We evaluated characteristics associated with recent HIV infection among persons who inject drugs (PWID) from 19 U.S. cities who participated in 2012 National HIV Behavioral Surveillance. Recent ...infection was defined as having a reactive HIV test, a Bio-Rad Avidity index cutoff ≤ 30%, no reported HIV diagnosis ≥ 12 months before interview, and no evidence of viral suppression. Of 8667 PWID, 50 (0.6%) were recently HIV infected. Having a greater number of sex partners (≥ 2 partners vs. 0) prevalence ratio (PR) 4.7, 95% confidence interval (CI) 1.3–17.8, injecting heroin and other drugs (PR 3.0, 95% CI 1.3–6.6) or exclusively non-heroin drugs (PR 5.9, 95% CI 1.7–20.7) compared to injecting only heroin, and having male–male sex in the past year (PR 7.1, 95% CI 3.0–16.6) were associated with recent infection. Promoting not only safe injection practices but also safe sex practices will be key to preventing new HIV infections.
BACKGROUND:Monitoring the effects of HIV prevention efforts among persons who inject drugs is key to informing prevention programs and policy.
METHODS:Data for this study came from the 2012 National ...HIV Behavioral Surveillance interviews with persons who inject drugs across 20 US cities. The present analyses include those who identified as female, ever had sex with a man, and were at risk of HIV infection (did not report a previous positive HIV test result) (n = 2624). We conducted latent class analysis to identify sexual risk classes, and modeled associations with engagement in HIV prevention services and HIV test results.
RESULTS:We identified 6 classes of sexual risk behavior(1) low risk, (2) monogamous, (3) casual partner, (4) multiple partners, (5) exchange sex, and (6) exchange plus main partner. The class distribution was similar across the mainland regions. Bisexual orientation and homelessness were significant predictors of higher-risk class. HIV prevalence and participation in behavioral interventions did not vary significantly by risk class, while obtaining and using free condoms did. Independent of risk class, women in cities in the South were significantly less likely to use free condoms, and HIV prevalence was higher among non-Hispanic black women and women aged 40–49 years.
CONCLUSIONS:Bisexual orientation and homelessness were predictors of higher risk. Condom distribution programs reached fewer women in cities in the South. Race and age disparities in HIV-positive rates persisted after adjusting for sexual risk class.
The laparoscopic approach to appendectomy for acute appendicitis is becoming increasingly favored among surgeons. Endoscopic stapling remains a common approach for division of the appendix and ...mesoappendix, but staple line bleeding along the mesentery is commonly observed, occasionally demanding surgical control for complete hemostasis. Bioabsorbable seamguard was used as an adjunct to endoscopic stapling of the mesoappendix in 33 consecutive adult patients during laparoscopic appendectomy for acute appendicitis, with complete immediate staple line hemostasis observed by the operative surgeon in all cases. There were no intraoperative complications and no late infectious intra-abdominal complications. There were no postoperative bleeding complications. Bioabsorbable seamguard is a safe and effective adjunct to endoscopic mesoappendiceal stapling which prevents intraoperative and postoperative staple line bleeding.
Coronary heart disease (CHD) is the leading cause of mortality in African Americans. To identify common genetic polymorphisms associated with CHD and its risk factors (LDL- and HDL-cholesterol (LDL-C ...and HDL-C), hypertension, smoking, and type-2 diabetes) in individuals of African ancestry, we performed a genome-wide association study (GWAS) in 8,090 African Americans from five population-based cohorts. We replicated 17 loci previously associated with CHD or its risk factors in Caucasians. For five of these regions (CHD: CDKN2A/CDKN2B; HDL-C: FADS1-3, PLTP, LPL, and ABCA1), we could leverage the distinct linkage disequilibrium (LD) patterns in African Americans to identify DNA polymorphisms more strongly associated with the phenotypes than the previously reported index SNPs found in Caucasian populations. We also developed a new approach for association testing in admixed populations that uses allelic and local ancestry variation. Using this method, we discovered several loci that would have been missed using the basic allelic and global ancestry information only. Our conclusions suggest that no major loci uniquely explain the high prevalence of CHD in African Americans. Our project has developed resources and methods that address both admixture- and SNP-association to maximize power for genetic discovery in even larger African-American consortia.
