Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States

Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States.BackgroundIt is hypothesized, but not proven, that peritoneal dialysis might be the optimal treatment for end-stage renal disease (ESRD) patients with established congestive heart failure (CHF) through better volume regulation compared with hemodialysis.MethodsNational incidence data on 107,922 new ESRD patients from the Center for Medicare and Medicaid Services (CMS) Medical Evidence Form were used to test the hypothesis that peritoneal dialysis was superior to hemodialysis in prolonging survival of patients with CHF. Nonproportional Cox regression models evaluated the relative hazard of death for patients with and without CHF by dialysis modality using primarily the intent-to-treat but also the as-treated approach. Diabetics and nondiabetics were analyzed separately.ResultsThe overall prevalence of CHF was 33% at ESRD initiation. There were 27,149 deaths (25.2%), 5423 transplants (5%), and 3753 (3.5%) patients lost to follow-up over 2years. Adjusted mortality risks were significantly higher for patients with CHF treated with peritoneal dialysis than hemodialysis [diabetics, relative risk (RR) = 1.30, 95% confidence interval (CI) 1.20 to 1.41; nondiabetics, RR = 1.24, 95% CI 1.14 to 1.35]. Among patients without CHF, adjusted mortality risk were higher only for diabetic patients treated with peritoneal dialysis compared with hemodialysis (RR = 1.11, 95% CI 1.02 to 1.21) while nondiabetics had similar survival on peritoneal dialysis or hemodialysis (RR = 0.97, 95% CI 0.91 to 1.04).ConclusionNew ESRD patients with a clinical history of CHF experienced poorer survival when treated with peritoneal dialysis compared with hemodialysis. These data suggest that peritoneal dialysis may not be the optimal choice for new ESRD patients with CHF perhaps through impaired volume regulation and worsening cardiomyopathy

Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK

HIV pre-exposure prophylaxis (PrEP) has proven efficacy in reducing the risk of HIV infection in men who have sex with men (MSM), but has not yet been commissioned in the UK. The aim of this study was to investigate perceived need and benefit (or experience of) PrEP among HIV-negative MSM attending sexual health clinics. HIV-negative MSM attending three sexual health centres in London, UK were opportunistically invited to complete a questionnaire. Data collected comprised demographic data and sexual and drug use behaviours as well as questions regarding perceptions of risk and need for PrEP. Logistic regression analysis was undertaken to identify variables predicting acceptability of, and intention to use, PrEP. In addition, data were gathered in respondents already taking PrEP. Eight hundred and thirty-nine questionnaires were analysed. The median age of respondents was 35 years (IQR 28–41, range 18–78), 650 (77%) were of white ethnicity and 649 (77%) had a university education. Four hundred and fifty-six (54%) reported at least one episode of condomless anal sex in the preceding three months, 437 (52%) reported recreational drug use in the preceding three months and 311 (37%) had been diagnosed with a sexually transmitted infection within the preceding six months. Four hundred and sixty-three (64%) of 726 strongly agreed with the statement ‘I think I would benefit from PrEP’. Multivariate logistic regression analysis demonstrated that having receptive anal intercourse (RAI) without condoms, having an awareness of the risk of unprotected RAI and having belief in the effectiveness of PrEP were independent predictors for someone thinking they would benefit from taking PrEP. Eight percent of respondents (59/724) had already taken or were currently taking PrEP. The results suggest that individuals at risk are likely to perceive themselves as benefiting from PrEP. The majority perceived their risk of acquiring HIV and benefit from PrEP accurately. Overall they appeared to have little concern over the use of PrEP and generally positive attitudes. Further investigation is warranted to understand why those at risk do not perceive benefit from PrEP

‘Hey, you stylized woman there!’: An uncomfortable reflexive account of performative practices in the field

This article presents an uncomfortable reflexive account of a feminist poststructuralist research project on young women in Lagos, Nigeria who dress in what I call “hyper-feminine style.” It reflects on the messy processes by which I framed the research and recruited participants, and considers how the women who did or did not eventually take part exercised agency to resist the terms of my address. The article illustrates the usefulness of Butler’s (1997a) theoretical notions of “excitable discourse” and “performative interpellation” for poststructuralist reflexive practice, concerning as they do the unpredictable political and ontological effects of what one says and does

Student accounts of space and safety at a South African university: implications for social identities and diversity

