Development and validation of vulnerable and enabling indices for hiv viral suppression among people with hiv enrolled in the ryan white program

Background: Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). Methods: We used Ryan White Program (RWP) data and principal component analysis to develop general and gender-and racial/ethnic-specific indices. We assessed internal reliability (Cronbach’s alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. Results: Three general factors accounting for 79.2% of indicators’ variability surfaced: mental health, drug use, and socioeconomic status (Cronbach’s alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender-or racial/ethnic-specific indices did not improve psychometric performance. Discussion: General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender-and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Factors Associated with HIV Testing Behaviors among Latino Emerging Adults

Latino emerging adults account for a significant proportion of incident HIV cases among emerging adults aged 18-24 in the United States, but have a lower prevalence of HIV testing compared to other racial/ethnic emerging adult groups. Yet, factors that influence HIV testing behaviors among Latino emerging adults are poorly understood. This dissertation examined sociocultural and psychological factors of HIV testing behaviors among a sample of 157 sexually active Latino emerging adults aged 18 to 25. Cross-sectional data from the Project on Health among Emerging Adult Latinos (Project HEAL) were used. Robust Poisson regressions were used to estimate adjusted prevalence ratios (aPRs) and hierarchical logistic regressions were used to estimate adjusted odds ratios (aORs) for HIV testing behaviors. Findings indicated that 59.9% of participants reported lifetime history of HIV testing. Of those engaging in sexual risk behaviors, 62.8% reported lifetime history of HIV testing. Familism support was significantly associated with lifetime history of HIV testing (aPR= .81, 95% confidence interval [CI]: .68-.95). Nativity status but not gender moderated the association between familism support and lifetime history of HIV testing. Also, self-efficacy for HIV testing was significantly associated with lifetime history of HIV testing (aOR=3.49, 95% CI: 1.78-6.83), and this association was moderated by distress tolerance and sexual risk behaviors. Lastly, cognitive reappraisal was significantly associated with HIV testing intentions (aOR=1.44, 95%CI=1.04-1.99), and this association was moderated by gender. Collectively, our findings highlight the significance of sociocultural and psychological factors that are associated with HIV testing behaviors and may have the potential to inform evidence-based prevention programs that promote HIV testing among Latino emerging adults. Future research should examine the direction of these potential casual associations to better inform HIV testing efforts

Formalizing Artisanal Gold Mining under the Minamata Convention: Previewing the Challenge in Sub-Saharan Africa

This article contributes to a growing body of literature which explores how the Minamata Convention on Mercury is influencing the development of artisanal and small-scale mining (ASM) – low-tech mineral extraction and processing – in sub-Saharan Africa. Conceived to raise awareness of the environmental impact of mercury and to minimize its use in industry, the Convention focuses heavily on ASM, the largest source of anthropogenic emissions of mercury worldwide. Article 7 of the Convention requires ratifying countries with ‘more than significant quantities of ASGM [artisanal and small-scale gold mining]’ to draft comprehensive National Action Plans (NAPs) that outline training programs for the handling of mercury and strategies for reducing emissions from artisanal and small-scale gold mines. The focus here, however, is on one point in particular, the importance of which, thus far, has been largely-overlooked: the need for ratifying countries to include in their NAPs ‘Steps to facilitate the formalization or regulation of the artisanal and small-scale gold mining sector’. In sub-Saharan Africa, where most ASM activities are found in the informal ‘space’, this promises to be a contentious issue moving forward. The article explains why this is the case, drawing heavily on findings from research being conducted in Ghana, Sierra Leone and Mali, three of the region’s most dynamic ASM economies

Efficacy of a school-based intervention to bring awareness about PCB contamination and exposure avoidance in Guánica, Puerto Rico

Production of polychlorinated biphenyls (PCB) was banned in the US in 1970s. However, susceptible populations especially those living at/around the contaminated sites continue to be at a risk of elevated exposure to PCBs because information about the contamination (of the environment) and its associated health risks may not reach these populations. A recent study found the second highest concentration of PCBs ever recorded worldwide in the sediment samples of Guánica Bay, located in the southwestern part of Puerto Rico. PCB levels in fish from the bay were also higher than the tolerance limit of Food and Drug Administration (FDA), which motivated this research to initiate a school-based campaign to bring community awareness about the contamination of the bay and engage students in preventive strategies to reduce their exposure to PCBs. Surveys before and after the campaign were administered in the high school as well as in the communities of Guánica Municipality. The analyses of the survey data suggest that the campaign was effective in bringing awareness among schoolchildren (6.6% before versus 69.7% after the campaign; χ ~ 60.4; p < 0.001) and strategies to reduce PCB exposure and its toxicity such as removing adipose tissues from seafood/fish and exercising. In the community, there was a significant decline in the consumption of seafood/fish harvested from the bay after the campaign (54.6% before versus 33% after the campaign; χ ~ 10.85; p < 0.001). However, the awareness did not result in significant behavior modifications among schoolchildren, such as avoiding swimming and fishing in the bay. Given hazardous levels of PCBs and some students use the bay for various purposes, including one-third of community members still use seafood/fish harvested from the bay, attention of different stakeholders is warranted for clean-up efforts as well as engaging children and communities in PCB exposure avoidance strategies

Development and Validation of Vulnerable and Enabling Indices for HIV Viral Suppression among People with HIV Enrolled in the Ryan White Program

Background: Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). Methods: We used Ryan White Program (RWP) data and principal component analysis to develop general and gender- and racial/ethnic-specific indices. We assessed internal reliability (Cronbach’s alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. Results: Three general factors accounting for 79.2% of indicators’ variability surfaced: mental health, drug use, and socioeconomic status (Cronbach’s alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender- or racial/ethnic-specific indices did not improve psychometric performance. Discussion: General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender- and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations

The complete chloroplast genome of the threatened Napa False Indigo Amorpha californica var. napensis Jeps. 1925 (Fabaceae) from Northern California, USA

Amorpha californica var. napensis Jeps. 1925, the Napa false indigo, is a threatened shrub endemic to northern California. Here the complete chloroplast genome of topotype material of var. napensis was assembled and characterized to contribute to the bioinformatics, systematics, and conservation of this variety. The chloroplast genome (GenBank accession OK274088) is 158,294 base pairs (bp) in length, encodes 130 genes including 85 protein-coding, 37 tRNA, 8 rRNA, and shows a high-level of gene synteny to other Papilionoideae. Phylogenetic analysis fully resolved var. napensis in a clade with A. fruticosa L. and A. roemeriana Scheele, sister to the Dalbergieae. The newly sequenced chloroplast genome shows that the genetic differences between var. napensis and Amorpha californica Nutt. var. californica are greater than the variation observed between var. napensis and many other Amorpha spp. sequences deposited in GenBank. These data suggest that var. napensis should be elevated to full species rank