Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening.

Substance use complicates HIV care and prevention. Primary care clinics are an ideal setting to screen for and offer interventions for unhealthy alcohol and drug use; however, few HIV clinics routinely screen for substance use. We enrolled 208 clinic patients at an urban underserved HIV primary care clinic. We screened the patients for substance use with the Alcohol, Smoking, and Substance Involvement Score Test and measured urine toxicology. Of the 168 participants who completed screening, the majority reported tobacco or nonprescribed substance use in the previous 3 months. More African American participants reported low or no risk amphetamine use compared to Hispanic, White, or Other race participants (p < .001). Implementing standard clinic practice for screening and assessing substance use in HIV primary care clinics is needed

Estimated phosphorous requirement with and without added phytase of starting broiler chicks

For poultry the availability of phosphorus from ingredients of plant origin is limited, because this element is bound to phytates, and birds do not produce the enzyme phytase. Thus, it is necessary to complement their diets with inorganic P. Recently, microbial phytase has been utilized to improve the availability of P from phytates. Two experiments were conducted to calculate the optimal biological level of available P (Pa) with and without phytase, and to evaluate the effect of phytase on body weight gain (WG) and ash content of the tibia (% ASH) of broilers from 1-21 days of age. In Expt. 1 seven levels of Pa were evaluate: 0.30, 0.35, 0.40, 0.45, 0.50, 0.55, and 0.60%; in Expt. 2, four levels of Pa 0.15, 0.27, 0.39, and 0.51%, and four levels of phytase 0, 200, 400, and 600 FTU (units of phytase/kg of diet) were evaluated in a factorial arrangement. In Expt. 1 there were differences (P<.05) in WG and % ASH with the levels of 0.45 and 0.50% Pa being the best. The optimal biological level was 0.46% for WG, similar to the 0.45% proposed by NRC (1994); and 0.49% for%ASH. In Exp. 2 the effect of phytase level onWGand%ASH, followed a linear tendency, the 600 FTU level surpassing the 0 FTU level by 13.5% forWGand 8.5 for%ASH (P<.05). The optimal biological level (P<.05) of Pa forWGwas estimated as 0.47 with 0 FTU and 0.394% with 600 FTU, and for%ASH as 0.47% with 0 FTU and 0.43% with 600 FTU. For maximum WG it is possible to reduce the inorganic P level by 0.75 g/kg diet (0.075%) when supplementing with 600 FTU)

Duration of heat treatment and true digestibility of amino acids in meat meal for Leghorn cockerels

Knowledge of the true digestibility of amino acids in the ingredients of a poultry ration is important in order to use them properly, especially the proteinic ingredients that have been heated during processing, such as meat meal. Protein solubility is a good indicator of heat damage. To estimate true digestibility, Leghorn White cockerels were fasted for 24 h and then force fed with meat meal autoclaved at 121°C and 1.5 kg/cm2 for 0, 15, 30, 45 and 60 minutes. A correction for endogenous amino acids was included. Nitrogen was determined by micro Kjeldahl; protein solubility by the methods of 2% KOH and coomassie blue; amino acids concentrations were also determined by HPLC. Treatments had an effect (P<.05) on meat meal protein solubility, means being 89% and 84% for the KOH and coomassie blue methods, respectively. However, protein solubility increased until 30 minutes and then decreased according to the KOH method, whereas it increased until 15 minutes (P<.05) and then remained constant by the coomassie blue method. Autoclaving had an effect on true digestibility of all amino acids, except methionine. There was a high and significant correlation (0.81) between protein solubility by the KOH method and true digestibility of amino acids

Peer expectations about outstanding competencies of men and women medical students

Men and women enrolled in a combined premedical-medical school programme were asked as they began their clinical training to rate their anticipated competence on sixteen criteria relevant to medical practice. Competence dimensions tapped scientific/technical skills, dedication/commitment, and interpersonal skills. Students then were asked to nominate one classmate whom they expected might be‘the best’in each area. Self-ratings revealed few differences among men and women. Peer nominations, however, revealed a preponderance of male nominees in ten competence areas. Women dominated nominations only in the category of sensitivity to patients. Patterns persisted when peer nominations were controlled for students’academic standing and self-ratings on parallel dimensions. The data suggest that medical school peer groups share expectations about competencies of men and women as physicians which are consistent with generalized sex stereotypes and career patterns of men and women physicians.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74843/1/1467-9566.ep11340055.pd

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

Background Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations

Does “Asymptomatic” Mean Without Symptoms for Those Living with HIV Infection?

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as ‘‘asymptomatic’’ by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003 - 2005 and 2005 - 2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care

Self-compassion and risk behavior among people living with HIV/AIDS.

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA