How Medicaid and States Could Better Meet Health Needs of Persons Experiencing Homelessness.

An estimated 580 000 people experienced homelessness on any single night in the United States in 2020. This article argues that, to address these persons\u27 unmet needs, Medicaid should collaborate with clinicians and state programs to provide permanent supportive housing and housing support services to individuals experiencing homelessness. Access to shelter can improve health outcomes for individuals experiencing homelessness and reduce overall health care costs

Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: ASystematic Review

Background Sub-Saharan Africa carries the highest HIV burden globally. It is important to understand how interventions cost-effectively fit within guidelines and implementation plans, especially in low- and middle-income settings. We reviewed the evidence from economic evaluations of HIV prevention interventions in sub-Saharan Africa to help inform the allocation of limited resources. Methods We searched PubMed, Web of Science, Econ-Lit, Embase, and African Index Medicus. We included studies published between January 2009 and December 2018 reporting cost-effectiveness estimates of HIV prevention interventions. We extracted health outcomes and cost-effectiveness ratios (CERs) and evaluated study quality using the CHEERS checklist. Findings 60 studies met the full inclusion criteria. Prevention of mother-to-child transmission interventions had the lowest median CERs ($1144/HIV infection averted and$191/DALY averted), while pre-exposure prophylaxis interventions had the highest ($13,267/HIA and$799/DALY averted). Structural interventions (partner notification, cash transfer programs) have similar CERs ($3576/HIA and$392/DALY averted) to male circumcision ($2965/HIA) and were more favourable to treatment-as-prevention interventions ($7903/HIA and $890/DALY averted). Most interventions showed increased cost-effectiveness when prioritizing specific target groups based on age and risk. Interpretation The presented cost-effectiveness information can aid policy makers and other stakeholders as they develop guidelines and programming for HIV prevention plans in resource-constrained settings

Assessing Impact of COVID-19 Pandemic on Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Infants Born in Four States

The study compares receipt and timeliness of newborn hearing screening and follow-up diagnostic services between the pre-pandemic birth cohort and the pandemic birth cohort in four participating states. Findings from this study will help inform state Early Hearing Detection and Intervention (EHDI) programs in the future should major public health event occur again

Personal NO2 and volatile organic compounds exposure levels are associated with markers of cardiovascular risk in women in the Cape Town region of South Africa

CITATION: Everson, F., et al. 2019. Personal NO2 and volatile organic compounds exposure levels are associated with markers of cardiovascular risk in women in the Cape Town region of South Africa. International Journal of Environmental Research and Public Health, 16(13):2284, doi:10.3390/ijerph16132284.The original publication is available at http://www.mdpi.comENGLISH ABSTRACT: Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region.https://www.mdpi.com/1660-4601/16/13/2284Publisher's versio

Investigating the effects of first line and second line antiretroviral drugs on HIV exposed endothelial function - A clinical study, supported by a mechanistic in-vitro approach

