Impact of High-Risk Sex and Focused Interventions in Heterosexual HIV Epidemics: A Systematic Review of Mathematical Models

Background: The core-group theory of sexually transmitted infections suggests that targeting prevention to high-risk groups (HRG) could be very effective. We aimed to quantify the contribution of heterosexual HRGs and the potential impact of focused interventions to HIV transmission in the wider community. Methods: We systematically identified studies published between 1980 and 2011. Studies were included if they used dynamical models of heterosexual HIV transmission, incorporated behavioural heterogeneity in risk, and provided at least one of the following primary estimates in the wider community (a) the population attributable fraction (PAF) of HIV infections due to HRGs, or (b) the number per capita or fraction of HIV infections averted, or change in HIV prevalence/incidence due to focused interventions. Findings: Of 267 selected articles, 22 were included. Four studies measured the PAF, and 20 studies measured intervention impact across 265 scenarios. In low-prevalence epidemics (≤5% HIV prevalen

Expression of CD40 ligand, interferon-gamma and Fas ligand genes in endomyocardial biopsies of human cardiac allografts: correlation with acute rejection

The purpose of the present study was to investigate the expression (mRNA) of CD40 ligand (CD40L), interferon-gamma (IFN-gamma) and Fas ligand (FasL) genes in human cardiac allografts in relation to the occurrence of acute cardiac allograft rejection as well as its possible value in predicting acute rejection. The mRNA levels were determined by a semiquantitative reverse transcriptase-polymerase chain reaction method in 39 samples of endomyocardial biopsies obtained from 10 adult cardiac transplant recipients within the first six months after transplantation. Biopsies with ongoing acute rejection showed significantly higher CD40L, IFN-gamma and FasL mRNA expression than biopsies without rejection. The median values of mRNA expression in biopsies with and without rejection were 0.116 and zero for CD40L (P<0.003), 0.080 and zero for IFN-gamma (P<0.0009), and 0.156 and zero for FasL (P<0.002), respectively. In addition, the levels of IFN-gamma mRNA were significantly increased 7 to 15 days before the appearance of histological evidence of rejection (median of 0.086 in pre-rejection biopsies), i.e., they presented a predictive value. This study provides further evidence of heightened expression of immune activation genes during rejection and shows that some of these markers may present predictive value for the occurrence of acute rejection.Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Departamento de PatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, Depto. de PediatriaUNIFESP, Depto. de PatologiaUNIFESP, EPM, Depto. de MedicinaSciEL

Perfil clinico e endocrinologico de pacientes femininas com acne vulgaris provenientes de consultas dermatologicas

Foi objetivo do estudo descrever o quadro clínico e endocrinológico da Acne vulgaris em pacientes femininas provenientes de consultas dermatológicas. Em 81 pacientes foi traçado o perfil da Acne vulgaris através de avaliação clínica (subjetiva e objetiva). O perfil endocrinológico . foi avaliado através das dosagens de: Testosterona, Androstenediona, Sulfato de Dehidroepiandrosterona, Estradiol, Prolactina, FSH e LH (basais e após estímulo com LHRH), Cortisol e 17 Hidroxiprogesterona (basais e após estímulo com ACTH). Como controle para as dosagens hormonais foram utilizadas 14 mulheres normais. Revisaram-se os aspectos clínicos, epidemiológicos e patogênicos da acne, com ênfase nos aspectos endocrinológicos. As principais conclusões foram as seguintes: As pacientes estudadas foram mais jovens do que as pacientes provenientes de clínicas dermatológicas, a automed i cação f o i f r e q ü ente ( 6 5% ) e os graus de, P i 11 s b u r y I I e I I I os mais · freqüentes. Graus de Pillsbury III e IV estiveram associados a cicatrizes, e a seborréia foi indicativa de acne mais grave. A freqüência de dosagens ~ormonais alteradas foi de 27 %. A presença de ciclos menstruais regulares e escore de Ferriman inferior a 15 tiveram, em conjunto, um valor preditivo negativo de 85 %. Não houve correlação da gravidade da acne com dosagens hormonais alteradas. Também nao se encontraram mais alterações menstruais e hirsutismo nas pacientes com acne, quando comparadas com outras pacientes provenientes de consultas dermatológicas. As pacientes com acne tiveram níveis de andrógenos e de prolactina mais altos, porém sem significado estatístico, do que as controles. A testosterona e a prolactina podem ser utilizadas, em conjunto com dados de anamnese e exame físico, para triagem de alterações endócrinas de pacientes com acne

Perfil clinico e endocrinologico de pacientes femininas com acne vulgaris provenientes de consultas dermatologicas

Foi objetivo do estudo descrever o quadro clínico e endocrinológico da Acne vulgaris em pacientes femininas provenientes de consultas dermatológicas. Em 81 pacientes foi traçado o perfil da Acne vulgaris através de avaliação clínica (subjetiva e objetiva). O perfil endocrinológico . foi avaliado através das dosagens de: Testosterona, Androstenediona, Sulfato de Dehidroepiandrosterona, Estradiol, Prolactina, FSH e LH (basais e após estímulo com LHRH), Cortisol e 17 Hidroxiprogesterona (basais e após estímulo com ACTH). Como controle para as dosagens hormonais foram utilizadas 14 mulheres normais. Revisaram-se os aspectos clínicos, epidemiológicos e patogênicos da acne, com ênfase nos aspectos endocrinológicos. As principais conclusões foram as seguintes: As pacientes estudadas foram mais jovens do que as pacientes provenientes de clínicas dermatológicas, a automed i cação f o i f r e q ü ente ( 6 5% ) e os graus de, P i 11 s b u r y I I e I I I os mais · freqüentes. Graus de Pillsbury III e IV estiveram associados a cicatrizes, e a seborréia foi indicativa de acne mais grave. A freqüência de dosagens ~ormonais alteradas foi de 27 %. A presença de ciclos menstruais regulares e escore de Ferriman inferior a 15 tiveram, em conjunto, um valor preditivo negativo de 85 %. Não houve correlação da gravidade da acne com dosagens hormonais alteradas. Também nao se encontraram mais alterações menstruais e hirsutismo nas pacientes com acne, quando comparadas com outras pacientes provenientes de consultas dermatológicas. As pacientes com acne tiveram níveis de andrógenos e de prolactina mais altos, porém sem significado estatístico, do que as controles. A testosterona e a prolactina podem ser utilizadas, em conjunto com dados de anamnese e exame físico, para triagem de alterações endócrinas de pacientes com acne

Socio-demographic characteristics and behavioral risk factors of female sex workers in Sub-Saharan Africa: a systematic review

Sex work remains an important contributor to HIV transmission within early, advanced and regressing epidemics in sub-Saharan Africa, but its social and behavioral underpinnings remain poorly understood, limiting the impact of HIV prevention initiatives. This article systematically reviews the socio-demographics of female sex workers (FSW) in this region, their occupational contexts and key behavioral risk factors for HIV. In total 128 relevant articles were reviewed following a search of Medline, Web of Science and Anthropological Index. FSW commonly have limited economic options, many dependents, marital disruption, and low education. Their vulnerability to HIV, heightened among young women, is inextricably linked to the occupational contexts of their work, characterized most commonly by poverty, endemic violence, criminalization, high mobility and hazardous alcohol use. These, in turn, predict behaviors such as low condom use, anal sex and co-infection with other sexually transmitted infections. Sex work in Africa cannot be viewed in isolation from other HIV-risk behaviors such as multiple concurrent partnerships-there is often much overlap between sexual networks. High turn-over of FSW, with sex work duration typically around 3 years, further heightens risk of HIV acquisition and transmission. Targeted services at sufficiently high coverage, taking into account the behavioral and social vulnerabilities described here, are urgently required to address the disproportionate burden of HIV carried by FSW on the continent

Comment on: Does empathy change during undergraduate medical education?–A meta-analysis

Comment on: Spatoula V, Panagopoulou E, Montgomery A. 2019. Does empathy change during undergraduate medical education? – a meta-analysis. Med Teach. 41:895–904

Range of intervention impact, by outcomes measured in the wider community for epidemics with an HIV prevalence >5%, in the absence of risk compensation.

<p>Population in which the outcome was measured includes: ^αlow-risk females; ^βgeneral population (excludes high-risk groups); ^γtotal population (includes high-risk groups); ^ωante-natal clinic attendees. °Reduce partnership rate per year (among clients 20 to 15; among FSWs 400 to 50). **Efficacy in reducing HIV susceptibility per sex act (or transmission probability if intervention effect on HIV susceptibility was not differentiated from intervention effect on HIV infectivity). Infections averted refer to the following: *per 100,000 uninfected adults per year of intervention (Vissers 2008 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050691#pone.0050691-Vissers1" target="_blank">[36]</a>); (^#per 100,000 adults per year of intervention (Abbas 2008 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050691#pone.0050691-Abbas1" target="_blank">[39]</a> and Vickerman 2006 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050691#pone.0050691-Vickerman3" target="_blank">[26]</a>_ENREF_43_ENREF_43). N = number of studies. STI (sexually transmitted infection). PREP (pre-exposure prophylaxis). ↓(decline). FSW (female sex worker). Non-commercial HRG refers to individuals who engage in multiple (non-commercial) partnerships.</p

Summary estimates of the fraction of infections prevented in the wider population, when interventions were focused on FSWs, in the absence of risk compensation.

<p>Population in which the outcome was measured includes: ^αlow-risk females; ^βgeneral population (excludes high-risk groups); ^γtotal population (includes high-risk groups); ^ωante-natal clinic attendees.STI (sexually transmitted infection). N_s refers to the number of simulated scenarios. Summary estimates reflect the median and range if ≥5 scenarios across at least 2 studies were available within each category. Estimates were grouped across intervention-related characteristics. *Efficacy in reducing HIV susceptibility per sex act (or transmission probability if intervention effect on HIV susceptibility was not differentiated from intervention effect on HIV infectivity). FSW (female sex worker).</p