Barriers to health care services for migrants living with HIV in Spain

BACKGROUND: In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain. METHODS: Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression. RESULTS: Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2–7.2]) and women (OR: 10.5 [95%CI: 3.1–34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9–5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2–3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3–30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3–25.1]) were more likely to report barriers. CONCLUSION: Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints

Haematic Antegrade Repriming procedure to initiate a safer cardiopulmonary bypass.

SUMMARY: Background: Cardiopulmonary bypass is a safe technique frequently required in cardiac surgery. Despite that, it carries several undesired effects related to haemodilution, emboli and alterations on the coagulation and microcirculation. Different strategies like the minimized circuits (MiECC) or the retrograde autologous priming (RAP) have attemped to reduce its impact, but finally lead to inconsistent results as independent measures due to the heterogeneity on its practice. The haematic antegrade repriming (HAR) detailes a standardized materials and methodology that could offer a reproducible method inspired in evidence-based recommendations. Description of the technique: HAR is performed in a standardized Class IV MiECC that is reprimed antegradely with autologous blood obtained from the aorta of the patient, before the cardiopulmonary bypass (CPB) initiation. Then, CPB is started with the support of vacuum assisted venous drainage (VAVD). Discussion: The strict application of HAR results in a fix haemodilution of 300ml of crystalloid priming, avoiding the sudden haemodilution and the crystalloid embolism of the CPB initiation. The synergic effect that converges in HAR could exceed the evidence-based benefits of RAP, MiECC and VAVD promising to improve the outcomes in terms of transfusion, complications, stay and survival. Conclusion: HAR is proposed as a new approach to increase the safety of the CPB. Its overall benefits should be properly assessed and validated by current and further studies.Improved graphics indications and procedure

Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial

© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity SocietyThis document is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the accepted version of a published work that appeared in final form in ASAIO JournalParticulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08-0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation