Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV.

Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm <sup>3</sup> ) adjusting for covariates. Analyses were conducted separately by site. The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively. In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control

Equivalence of 2 effective graft-versus-host disease prophylaxis regimens: Results of a prospective double-blind randomized trial

AbstractWe have previously demonstrated a decrease in the incidence of acute graft-versus-host disease (GVHD) with the addition of methotrexate (MTX) to cyclosporine (CSP) and prednisone (PSE) chemotherapy in patients with leukemia. We have now completed a prospective randomized trial comparing the 3-drug regimen (CSP/MTX/PSE, including 3 doses of MTX) to the standard 2-drug regimen (CSP/MTX, including 4 doses of MTX) to investigate the benefit of PSE used up front for the prevention of acute and chronic GVHD. In the trial, 193 patients were randomized and 186 were included in the final analysis. All patients received a bone marrow graft from a fully histocompatible sibling donor. The preparatory regimen consisted of fractionated total-body irradiation (fTBI) and etoposide in all but 13 patients, who received fTBI and cyclophosphamide. The patients were randomized to receive either CSP/MTX/PSE or CSP/MTX. The 2 groups were well balanced with respect to diagnosis, disease stage, age, donor-recipient sex, and parity. In an intent-to-treat analysis, the incidence of acute GVHD was 18% (95% confidence interval [CI] 12-28) for the CSP/MTX/PSE group compared with 20% (CI 10-26) for the CSP/,MTX group (P = .60), with a median follow up of 2.2 years. Overall survival was 65% for those receiving CSP/MTX/PSE and 72% for those receiving CSP/MTX (P = .10); the relapse rate was 15% for the CSP/MTX/PSE group and 12% for the CSP/MTX group (P = .83). The incidence of chronic GVHD was similar (46% versus 52%; P = .38), with a follow-up of 0.7 to 6.0 years. Of interest, 21 patients went off study due to GVHD (5 in the CSP/MTX/PSE group and 16 in the CSP/MITX group [P = .02]), and 11 patients went off study because of alveolar hemorrhage (3 in the CSP/MTX/PSE group and 8 in the CSP/MTX group [P = .22]). The addition of PSE did not result in a higher incidence of infectious complications, bacterial (66% versus 58%), viral (77% versus 66%), or fungal (20% versus 20%), in those receiving CSP/MTX/PSE versus CSP/MTX, respectively. These data suggest that the addition of PSE was associated with a somewhat lower incidence of early posttransplantation complications but did not have a positive impact on the incidence of acute or chronic GVHD or event-free or overall survival.Biol Blood Marrow Transplant 2000;6(3):254-61

Avaliação das práticas diferenciais de amamentação: a questão da etnia

Breastfeeding practices in two Brazilian metropolitan areas (S. Paulo and Recife) are described, as part of a study carried out in 1987. In a random sample of healthy 0-8 month old infants, selected from all health care units, higher breastfeeding rates were found in S. Paulo (initiation, prevalence, median and average) than in Recife. The mean duration of breastfeeding, mixed and full, was of 127.5 and 66.6 days, respectively, for S. Paulo, and of 104.4 and 31.7 days for Recife. When data are analysed according to ethnic group, white S. Paulo women breastfeed more than white Recife women. Full breastfeeding rate is more prevalent among white and "mulato" S. Paulo women. However, when the data were analyzed for each city separately, it was found, remarkably, that the non-whites breastfeed more than the whites. In Recife, full breastfeeding is particularly low in whites (of 15.3 days median) and "mulatos" (of 16.7 days), but of 34.5 days in blacks. The study points out the need for greater in-depth investigation of the issue of ethnicity and infant feeding practices, still inadequately understood in world literature.Descreve-se a situação da prática de amamentar em duas áreas metropolitanas brasileiras: São Paulo e Recife, Brasil, em estudos conduzidos em 1987. Em amostras representativas da população de crianças saudáveis de 0-8 meses atendidas pelo sistema de saúde, nota-se que é maior em São Paulo a proporção das mães que iniciam a amamentação e a prevalência de amamentados. A duração média do aleitamento materno total (AM) e quase exclusivo (AE) é respectivamente de 127,5 e 66,6 dias em São Paulo. Em Recife, 104,4 e 31,7 dias, respectivamente, para AM e AE. Estudaram-se também os dados de amamentação conforme a cor da pele da mãe, concluindo que se amamenta mais em São Paulo do que em Recife, significativamente entre brancas. O aleitamento materno quase exclusivo é praticado mais em São Paulo do que em Recife, por brancas e pardas. Observando-se os grupos étnicos em cada uma das cidades, notou-se que são as mulheres não-brancas (pretas e pardas) aquelas que amamentam mais, sendo particularmente baixo o aleitamento quase exclusivo em Recife, maior entre as pretas (34,5 dias de mediana de AE) comparado a 15,3 dias entre brancas e 16,7 entre pardas. O estudo aponta para a necessidade de se elaborar desenhos de pesquisa que levem em conta a questão da etnia e a amamentação, questão não respondida pela literatura em nível mundial

Soil Stabilization and Revegetation at the INEEL Recommendations for Improvement

Soil stabilization for the INEEL Stormwater Pollution Prevention Plan (SWPPP) has mostly been by revegetation, but has experienced only limited success. The purpose of this report is to discuss issues associated with revegetation failures and to explore possible remedies

Interfacing anthropology and epidemiology: The Bedouin Arab infant feeding study

This paper encapsulates a 10 year effort of multi-disciplinary research on the relationship between infant feeding, growth, and morbidity among the Negev Bedouin Arabs of Israel as they underwent a transition from semi-nomadism to urban settlement. The research team was multi-disciplinary including a nutritional epidemiologist and an anthropologist who both came to the study with previous experience in interdisciplinary work. The specific study objectives were (1) a description of infant feeding practices among Negev Bedouin Arab women at various stages of settlement, (2) an examination of the trend in these infant feeding practices, (3) a comparison of the extent to which different infant feeding practices are related to infant morbidity and growth after adjustment for exposure to social change and other covariates. The data collection took place in 1981-1983 and the analysis from 1984-1988. In this paper, two areas of the study are discussed in depth: the duration of exclusive breast feeding during the practice of the traditional postpartum 40 day rest period, and the development of a culture-specific scale of socioeconomic status. Through these examples, we highlight the use of ethnographic data and the merging of epidemiology and anthropology from hypothesis generation through data collection, data analysis and interpretation.interdisciplinary triangulation of data growth breastfeeding