Transformation efforts in South African higher education have been under increased scrutiny in recent years, especially following the last years of student activism and calls for decolonization of universities. This article presents data from a participatory photovoice study in which a group of students reflect on their experiences of feeling safe and unsafe at an urban-based historically disadvantaged university. Findings highlight the way in which historical inequalities on the basis of social identities of race, class, and gender, among others, continue to shape experiences, both materially and social-psychologically, in South African higher education. However, and of particular relevance in thinking about a socially just university, participants speak about the value of diversity in facilitating their sense of both material and subjective safety. Thus, a diverse classroom and one that acknowledges and recognizes students across diversities, is experienced as a space of comfort, belonging and safety. Drawing on feminist work on social justice, we argue the importance of lecturer sensitivity and reflexivity to their own practices, as well as the value of social justice pedagogies that not only focus on issues of diversity and equality but also destabilize dominant forms of didactic pedagogy, and engage students’ diverse experiences and perceptions

Beauty surveillance: the digital self-monitoring cultures of neoliberalism

This paper argues that ‘beauty apps’ are transforming the arena of appearance politics and foregrounds a theoretical architecture for critically understanding them. Informed by a feminist-Foucaultian framework, it argues that beauty apps offer a technology of gender which brings together digital self-monitoring and postfeminist modalities of subjecthood to produce an hitherto unprecedented regulatory gaze upon women that is marked by the intensification, extensification and psychologization of surveillance. The paper is divided into four sections. First it introduces the literature on digital self-tracking. Secondly it sets out our understanding of neoliberalism and postfeminism. Thirdly it looks at beauty and surveillance, before offering, in the final section, a typology of appearance apps. This is followed by a discussion of the modes of address/authority deployed in these apps – especially what we call ‘surveillant sisterhood’ - and the kinds of entrepreneurial subjectivity they constitute. The paper seeks to make a contribution to feminist surveillance studies and argues that much more detailed research is needed to critically examine beauty apps

The clinical presentation of monkeypox: a retrospective case-control study of patients with possible or probable monkeypox in a West London cohort

Objectives: Since May 2022, cases of human monkeypox virus (hMPXV) with human-to-human cross-transmission have significantly increased in non-endemic countries. Our aim was to characterise diagnostic features of patients with confirmed and possible monkeypox to guide future risk stratification, and to describe a virtual care model. Methods: We performed a retrospective case-control study of 140 patients assessed and screened for suspected monkeypox; on hMPXV PCR testing, 70 were confirmed positive and 70 negative. Data were compared to generate odds ratios of demographic and clinical features. Results: Positive patients were predominantly cis-male (99%) and self-identified as gay, bisexual and other men who have sex with men (GBMSM) (94%). Lymphadenopathy at presentation was associated with a higher likelihood of a positive result (OR 7.69 [95% CI 3.58, 16.51]). Positive patients were more likely to have a rash affecting the genital (OR 5.38 [95% CI 2.57, 11.23]) or buttocks/perianal region (OR 3.79 [1.70, 8.45]) compared with negative controls. 79% of patients engaged with virtual ward follow-up. Conclusions: These data can inform a risk-based approach to management of suspected monkeypox in GBMSM populations. Lymphadenopathy at presentation and the location of the rash were more associated with a positive hMPXV result. Health authorities can consider a virtual ward approach in the hMPXV outbreak

Predictors of HIV and Syphilis among Men Who Have Sex with Men in a Chinese Metropolitan City: Comparison of Risks among Students and Non-Students

Men who have sex with men (MSM) are at a substantial risk of HIV, given rising HIV prevalence in urban China. Adolescent and adult students often take HIV-related risk as part of sexual exploration. We compared the risks of HIV and syphilis infections and risky sexual behaviors between student and non-student among urban MSM.Respondent driven sampling approach was used to recruit men who were self-identified as MSM in Chongqing Metropolitan City in southwestern China in 2009. Each participant completed a computer-assisted self-interview which collected demographic and behavioral data, and provided blood specimens for HIV and syphilis testing. Multivariable logistic regression analyses identified predictors for HIV and syphilis infections while comparing student and non-student MSM.Among 503 MSM participants, 36.4% were students, of whom 84.2% were in college. The adjusted prevalence of HIV infection was 5.5% (95% confidence interval [CI]: 2.1%-10.2%) in students and 20.9% (95% CI: 13.7%-27.5%) in non-students; the adjusted prevalence of syphilis was 4.4% (95% CI: 0.7%-9.0%) in students and 7.9% (95% CI: 3.6%-12.9%) in non-students (P = 0.12). Two groups had similar risky sexual behaviors such as number of sexual partners and exchanging sex for money. Multivariate analysis showed that students had lower HIV prevalence than non-students (adjusted odds ratio [AOR]: 0.3; 95% CI: 0.1-0.8) adjusting for age, ethnicity and other variables.Student MSM have lower HIV and similar syphilis prevalence compared with non-student MSM. However, due to a shorter duration of sexual experience and high prevalence of at-risk sexual behaviors among student MSM, HIV risk might be quite high in students as in non-students