We assessed whether HIV status was associated with white matter hyperintensities (WMH), a neuroimaging correlate of cerebral small vessel disease (CSVD), in men aged ≥50 years. A cross-sectional ...substudy was nested within a larger cohort study. Virologically suppressed men living with HIV (MLWH) and demographically matched HIV-negative men aged ≥50 underwent magnetic resonance imaging (MRI) at 3 Tesla. Sequences included volumetric three-dimensional (3D) T1-weighted, fluid-attenuated inversion recovery and pseudocontinuous arterial spin labeling. Regional segmentation by automated image processing algorithms was used to extract WMH volume (WMHV) and resting cerebral blood flow (CBF). The association between HIV status and WMHV as a proportion of intracranial volume (ICV; log-transformed) was estimated using a multivariable linear regression model. Thirty-eight MLWH median age 59 years (interquartile range, IQR 55-64) and 37 HIV-negative median 58 years (54-63) men were analyzed. MLWH had median CD4
count 570 (470-700) cells/μL and a median time since diagnosis of 20 (14-24) years. Framingham 10-year risk of cardiovascular disease was 6.5% in MLWH and 7.4% in controls. Two (5%) MLWH reported a history of stroke or transient ischemic attack and five (13%) reported coronary heart disease compared with none of the controls. The total WMHV in MLWH was 1,696 μL (IQR 1,229-3,268 μL) or 0.10% of ICV compared with 1,627 μL (IQR 1,032-3,077 μL), also 0.10% of ICV in the HIV-negative group (
= .43). In the multivariable model, WMHV/ICV was not associated with HIV status (
= .86). There was an age-dependent decline in cortical CBF -3.9 mL/100 mL/min per decade of life (95% confidence interval 1.1-6.7 mL) but no association between CBF and HIV status (
> .2 in all brain regions analyzed). In conclusion, we found no quantitative MRI evidence of an increased burden of CSVD in MLWH aged 50 years and older.
The link between agricultural pricing and land degradation is often difficult to analyze empirically. The authors'understanding of how agricultural supply responds to changing prices in developing ...countries is incomplete. Even more incomplete is the author's analysis of subsequent impacts on the resource base sustaining agricultural production. Yet available evidence suggests that some important effects do exist, and much further analysis of them is warranted. The social, economic, and environmental relationships that determine the often countervailing effects of price changes on land use and management are extremely complex. Not enough is known about: (1) farming systems in developing countries; (2) open-access use and common property resource rights; (3) land tenure regimes and security; (4) access to technology and other farming systems information; (5) the distribution of wealth and income; and (6) coping strategies for variable climatic, economic, and social conditions. All these factors influence how rural households respond to price changes in terms of managing land and natural resources, and often they may override the incentive effects of price changes. Changes in pricing policies will then be less effective in correcting resource degradation than other approaches to dealing with its underlying causes. Such approaches include providing better research and extension advice, improving property rights and management, and establishing more secure tenure or access rights. At the same time, it is wrong to assume that poor farmers - even those in resource-poor regions far from major markets - are totally isolated from agricultural markets. Virtually all subsistence households require some regular market income for cash purchases of agricultural inputs and basic necessities; many small farmers provide important cash and export crops. So changes in market prices often significantly affect the livelihoods of rural groups. Clearly, the economic incentives emerging from these impacts will affect farmers'decisions to invest in land management and improvements. Just because we do not always understand the economic and social factors determining these incentive effects does not mean they do not exist. Nor should the complexity of the links between price changes and resource management - which sometimes appear counterintuitive - deter further analysis of the role of agricultural pricing in land degradation.
Objectives
While cognitive impairment is frequently reported in HIV‐positive individuals and has historically been associated with poorer functional outcomes, the associations between cognitive ...impairment and patient‐reported outcome measures (PROMs) in contemporary cohorts are unclear.
Methods
We tested cognitive function using a computerized battery (CogState™) in 290 HIV‐positive and 97 HIV‐negative individuals aged ≥ 50 years participating in the Pharmacokinetic and Clinical Observations in People Over Fifty (POPPY) study. Participants completed questionnaires detailing physical and mental health Short Form Health Survey (SF‐36), cognitive function European AIDS Clinical Society (EACS) questions, activities of daily living Lawton Instrumental Activities of Daily Living (IADL), depression Patient Depression Questionnaire (PHQ‐9) and Centres for Epidemiologic Studies Depression scale (CES‐D), falls and sexual desire. Cognitive impairment was defined using the Frascati criteria, global deficit score (GDS) and multivariate normative comparison (MNC). In the HIV‐positive group, the classification performances of the different definitions of cognitive impairment and dichotomized questionnaire results were calculated.
Results
The prevalence of cognitive impairment in the HIV‐positive group was 34.5% (GDS), 30.0% (Frascati) and 22.1% (MNC), with only 2% diagnosed with HIV‐associated dementia. In general, the associations between cognitive impairment and PROMs were weak regardless of the definition used: mean c‐statistics were 0.543 (GDS), 0.530 (MNC) and 0.519 (Frascati). Associations were similar using the global T‐score to define cognitive impairment. Summary health scores (SF‐36) were lower, but only significantly so for those with cognitive impairment identified using MNC, for both mental health (61.4 vs. 75.8; P = 0.03) and physical health (60.9 vs. 75.0; P = 0.03).
Conclusions
The associations between cognitive impairment and PROMs were weak, possibly because impairment was mild and therefore largely asymptomatic. Further work is needed to elucidate the clinical implications of cognitive impairment in HIV‐disease.
Objectives
To investigate the patterns and frequency of multiple risk behaviours (alcohol, drugs, smoking, higher risk sexual activity) among men who have sex with men (MSM) living with HIV.
Methods
...Cross sectional study.
Results
147 out of 819 HIV‐positive MSM exhibited a high‐risk phenotype (defined as >3 of smoking, excess alcohol, sexually transmitted infection and recent recreational drug use). This phenotype was associated with younger age, depressive symptoms and <90% adherence in multivariable logistic regression.
Conclusion
In a cohort of MSM, a small, but significant proportion exhibited multiple concurrent risk behaviours.
Objective. To describe changes in oral health behaviors following implementation of a nursing intervention targeting children at risk for early childhood caries at an urban 2-site primary care ...practice. Methods. Nurses used a proprietary Nursing Caries Assessment Tool (N-CAT) to identify behaviors associated with early childhood caries risk, then provided brief focused dental education, fluoride varnish applications, and dental referrals to children without a dental home. We used generalized estimating equation logistic regression models, adjusted for age at visit, to analyze changes in oral health behaviors over time including the following: (1) tooth brushing frequency, (2) use of fluoride toothpaste, and (3) adult help with brushing among children younger than 5 years of age who had at least 2 N-CATs documented during well care visits between April 2013 and June 2015. We also evaluated dietary habits including going to bed with a bottle or sippy cup and sugar-sweetened beverage consumption, as secondary study outcomes during the same time frame. Results. A total of 2097 children with a mean age of 15.8 (SD 7.6) months at the initial visit were included in the analysis; 51% were boys; 28% were black, 36% Hispanic/Latino, 5% white, 2% Asian, and 19% other; 75% were publicly insured. During the study period, significant (P < .05) improvements were noted across the 3 oral health behaviors studied among children younger than 18 months. Conclusion. Nursing interventions show promise for promoting preventive dental care in primary care settings and deserve further study.
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