The purpose of this study was to investigate the effect of endurance activities designed to simulate the physiological demands of soccer match-play and training, on leg strength, electromechanical ...delay, and knee laxity.
Eight recreational soccer players completed four exercise trials in random order: 1) a prolonged intermittent high intensity shuttle run (PHISR) which required subjects to complete a total distance of 9600 m in a form simulating the pattern of physical activity in soccer match-play (activity mode; rest-to-work intervals; approximately 90 min duration), 2) a shuttle-run (SR), (3) a treadmill run (TR) which required subjects to complete an equivalent distance at a running speed corresponding to 70% VO2max, and 4) a control condition consisting of no exercise.
Results from repeated measures ANOVA revealed significant condition (PHISR; SR; TR; control) by time (pre; mid; post) interactions for peak torque (PT: knee extension and flexion: 1.05 rad.s-1), EMD and anterior tibio-femoral displacement (TFD) (P < 0.05). Impairment to indices of knee joint performance was observed in PHISR, SR, and TR trials. The greatest decrement occurred in PHISR and SR trials (up to 44%). Knee extensor and flexor strength performance near to full knee extension (0.44 rad knee flexion) was not changed following the functionally-relevant endurance activities.
Even though strength performance near to full knee extension was preserved following acute endurance activities, the risk of ligamentous injury may be increased by concomitant impairment to EMD and anterior TFD.
Mental health policy in England is undergoing radical change involving the integration of services aimed at improving outcomes for patients. At the same time, there is limited evidence about how ...conventional services are performing. The present paper reports data on the services provided and short-term outcomes achieved in eight community services in England.
A survey of caseloads of nurses and social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024). After 5 months a random sample of psychotic cases was followed up (n = 393).
A tendency was observed for health and social care practitioners to use the services available from within their own organisation. Over time, in the most severe cases, there was a substantial increase in provision of the services of the other organisation. Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both professional groups, and both reported similar amounts of met and unmet need (and in the same categories) at follow-up.
The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.
The purpose of the present study was to investigate the interrelationship between carbohydrate and fat metabolism at rest after isoenergetic meals of varying proportions of carbohydrate and fat. ...Eight physically-active subjects (BMI 18·1–23·4 kg/m2) were studied at rest on three occasions after an overnight fast. In a balanced design they were given meals containing carbohydrate, protein and fat in the following amounts respectively (g/70 kg body weight): meal 1 121,16,48; meal 2 70,16,70; meal 3 50, 14, 80. All meals were isoenergetic, containing 4·0 MJ/70 kg body weight, and were of similar appearance. In addition, on a fourth occasion five of the eight subjects consumed meal 4 (g/70 kg body weight): Carbohydrate 0, protein 0, fat 108. Blood samples were taken before eating the meal and at intervals following the meal to determine metabolic and hormonal responses. Energy expenditure and substrate oxidation were measured by indirect calorimetry and balance was calculated over the 5 h postprandial period. The incremental areas under the time curves for fat oxidation were greatest after meals 3 and 4 (P<0·05), whereas incremental areas under thecarbohydrate oxidation v. time curves were relatively reduced after these two meals (P<0·05). This was accompanied by lesser suppression of plasma non-esterified fatty acid concentrations (P<0·001) and reduced plasma insulin concentrations (P<0·001) following these meals. Energy balance was almost identical after the three isoenergetic meals. In contrast, there was an inverse relationship between Carbohydrate and fat balance following these meals, with carbohydrate balance decreasing as carbohydrate intake decreased and fat balance increasing as fat intake increased. We conclude that there is a close interrelationship between carbohydrate and fat metabolism following isoenergetic meals in resting subjects.
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