Pericardial effusion complicated by tamponade: a case report

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The Association of HIV Counseling and Testing with HIV Risk Behaviors in a Random Population-based Survey in Kisumu, Kenya

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population

Reflexões sobre o crescente número de cesáreas no Brasil: um chamado à consciência

INTRODUÇÃO: A incidência de cesarianas tem aumentado ao longo das décadas em escala global, e no Brasil, esse índice atingiu uma marca significativa de 56% -  colocando-o substancialmente acima da média observada em nações em desenvolvimento. METODOLOGIA: Revisão narrativa da literatura realizada a partir da busca bibliográfica na base de dados PubMed, com os descritores “Cesarean”, “Prenatal care”, “Childbirth”. RESULTADOS: Os estudos pesquisados foram publicados em periódicos internacionais, sendo selecionados artigos de revisão, revisão sistemática e metanálise. DISCUSSÃO: No contexto obstétrico nacional, a tendência de aumento nas taxas de cesáreas começou a se manifestar em 2017 e foi exacerbada pela pandemia. Apesar dos esforços para reorganizar a rede de assistência pré-natal durante o período pandêmico, especialmente para pacientes com risco obstétrico, na prática, esses esforços foram limitados. Consequentemente, observou-se um influxo de gestantes em estágios avançados de complicações obstétricas nas unidades de maternidade, muitas das quais necessitando de cesariana para mitigar desfechos materno-perinatais desfavoráveis. CONCLUSÃO: Em conclusão, o aumento nas taxas de cesáreas no Brasil, que já vinha sendo observado há quase uma década e foi intensificado durante a pandemia, destaca a necessidade urgente de políticas e práticas que promovam uma abordagem mais equilibrada e baseada em evidências na assistência obstétrica

Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs

Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV

Association of Attitudes and Beliefs towards Antiretroviral Therapy with HIV-Seroprevalence in the General Population of Kisumu, Kenya

Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment.We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age.1,655 (90%) of 1,844 people aged 15-49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16-1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22-3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15-24 years) men (OR = 1.56; 95% CI 1.12-2.19).ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability

Vedere. Lo sguardo di E.T.A. Hoffmann

Vedere la folla attraverso una serie di inquadrature e con lo sguardo del voyeur, dello spettatore, dello scienziato, del visionario. Vedere la notte in un’oscurità che si popola di presenze inquietanti e sottrae il reale alla vista segnando la crisi della rappresentazione classica. Uno studio a quattro mani sul “vedere” in E.T.A. Hoffmann, corredato da un ricco apparato iconografico, che dimostra la centralità di questo autore sia sul versante di una teoria dello sguardo romantico sia su quello del rapporto tra dispositivi ottici e scrittura letteraria

Case report: Pericardial effusion complicated by tamponade

Pericardial effusion is fluid in the space between the heart and the pericardial sac. There are many causes of pericardial effusion, with infection (viral and TB) as the most common. If fluid rapidly accumulates in the pericardial space, like in chest trauma, this fluid can compress the heart (cardiac tamponade) and cause circulatory failure. With slow accumulation of fluid, the pericardial sac will stretch to accommodate the fluid. However, if fluid continues to accumulate, tamponade will eventually occur. This is an emergency situation requiring aspiration of pericardial fluid (pericardiocentesis)

The association of HIV counseling and testing with HIV risk behaviors in a random population-based survey in Kisumu, Kenya.