Thesis (MMed)--Stellenbosch University, 2017ENGLISH ABSTRACT : Background: There is an interaction between HIV, antiretroviral treatment (ART) and endothelial dysfunction; furthermore, HIV-infected individuals (± ART) show an increased incidence of cardiovascular risk factors. However, the evidence stems mainly from studies in developed countries with a paucity of data on these interactions in the South African context. Aims: To investigate the effects of first line and second line ART on HIV exposed vascular endothelial function, in a clinical and in vitro setting. Methods: In the clinical study, participants were recruited in Worcester and allocated to one of four study groups: HIV-negative, HIV-positive ART naïve, HIV-positive first line ART and HIV-positive second line ART. Data were collected via health questionnaires, anthropometric assessments, blood pressure measurements, brachial artery flow mediated dilatation (FMD) and blood chemistry analyses (C-reactive protein (CRP), fasting glucose, HbA1c, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, as well as CD4 count and viral load in HIV-infected individuals). For the in vitro sub-study, a conditioned growth medium was developed containing HIV-related proteins in which aortic endothelial cells (AECs) were incubated. Additionally, AECs were treated with first and second ART drugs. End-points were nitric oxide (NO) production, cell viability and ROS production measured by flow cytometric analysis. Results: There were no inter-group differences with regard to FMD. The median BMI and waist circumference measurements were lower in the HIV-positive groups versus HIV-negative (p < 0.05). Median total cholesterol levels were lower (p < 0.05) in the HIV-positive ART groups versus HIV-negative, and higher in the HIV-positive first line ART group versus the ART naïve group (p< 0.05). Furthermore, mean LDL-cholesterol levels were lower in all HIV-positive groups versus HIV-negative (p< 0.05). Median HBA1C% values were lower in the HIV-positive second line ART versus ART-naïve group (p < 0.05). Regression analyses showed that smoking in first line ART, and CRP and CD4 levels in second line ART were negatively associated with FMD%. In the in vitro sub-study, the HIV-1 gp160 protein was identified in the HIV-conditioned medium. No effects were observed in HIV-conditioned medium treated AECs. In the first and second line ART dose-response investigations, it was found that double first line drug concentration and normal second line drug concentration exerted no harmful effects on AECs. Discussion and Conclusion: Clinical data suggested that the cardiovascular risk profile appeared to be more favourable in HIV-positive groups versus HIV-negative. There were no inter-group differences in terms of endothelial function (FMD). CD4 and CRP, as well as female gender were independent predictors of vascular endothelial function in the HIV-positive second line ART group. Furthermore, smoking was found to be a negative independent predictor of endothelial function in the HIV-positive first line ART group. The in vitro findings showed that the HIV-conditioned medium protocol successfully resulted in the expression of the HIV-1 gp160 protein; however, the conditioned medium failed to induce injury. In the ART dose-response investigations, the double drug concentration for first line ART and normal drug concentration for second line ART, could be considered a safe concentration to use in future investigations.AFRIKAANSE OPSOMMING : Agtergrond: Daar bestaan ‘n interaksie tussen MIV, antiretrovirale terapie (ART) en endoteeldisfunksie; verder toon MIV-geïnfekteerde persone (±ART) ‘n hoër insidensie van kardiovaskulêre risikofaktore. Hierdie verwantskappe is hoofsaaklik bepaal in populasies van ontwikkelde lande en daar is ‘n tekort aan data in die Suid-Afrikaanse konteks. Doelwitte: Om die effekte van eerste en tweede linie ART op MIV-blootgestelde vaskulêre endoteelfunksie in ‘n kliniese en in vitro omgewing te ondersoek. Metodes: In die kliniese studie was deelnemers in Worcester gewerf en in een van vier studiegroepe ingedeel: MIV-negatief, MIV-positief sonder ART, MIV-positief eerste linie ART en MIV-positief tweede linie ART. Data is ingesamel via vraelyste, antropometriese metings, bloeddruk bepalings, bragiale arterie vloei-gemedieerde dilatasie (FMD) en bloed biochemiese analises (C-reaktiewe proteïen (CRP), vastende glukose, HbA1C, totale cholesterol, LDL-cholesterol, HDL-cholesterol, trigliseriede, asook CD4 telling en virale lading in MIV-geïnfekteerde individue). Vir die in vitro sub-studie was ‘n gekondisioneerde groeimedium ontwikkel wat MIV-verwante proteïene bevat waarin aorta endoteelselle (AECs) geïnkubeer was. Verder was AECs met eerste en tweede linie ART middels behandel. Eindpunte was stikstofoksied (NO) produksie, sellewensvatbaarheid en ROS produksie soos gemeet met vloeisitometriese analise. Resultate: Daar was geen inter-groep verskille t.o.v. FMD nie. Die mediaan BMI en middellyf omtrek metings was laer in die MIV-positiewe groepe versus MIV-negatief (p<0.05). Mediaan totale cholesterol vlakke was laer (p<0.05) in die MIV-positiewe ART groepe versus MIV-negatief, en hoër in die MIV-positief eerste linie ART groep versus geen ART (p<0.05). Verder was die gemiddelde LDL-cholesterol vlakke laer in alle MIV-positiewe groepe versus die MIV-negatiewe groep (p<0.05). Mediaan HbA1c% waardes was laer in die MIV-positiewe tweede linie ART groep versus MIV-positief sonder ART (p<0.05). Regressie analises het getoon dat rook in eerste linie ART, en CRP en CD4 vlakke in tweede linie ART negatief met FMD% geassosieer het. In die in vitro sub-studie was die MIV-1 gp160 proteïen geïdentifiseer in die MIV-gekondisioneerde medium. Geen effekte was in AECs wat aan MIV-gekondisioneerde medium blootgestel was, waargeneem nie. In die eerste en tweede linie ART dosis-respons eksperimente, het die dubbel dosis eerste linie ART en normale dosis tweede linie ART geen nadelige effekte op die AECs uitgeoefen nie. Bespreking en Slotsom: Die kliniese data toon ‘n meer gunstige kardiovaskulêre risiko profiel in die MIV-positiewe groepe versus MIV-negatiewe groep. Daar was geen inter-groep verskille t.o.v. endoteelfunksie (FMD) nie. CD4 en CRP, sowel as vroulike geslag was onafhanklike voorspellers van vaskulêre endoteelfunksie in die MIV-positiewe tweede linie ART groep. Verder was rook ‘n negatiewe onafhanklike voorspeller van endoteelfunksie in die MIV-positiewe eerste linie ART groep. Die in vitro data het getoon dat die MIV-gekondisioneerde protokol op suksesvolle wyse tot die uitdrukking van die MIV-1 gp160 proteïen gelei het, hoewel die gekondisioneerde medium nie daarin kon slaag om skade te veroorsaak nie. In die ART dosis-respons eksperimente is aangetoon dat die dubbel dosis eerste linie ART en normale dosis tweede linie ART ‘n veilige konsentrasie is wat in toekomstige studies gebruik kan word

