Sexual Risk as an Outcome of Social Oppression Díaz, Rafael M; Ayala, George; Bein, Edward
Cultural diversity & ethnic minority psychology,
08/2004, Letnik:
10, Številka:
3
Journal Article
Recenzirano
Based on data from a probability sample of 912 Latino gay men in 3
U.S. cities, a multivariate model of sexual risk was
tested, including experiences of homophobia, racism, and
poverty as predictors. ...Participants reported multiple instances of
verbal and physical abuse, rude mistreatment, and discrimination
on account of their sexual orientation and their race or ethnicity.
Many reported experiences of poverty, such as inability to pay for
basic necessities of food or shelter. Men who reported more instances
of social discrimination and financial hardship were more psychologically
distressed and more likely to participate in "difficult" sexual
situations, as predicted. Participation in difficult sexual
situations mediates the effects of social oppression and psychological
distress on sexual risk behavior.
Acute heart failure (AHF) is associated with a poor prognosis regardless of left ventricular ejection fraction (LVEF). STRONG-HF showed the efficacy and safety of a strategy of rapid uptitration of ...oral treatment for heart failure (HF) and close follow-up (high-intensity care), compared with usual care, in patients recently hospitalized for AHF and enrolled independently from their LVEF.
In this study, we sought to assess the impact of baseline LVEF on the effects of high-intensity care vs usual care in STRONG-HF.
The STRONG-HF trial enrolled patients hospitalized for AHF with any LVEF and not treated with full doses of renin-angiotensin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. High-intensity care with uptitration of oral medications was performed independently from LVEF. The primary endpoint was the composite of HF rehospitalization or all-cause death at day 180.
Among the 1,078 patients randomized, 731 (68%) had LVEF ≤40% and 347 (32%) had LVEF >40%. The treatment benefit of high-intensity care vs usual care on the primary endpoint was consistent across the whole LVEF spectrum (interaction P with LVEF as a continuous variable = 0.372). Mean difference in the EQ-5D visual analog scale change from baseline to day 90 between treatment arms was slightly greater at higher LVEF values, but with no interaction between LVEF as a continuous variable and the treatment strategy (interaction P = 0.358). Serious adverse events were also independent from LVEF.
Rapid uptitration of oral medications for HF and close follow-up reduce 180-day death and HF rehospitalization after AHF hospitalization independently from LVEF. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-ProBNP Testing, of Heart Failure Therapies STRONG-HF; NCT03412201)
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Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke ...(SHS) worldwide.
We did a standardised case-control study of acute myocardial infarction (AMI) with 27 089 participants in 52 countries (12 461 cases, 14 637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers.
Current smoking was associated with a greater risk of non-fatal AMI (odds ratio OR 2·95, 95% CI 2·77–3·14, p<0·0001) compared with never smoking; risk increased by 5·6% for every additional cigarette smoked. The OR associated with former smoking fell to 1·87 (95% CI 1·55–2·24) within 3 years of quitting. A residual excess risk remained 20 or more years after quitting (1·22, 1·09–1·37). Exclusion of individuals exposed to SHS in the never smoker reference group raised the risk in former smokers by about 10%. Smoking beedies alone (indigenous to South Asia) was associated with increased risk (2·89, 2·11–3·96) similar to that associated with cigarette smoking. Chewing tobacco alone was associated with OR 2·23 (1·41–3·52), and smokers who also chewed tobacco had the highest increase in risk (4·09, 2·98–5·61). SHS was associated with a graded increase in risk related to exposure; OR was 1·24 (1·17–1·32) in individuals who were least exposed (1–7 h per week) and 1·62 (1·45–1·81) in people who were most exposed (>21 h per week). Young male current smokers had the highest population attributable risk (58·3%; 95% CI 55·0–61·6) and older women the lowest (6·2%, 4·1–9·2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15·4% (12·1–19·3).
Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.
Microbicides are an important strategy for preventing the sexual transmission of HIV but, so far, the most advanced tenofovir-based microbicides have had modest efficacy. This has been related to ...adherence problems and high prevalence of tenofovir-resistant HIV-1 strains. P3 is a new peptide with potent activity against HIV that may be a good microbicide candidate. In this work P3 was formulated in a gel of hydroxyethyl cellulose and its activity, stability and safety profile in Balb/c mice were evaluated. HIV infection was fully blocked by a 1.5% gel containing P3 at the IC90 (366.4 nM) concentration. The antiviral activity did not change at 4°C during 4 months and at 25, 37 and 65°C for 1 week. P3 was stable and fully functional at acidic pH up to 24h, under different concentrations of hydrogen peroxide and in the presence of genital fluids up to 48h. P3 had no antibacterial activity and did not affect sperm motility and vitality. Finally, P3 didn't cause significant alterations in the vaginal epithelium of Balb/c mice at 0.06 (456.8 μM) and 0.2 mg/day (1522.7 μM) doses. These findings indicate that P3 is an excellent candidate for further development as a microbicide gel for the prevention of HIV transmission in women.
A variety of NPWT products have become commercially available in the last 30 years. Utilizing advanced wound therapies appropriately can improve patient outcomes and decrease health care ...expenditures. Due to the increasing number of available product options, Hurd and colleagues published 10 Consensus Statements and a clinical decision tree to provide guidance on how and when to use NPWT and when to transition between device types.
To demonstrate the applicability of the consensus panel's statements and the clinical decision tree, 2 clinicians in the United States and Canada explored the benefits of applying these recommendations into their routine wound management practice.
Case studies were collected and reviewed in accordance with the Consensus Statements and clinical decision tree.
Case presentations illustrate the application of the consensus panel's guidance through the prescribing of the NPWT products utilized as standard of care within both facilities.