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population

Prévalence du sexe forcé et facteurs qui y sont liés chez les femmes et les hommes à Kisumu, Kenya

Sexual violence is a well-recognized global health problem, albeit with limited population-based data available from sub-Saharan Africa. We sought to measure the prevalence of forced sex in Kisumu, Kenya, and identify its associated factors. The data were drawn from a population-based cross-sectional survey. A two-stage sampling design was used: 40 clusters within Kisumu municipality were enumerated and households within each cluster selected by systematic random sampling. Demographic and sexual histories, including questions on forced sex, were collected privately using a structured questionnaire. The prevalence of forced sex was 13% (women) and 4.5% (men). After adjusting for age and cluster, forced sex among women was associated with transactional sex (OR 2.33; 95%CI 1.38-3.95), having more than two lifetime partners (OR 1.9; 95%CI 1.20-3.30), having post-primary education (OR 1.49; 95%CI 1.04-2.14) and a high economic status (OR 1.87; 95%CI 1.2-2.9). No factors were significantly associated with forced sex among the male respondents. Intimate partners were the most common perpetrators of forced sex among both women (50%) and men (62.1%). Forced sex prevention programs need to target the identified associated factors, and educate the public on the high rate of forced sex perpetrated by intimate partners (Afr J Reprod Health 2011; 15[4]: 87-97).La violence sexuelle est un problème de santé qui est bien reconnu partout dans le monde, bien que les données basées sur la population et disponible de l’Afrique subsaharienne soient limitées. Nous avons cherché à mesurer la prévalence du sexe forcé à Kisumu, Kenya et à identifier ses facteurs associés. Nous avons recueilli les données à partir d’une enquête transversale basée sur la population. Nous nous sommes servis d’un modèle d’échantillon à deux étapes : Nous avons énuméré 40 petits groupes au sein de la municipalité de Kisumu et les ménages au sein de chaque groupe choisi au hasard à partir d’un échantillon systématique. Des histoires démographiques et sexuelles y compris des questions sur le sexe forcé, ont été recueillies en privé à l’aide d’un questionnaire structuré. La prévalence du sexe forcé était 13%(femmes) et 4,5% (hommes). Après avoir ajusté selon l’âge et le groupe, le sexe forcé chez les femmes a été lié au sexe transactionnel (OR2,33 ; 95%CI 1,38-3,95% CI 1,20-3,30), ayant plus de deux partenaires de toute une vie(OR 1,9 ; 95% CI 1,20-3,30), ayant reçu une éducation post primaire (OR 1,49 ; 95%CI 1,04-214) et une haute situation économique (OR1, 87 ; 95%CI 1,2-2,9). Il n’y avait pas de facteur qui a été significativement lié au sexe forcé chez les interviewés mâles. Des partenaires intimes étaient les auteurs les plus communs du sexe forcé parmi les femmes (50%) et les hommes (62,1%). Les programmes destinés à la prévention du sexe forcé doivent viser les facteurs qui y sont liés et qui ont été identifiés et il faut sensibiliser le public à l’égard du taux élevé du sexe forcé qui est perpétré par des partenaires intimes (Afr J Reprod Health 2011; 15[4]: 87-97)

Attitudes and beliefs about anti-retroviral therapy are associated with high risk sexual behaviors among the general population of Kisumu, Kenya

Attitudes and beliefs about antiretroviral therapy (ART) may affect sexual risk behaviors among the general population in sub-Saharan Africa. We performed a cross-sectional population-based study in Kisumu, Kenya to test this hypothesis in October 2006. A total of 1655 participants were interviewed regarding attitudes and beliefs about ART and their sexual risk behaviors. The majority of participants, (71%) men and (70%) women, had heard of ART. Of these, 20% of men and 29% of women believed ART cures HIV. Among women, an attitude that "HIV is more controllable now that ART is available" was associated with sex with a non-spousal partner, increased lifetime number of sexual partners as well as a younger age at sexual debut. No significant associations with this factor were found among men. The belief that "ART cures HIV" was associated with younger age of sexual debut among women. The same belief was associated with an increased likelihood of exchanging sex for money/gifts and decreased likelihood of condom use at last sex among men. These findings were most significant for people aged 15-29 years. In high HIV seroprevalence populations with expanding access to ART, prevention programs must ensure their content counteracts misconceptions of ART in order to reduce high risk sexual behaviors, especially among youth