocial and structural barriers, including moderate/high alcohol use, stimulant use, and history of incarceration were all positively associated with recent PrEP use among urban transgender women. In addition, a psychosocial facilitator, gender affirmation, was positively associated with recent PrEP use, while, while collective self-esteem, a was negatively associated with it. Finally, common indications for PrEP have high sensitivity, but low specificity and predictive value for identifying those on PrEP.
We conclude that despite a large gap in PrEP use among those with indications, individuals experiencing psychosocial and structural barriers are more likely to use PrEP, and facilitators, such as psychological sense of affirmed gender may support its use.
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Transgender women are disproportionately impacted by HIV infection. We report herein the findings of a pre-post evaluation of the TransLife Care (TLC) project in Chicago, Illinois, on behaviors ...associated with HIV transmission among transgender women. Participants who received any TLC component versus those who did not were compared using mixed-effects logistic regression with random intercepts across follow-up time points. Ninety-seven participants aged 18 to 59 (median age 24) enrolled; 76.3% were transgender women of color. There was a decrease in condomless sex without consistent PrEP use at 8 months, which was not significantly different between those who did and did not receive the TLC intervention, controlling for calendar time. Evidence does not indicate that the TLC reduces condomless sex without PrEP protection among urban transgender women. However, given the preponderance of evidence of the influence of structural barriers on condomless sex, future research should continue to test the efficacy of structural interventions.
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally ...developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
To investigate the impact of the increased use of neoadjuvant chemotherapy on the complexity of cytoreductive surgeries for ovarian cancer.
Using the National Cancer Database, we performed a ...retrospective cohort study of women diagnosed between 2004 and 2015 with stage III or IV epithelial ovarian cancer who underwent either primary cytoreductive surgery (PDS) followed by adjuvant chemotherapy, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery. Cases were assigned a surgical complexity category as 1) Inadequate, 2) Low, 3) Moderate and, 4) High complexity. The primary outcome was the trend in surgical complexity over time. Secondary outcomes included temporal trends in treatment modality, perioperative mortality, and survival.
At total of 52,582 (76.3%) underwent PDS and 16,307 (23.7%) underwent NACT. The utilization of NACT increased from 7.7% in 2004 to 27.8% in 2015 (p-trend < 0.001). Patients undergoing moderate complexity surgeries increased from 28.9% to 33.5% and high complexity surgeries from 26.3% to 30% (p-trend < 0.001, for both). Trends in increasing surgical complexity were seen in both NACT and PDS cohorts. This increase in surgical complexity was seen most profoundly at the high-volume centers. Overall 30-day mortality decreased from 3.4% in 2004 to 1.4% in 2015; and 90-day mortality decreased from 7.6% to 4%. During the same time, 5-year survival increased from 39.7% to 49%.
Increase in the utilization of NACT is associated with decreased 30- and 90-day mortality and increase in five-year survival. Moreover, the overall complexity of ovarian cancer surgery has increased in both PDS and NACT cohorts.
•The utilization of NACT increased from 7.7% in 2004 to 27.8% in 2015.•High complexity surgeries increased from 26.3% to 30% from 2004 to 2015.•During the same time period, overall 30- and 90-day mortality decreased.•During the same time period, 5-year survival increased.
Objective
The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness‐based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate ...its impact on symptom improvement.
Methods
A single group, pre‐posttest design was implemented among female stages 0‐III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress‐reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2‐hour sessions for 6 weeks using an iPad.
Results
The mean age of the 15 enrolled BCS was 57 years; one participant was non‐Hispanic black, and 14 were non‐Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post‐mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large.
Conclusions
These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile‐based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.
Equine Herpesvirus type 1 (EHV-1) typically causes mild respiratory disease, but it can also cause late-term abortion, neonatal foal death and neurologic disease. Once a horse is infected, the virus ...concentrates to local lymphoid tissue, where it becomes latent. The virus can be reactivated during times of stress, which can lead to the initiation of devastating outbreaks. Understanding the carriage rate of latent EHV-1 in different geographic regions is essential for managing the disease. The objective of the current study was to estimate the prevalence of latent EHV-1 and compare the frequency of each variant in the submandibular lymph nodes of horses in Virginia. Sixty-three submandibular lymph nodes were collected post-partem from horses submitted to regional labs for necropsy, and qPCR was performed. All samples were negative for the
gene of EHV-1. The results demonstrated a low apparent prevalence of latent EHV-1 DNA in submandibular lymph nodes in this population of horses in Virginia. Despite this, the mainstay for outbreak prevention and mitigation continues to focus on minimizing risks and using appropriate and diligent biosecurity.