The relationship between carotid intima-media thickness, serum biomarkers of cardiovascular disease, and HIV-infection in a South African study population

Thesis (PhD)--Stellenbosch University, 2021.Background: Brachial artery flow-mediated dilatation (FMD) and carotid artery intima-media thickness(IMT)are measures of vascular endothelial function and subclinical atherosclerosis respectively. Both endothelial dysfunction and subclinical atherosclerosis have been linked with HIV and antiretroviral therapy (ART) in the developed world. Furthermore, known biomarkers of inflammation and endothelial dysfunction can be measured to predict cardiovascular outcomes in HIV-infected individuals. The exact link between endothelial dysfunction, atherosclerosis, HIV, ART and the biomarkers remains inconclusive, particularly in South African and Western Cape populations.Aims: To investigate the putative relationship between subclinical atherosclerosis, endothelial dysfunction, biomarkers of cardiovascular disease (CVD), and HIV-infection in a Western Cape study population. Methods:Two different epidemiological studies were performed: a cross-sectional main study (HIV-infected, n= 204 of whom on ART n=188and without ART n= 16;and HIV-free, n= 143), and a longitudinal sub-study to assess the 12-month temporal progression of selected CVD outcomes (HIV-free, n= 57). For both studies, participants were recruited from health clinics in Cape Town and Worcester between 2017 and 2018. Lifestyle and health data were collected, and vascular (FMD%and IMT by ultrasound technology), anthropometric (body-mass-index [BMI]; waist circumference [WC]), cardiovascular (lipid profile; blood pressure [BP]; plasma glucose), renal (creatinine; urine albumin creatinine ratio [ACR]), liver (gamma-glutamyl-transferase [GGT]) and HIV-related (viral load; CD4, duration of HIV, duration of treatment) measures were obtained. Serum biomarkers were analyzed using Luminex technology, including C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF), plasminogen activator inhibitor-1 (PAI-1) and adhesion molecules (intercellular adhesion molecule-1 [ICAM-1], vascular cellular adhesion molecule-1 [VCAM-1], e-selectin, p-selectin). Results: In the longitudinal study (mean age: 45 years), WC, plasma glucose, BP, and hypertension, increased at 12-months follow-up. In the cross-sectional study (mean age: 41 years), the HIV-infected group showed a lower BMI, WC, BP,hypertension and PAI-1 versus the HIV-free group (p<0.05), whereas anaemia, ACR, creatinine, GGT and VCAM-1 were increased in the HIV-infected group (p<0.05). Additionally, viral load and VCAM-1 levels were higher in the HIV-infected without ART group versus the ART treated group (p<0.05). CD4 count, total cholesterol, HDL, LDL, hemoglobin, GGT, creatinine levels were higher in the ART group compared to the ART naïve group (p<0.05). Flow mediated dilatation (FMD)was higher and IMT was lower in the ART group versus ART naïve group (p<0.05). Furthermore, no significant correlations were found between biomarkers and FMD and IMT. With regards to independent associations, in the HIV-infected group, age positively associated with IMT (p<0.001), while in the HIV-free group, age, high systolic BP, obesity and LDL cholesterol positively associated with IMT (p<0.05). In the HIV-infected group, ART positively associated, while viral load inversely associated with FMD%. In the HIV-free group, creatinine inversely associated with FMD% (p<0.05).Discussion and conclusion: Overall, our study showed a higher presence and progression of cardiovascular risk parameters in the HIV-free population. In the HIV context, ART showed a morecardioprotective and immune-protective effect, where it was associated with reduced subclinical atherosclerosis and improved endothelial function. Our study confirmed that age is an independent predictor of subclinical atherosclerosis while viral load is an independent, inverse predictor of endothelial function.Agtergrond: Bragiale arterie vloei-gemedieerde