Utilizing NPWT devices according to the consensus panel recommendations and the clinical decision tree may assist in optimizing care delivery to patients and address logistical and economic efficiencies.
This paper aims to present the real improvement opportunities of a simple organic Rankine cycle (ORC) as waste heat recovery system (WHRS) from the exhaust gases of a natural gas engine using toluene ...as the working fluid, based on the exergy and environmental point of view. From the energy and exergy balances, the advanced exergetic analysis was developed to determine the irreversibilities and opportunities for improvement. Since the traditional exergo-environmental analysis, it was found that the component with the greatest potential environmental impact associated with exergy (bF = 0.067 mPts/MJ) and per unit of exergy (ḂD = 8.729 mPts/h) was the condenser, while the exergy-environmental fraction was presented in the turbine (52.51%) and pump-2 (21.12%). The advanced exergo-environmental analysis showed that the environmental impact is more associated with the operational behavior of the components, with 75.33% of the environmental impacts being of endogenous nature, showing that the environmental impacts are generated to a reduced magnitude through the interactions between components. However, it was identified that much of the environmental impacts in ITC 1 could be reduced, with 81.3% of these impacts being avoidable. Finally, the sensitivity analysis results revealed that steel is the material of the components with the least environmental impact.
•This work investigates the safety level of a deep beam originally designed using the strut-and-tie model.•A methodology is proposed and tested coupling NLFEA and reliability methods for the ...structural safety assessment.•The probability of failure and the reliability index are obtained using RSM.•A sensitivity analysis is carry out to identify the key parameters for a deep beam reliability assessment.
Nonlinear finite element analysis (NLFEA) is an important tool for solving deterministic structural problems and predicting the behavior of concrete structures. Nevertheless, inherent uncertainties in structural engineering cannot be considered using deterministic approaches. For that reason, the inclusion of reliability concepts in NLFEA has been a frequent subject in recent investigations. This work aims to study the safety of the design of reinforced concrete deep beams. This is done by coupling the finite element analysis and reliability theory approaches. The assessment of the shear capacity of deep beams involves different phenomenons such as discontinuity regions and size effect. Therefore, this cannot be designed or analyzed by simple calculations. In this study, a simply supported deep beam designed with the strut-and-tie method (STM) is used as an example of structural reliability assessment. The nonlinear analyses were performed in the software ATENA, based on concrete fracture and plasticity theory. For reducing computational effort, the reliability analysis was performed using two different Response Surface Method (RSM) strategies. Uncertainties from concrete properties and geometrical dimensions were considered using probability density functions. As a result, the safety of the deep beam design was expressed in terms of the reliability index β and the probability of failure Pf. According to the results obtained, the conclusion was that NLFEA combined with the reliability theory concept can allow an advanced safety assessment of deep beam design.
Background
Scoring systems were developed to stratify patients with colorectal liver metastases considered for liver resection into different risk groups. Such scores have never been evaluated in ...recurrent liver metastases. The aim of this study was to evaluate whether these scores are applicable to patients with recurrent colorectal liver metastases and treated with curative intent.
Methods
We retrospectively analyzed data from 375 consecutive patients who underwent liver surgery for colorectal liver metastases between June 2010 and August 2015. Seventy‐three patients developed liver‐limited recurrence treated with curative intent. The predictive value of 6 scores (Fong, Sofocleous, Nagashima, Nordlinger, Konopke, and the Basingstoke index) was assessed in this set of patients.
Results
Median follow‐up was 36.2 months. Overall survival and progression‐free survival were 33.6 and 5.6 months, respectively. When scores were applied for OS, none showed a significant stratification between patients, although Nagashima's score showed a significant difference in overall survival between patients from the low‐risk group and those from the intermediate‐ and high‐risk groups (40.8 vs 30.5 months, P = 0.039). For PFS, only Fong's score showed a statistically significant stratification (6.6 vs 4.7 months, P = 0.027).
Conclusion
Scoring systems are of limited‐value in stratifying patients operated on for recurrent colorectal liver metastases.
Background
The advantages of laparoscopy over open liver resection in patients with cirrhosis have been widely demonstrated. On the other hand, information on the role of minimally invasive liver ...surgery in the presence of clinically significant portal hypertension (CSPH) is scarce. The aim of this study was to evaluate the role of laparoscopic liver resection in selected cirrhotic patients with CSPH.
Methods
A retrospective case–control study of cirrhotic patients with hepatocellular carcinoma who were treated with laparoscopic liver resection was conducted from December 2005 to April 2016. A total of 45 patients were included. Patients were divided into two groups according to the presence or absence of clinically significant portal hypertension. Fifteen cirrhotic patients with CSPH were matched with 30 patients without CSPH.
Results
Overall, there were no differences in intraoperative results. No conversion to open surgery occurred in the CSPH group, and 3 patients were converted in the Non-CSPH group (0 vs. 10%
p
= 0.57). Only 2 (7%) patients in the Non-CSPH group and 1 (7%) in the CSPH group had relevant complications (modified Clavien–Dindo classification III). Two patients in the Non-CSPH group and one in the CSPH group developed transient ascites (7 vs. 7%). Postoperative hospital stay was similar in both groups, with a median of 4 days in the CSPH group and 3 days in the Non-CSPH group (
p
= 0.37). The median follow-up of the entire cohort was 38 months (range 7–100). Overall survival rates at 1 and 3 years were 100 and 87%, respectively. There was no significant difference between the groups in terms of survival (
p
= 0.8).
Conclusion
This initial study showed that laparoscopic resection in patients with CSPH can be performed safely in well-selected patients and expand the current surgical indications in patients with CSPH. Prospective trials with a larger sample size are necessary to confirm these results.
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