Using variable temperature atomic pair distribution function analysis, we study the emergence of charge density wave (CDW) order in 1T-TiSe2 and find that it takes place via a two-step transition. ...First, upon decreasing temperature to about 235(3) K, CDW related lattice distortions emerge in the individual TiSe2 layers alone. Then, upon further decreasing the temperature, the two-dimensional distortions in the layers couple and the widely recognized three-dimensional 2ao x 2ao x 2co superstructure emerges at about 205(3) K. Because two different band gaps are known to emerge at the same temperatures, the finding indicates the presence of strong electron-phonon coupling. The transient phase between the two steps lacks inversion symmetry and may serve as a precursor of the debated chiral 1T-TiSe2 phase. Finally, our findings are important for the understanding of the enigmatic CDW transition in 1T-TiSe2 and CDW instabilities in van der Waals materials in general.
Outdoor, field-based team sports have been a staple of American and international cultures throughout recorded history and are currently played by millions of athletes around the globe. In modern ...competition, it is critical for athletes and support staff such as coaches, strength and conditioning specialists, and medical personnel to cooperate to optimize competitive readiness and performance. Important variables that can enhance or reduce physiological adaptations related to these areas include the relationship between the prescribed training workload and potential injuries. Therefore, it is important to understand and modify these aspects to fit the unique needs of individual athletes and specific teams. Recent advancements in technology now allow aspects of performance to be monitored in real time via methods that are reliable, cost effective, and noninvasive. The purpose of this literature review is to summarize and elucidate the available information on the potential relationship between heart rate monitoring and training load and how it may be used to prevent, predict, or detect an injury among athletes who participate in field-based sports. Overall, results indicate that while such technology has been used to describe and prescribe training workload, little research has been done to monitor the relationship between these variables and proclivity for or recovery from injury. Future longitudinal studies that encapsulate and address the highly dynamic nature and relationship of these variables are needed to better understand how they interact. Such an understanding may allow personnel such as coaches and staff to better support athletes on and off the field.
The prevalence of childhood obesity and metabolic syndrome have increased in the United States in recent decades, causing significant concern among experts and practitioners in kinesiology and ...medicine. However, exercise and dietetic science suggest that the risk factors and associated health concerns could be mitigated with regular physical activity and proper nutrition. However, many individuals face barriers to a healthier lifestyle due to misinformation and a lack of awareness. One group that may be especially susceptible to these obstacles is children, since they rely on parents or guardians for setting rules and boundaries, establishing routines and habits, and acting as role models. This prospective study was designed to determine if educating parents of overweight or obese children on healthy and unhealthy lifestyle choices would translate to changes in the reported behaviors of their children. An initial survey identified and addressed risk factors for metabolic syndrome in children, and a follow-up survey inquired about change in nutrition, physical activity, and screen time. While there was a moderate correlation between the intervention and reported changes in nutritional practices, there was little lifestyle change overall. These findings suggest that simply diagnosing risk factors or providing educational opportunities are not likely to be sufficient to elicit behavioral change in family units. Since the health behaviors of parents and children are intertwined, parents should be informed on issues relating to health. Interventions that are tailored to specific families or individuals may be more successful.
Abstract
Genetic variations of breast cancer survivors (BCS) may contribute to level of residual symptoms, such as depression, stress, fatigue, and cognitive impairment. The objective of this study ...was to investigate whether particular single-nucleotide polymorphisms (SNPs) moderated symptom improvement resulting from the Mindfulness-Based Stress Reduction for Breast Cancer (MBSRBC) program. An overarching goal of personalized medicine is to identify individuals as risk for disease and tailor interventions based on genetic profiles of patients with diseases including cancer. BCS were recruited from Moffitt Cancer Center and University of South Florida’s Breast Health Program and were randomized to either the 6-week MBSR(BC) program (n = 92) or Usual Care (n = 93). Measures of symptoms, demographic, and clinical history data were attained at baseline, 6 weeks, and 12 weeks. A total of 10 SNPs from eight genes known to be related to these symptoms were studied using genomic DNA extracted from blood. Our results were examined for effect sizes, consistency, and statistical significance (p < .05). Three SNPs (rs4680 in COMT, rs6314 in HTR2A, and rs429358 in APOE) emerged as having the strongest (though relatively weak) and most consistent effects in moderating the impact of the MBSR program on symptom outcomes. Although effects were generally weak, with only one effect withstanding multiple comparisons correction for statistical significance, this translational behavioral research may help start the identification of genetic profiles that moderate the impact of MBSR(BC). The ultimate goal of this study is the development of personalized treatment programs tailored to the genetic profile of each patient.
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