dilatasie (FMD) en karotis arterie intima-media dikte (IMD) verteenwoordig die meting van vaskulêre endoteelfunksie en subkliniese aterosklerose onderskeidelik. Voorheen het studies in ontwikkelde lande aangetoon. Daar is voorheen tudies in ontwikkelde lande aangetoon dat beide endoteeldisfunksie en subkliniese aterosklerose ‘n verband met MIV en antiretrovirale terapie (ART) toon. Verder kan verskeie inflammatoriese en endoteeldisfunksie biomerkers gemeet word om kardiovaskulêre uitkomste in MIV-geïnfekteerde populasies te voorspel. Die presiese verband tussen endoteeldisfunksie, aterosklerose, MIV, ART en die biomerkers is nog nie heeltemal verklaar of duidelik nie nie, veral nie in Suid-Afrikaanse en Wes-Kaapse bevolkings nie.Doelstelling: Om die potensiele vermoedelike verband tussen subkliniese aterosklerose, endoteeldisfunksie, kardiovaskulêre biomerkers en MIV-infeksie in ‘n Wes-Kaapse studiebevolking te ondersoek. Metodiek: Twee verskillende epidemiologiese studies was onderneem: ‘n deuranit hoofstudie (MIV-geïnfekteer, n= 204 waarvan n=188 op ART was, en n=16 ART sonder; MIV negatief is, n= 143), en ‘n longitudinale sub-studie om die 12-maande progressie van geselekteerde kardiovaskulêre uitkomste te ondersoek (MIV negatief, n= 57). Deelnemers was by gesondheidsklinieke in Kaapstad en Worcester tussen 2017 en 2018 gewerf. Lewenstyl-en gesondheidsinligting was ingesamel, asook vaskulêre (FMD en IMD met behulp van ultraklank tegnologie), antropometriese (liggaamsmassa-indeks [LMI]; middelomtrek [MO]), kardiovaskulêre (lipiedprofiel; bloeddruk [BP]; plasma glukose), nier (kreatinien; urien albumien-kreatinienverhouding [ACR]), lewer (gamma glutamieltransferase [GGT]) en MIV-verwante (virale lading; CD4, duur van MIV-infeksie, duur van behandeling) metings was ingesamel. Serum biomerkers was met behulp van Luminex tegnologie geanaliseer, insluitende C-reaktiewe proteïen (CRP), tumor nekrose faktor-alfa (TNF-α), vaskulêre endoteel groeifaktor (VEGF), plasminogeen-aktiveerder-inhibeerder-1 (PAI-1), en aanhegtingsmolekules (intersellulêre adhesiemolekule-1 [ICAM-1], vaskulêre sellulêre adhesiemolekule-1 [VCAM-1], e-selektien, p-selektien). Resultate: In die longitudinale studie (gemiddelde ouderdom: 45 jaar), het WC, plasma glukose, BP, en hipertensie toegeneem na 12 maande. In die deursnitstudie (gemiddelde ouderdom: 41 jaar), was BMI, WC, BP, hipertensie en PAI-1 laer in die MIV-geïnfekteerde groep in vergelyking met die geen MIV groep (p<0.05), terwyl anemie, ACR, kreatinien, GGT and VCAM-1 verhoog was in die MIV-geïnfekteerde groep (p<0.05). Verder was die virale lading en VCAM-1 vlakke hoër in die onbehandelde MIV-geïnfekteerdegroep in vergelyking met die ART groep (p<0.05). CD4 telling,totale cholesterol, HDL, LDL, hemoglobien, GGT en kreatinien vlakke was hoër in die ART groep (p<0.05 vs onbehandeld). FMD was hoër en IMT laer in die ART groep (p<0.05 vs. onbehandeld). Verderkon geen betekenisvolle korrelasies tussen die biomerkers, FMD en IMT aangetoon word nie. Wat onafhanklike assosiasies betref, het ouderdom positief geassosieer met IMT in die MIV-geïnfekteerde groep (p<0.001), terwyl ouderdom, hoë sistoliese bloeddruk, vetsug en LDL cholesterol positief met IMT geassosieer was in die kontrole groep (p<0.05). In die MIV-geïnfekteerde groep het ART positief geassosieer met FMD%, terwyl virale lading omgekeerd geassosieer met FMD%. In die geen MIV groep, was kreatinien omgekeerd geassosieer met FMD% (p<0.05).Bespreking en gevolgtrekking: Oor die algemeen het ons studie ‘n hoër teenwoordigheid en progressie van kardiovaskulêre risikofaktore in die geen MIV groep getoon. In die geval van die MIV-geïnfekteerde deelnemers, het ART behandeling meer kardio-en immuunbeskermende effekte getoon, waar dit met verlaagde subkliniese atereosklerose en beter endoteelfunksie geassosieer was. Die studie het ook bevestig dat ouderdom ‘n onfhanklike voorspeller van subkliniese aterosklerose is, terwyl virale lading ‘n onafhanklike, omgekeerde voorspeller van endoteelfunksie is.Doctora

