Factors associated with unprotected sex in people who consume sexually explicit media

OBJECTIVE: To analyze the factors associated with sex without the use of condoms in consumers of sexually explicit media (SEM). METHODS: Cross-sectional study, with a sample of 172 participants selected and collected through social media. To assess the predictors of unprotected sexual practices, the Poisson regression model was used. Values were expressed as a robust prevalence ratio (PR) with their respective confidence intervals. RESULTS: There was a statistically significant association between, the use of condoms and the type of scenes that the participants prefer (p = 0.03), the preference for films with scenes involving unprotected sex or even those that do not care about protection (p = 0.02), the type of pornography watched influencing sexual relations (p = 0.017), and the number of scenes seen per week (p = 0.05). CONCLUSIONS: The lack of condom use was associated with the access to erotic scenes.publishersversionpublishe

Coinfecção leishmaniose visceral-HIV em um estado brasileiro:: aspectos sociodemográficos, clínicos e laboratoriais

Objetivo: Analizar los patrones temporales, clínicos y epidemiológicos relacionados con la leishmaniasis visceral asociada al VIH en el estado de Piauí de 2007 a 2016. Métodos: Estudio de series de tiempo, con datos obtenidos del Sistema de Información de Enfermedades de Notificación, realizado con 224 casos de leishmaniasis visceral-vih en el período de 2007 a 2016. Resultados: Durante el período de estudio, se reportaron 224 casos de coinfección leishmaniasis visceral-vih, de los cuales el 83% eran hombres. El 44.6% era analfabeto y el 87.9% vivía en el área urbana. La prevalencia del Virus de inmunodeficiencia humana en individuos con leishmaniasis visceral fue del 11.8%. Conclusión: Fue observado la alta concentración de casos de leishmaniasis visceral aislada y asociada al Virus de inmunodeficiencia humana y el importante proceso de urbanización y periurbanización de la leishmaniasis visceral. Con eso, se observa el necesidad de expansión y fortalecimiento de las medidas de vigilancia epidemiológica en el Estado.Objetivo: Analisar padrões temporais epidemiológicos e clínicos relacionados à coinfecção leishmaniose visceral-HIV no Estado do Piauí no período de 2007 a 2016. Métodos: Estudo de série temporal, com dados obtidos do Sistema de Informação de Agravos de Notificação, realizado com 224 casos de leishmaniose visceral-hiv no período de 2007 a 2016. Resultados: No período do estudo foram notificados 224 casos de coinfecção leishmaniose visceral-hiv, sendo que 83% eram do sexo masculino, 44,6% eram analfabetos e 87,9% residiam na zona urbana. A prevalência de HIV entre os indivíduos com leishmaniose visceral foi de 11,8%. Conclusão: Observou-se a elevada concentração de casos de leishmaniose visceral isolada e associada ao Vírus da Imunodeficiência Humana e o significativo processo de urbanização e periurbanização da leishmaniose visceral. Com isso, observa-se a necessidade de ampliação e fortalecimento de medidas de vigilância epidemiológica no Estado.Objective: To analyze epidemiological and clinical temporal patterns related to HIV-associated visceral leishmaniasis in the state of Piauí from 2007 to 2016. Methods: A time series study with data obtained from the Disease Information System, conducted with 224 cases of HIV-associated visceral leishmaniasis in the period 2007 to 2016. Results: During the study period, 224 cases of HIV-associated visceral leishmaniasis coinfection, of which 83% were male, 44.6% were illiterate and 87.9% lived in the urban area. The prevalence of Human immunodeficiency virus among individuals with visceral leishmaniasis was 11.8%. Conclusion: It was observed the high concentration of cases of visceral leishmaniasis isolated and associated with Human immunodeficiency virus and the significant process of urbanization and periurbanization of visceral leishmaniasis. Thus, there is a need to expand and strengthen measures of epidemiological surveillance in the State

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research