Clinical Characteristics of Children With Tourette Syndrome With and Without Sleep Disorder.

BACKGROUND: Sleep problems are common in children with Tourette Syndrome (TS). However, research regarding their demographic and clinical profile is limited. METHODS: We examined characteristics of 114 children aged five to 17 years with a lifetime diagnosis of TS and compared children with sleep disorder (n&nbsp;= 32) and without sleep disorder (n&nbsp;= 82). Parent report from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome provided demographics and clinical information, other diagnosed disorders, medication use, TS severity, and impairment. RESULTS: More children with TS with sleep disorder were from households with lower parental education (P&nbsp;&lt;&nbsp;0.01) and poverty (P&nbsp;=&nbsp;0.04); had other diagnoses (P&nbsp;=&nbsp;0.03), including obsessive-compulsive disorder (P&nbsp;&lt;&nbsp;0.01), oppositional defiant disorder or conduct disorder (P&nbsp;&lt;&nbsp;0.01), attention-deficit/hyperactivity disorder (ADHD) (P&nbsp;=&nbsp;0.02), and autism (P&nbsp;=&nbsp;0.03); and had ever used TS medication (P&nbsp;=&nbsp;0.01) than children with TS without sleep disorder. More children with TS with sleep disorder had severe TS symptoms (P&nbsp;&lt;0.01),&nbsp;tic-related impairment (P&lt;0.01), and severe ADHD symptoms (P&nbsp;&lt;&nbsp;0.01) compared with children with TS without sleep disorder. CONCLUSIONS: Findings suggest greater parent-reported impact and tic-related interference in children with TS with sleep disorder compared with TS without sleep disorder. Results underscore the importance of monitoring and intervention for TS exacerbations, other diagnosed disorders, and medication use, and consideration of socioeconomic context in sleep disorder management and prevention in children with&nbsp;TS