HIV Prevalence,Knowledge, Attitudes,and Practices Among Polydrug Users in Brazil: A Biological Survey Using Respondent Driven Sampling

Brazil has a concentrated HIV epidemic among key populations. In 2009, the Ministry of Health conducted a survey in 10 Brazilian cities aiming to estimate HIV prevalence, knowledge, and associated risk behaviors of polysubstance users (PSU). Using Respondent Driven Sampling (RDS), 3449 PSU were recruited, answered an Audio-Computer Self Assisted Interview (ACASI) and were tested for HIV and syphilis. Analyses were weighted by individual’s social network size generated on RDSAT. Pooled HIV prevalence was 5.8% but varied across cities. Most PSU were male, non-white, without income, unemployed, with low levels of education. Overall, 12.0% used injectable drugs, 48.7% had sex with occasional partners and 46.4% engaged in commercial sex. A majority received free condoms (71.4%) but 76.7% exhibited inconsistent condom use. Findings can support policies aiming to improve health care and preventive interventions tailored to this population that remains at high risk of acquiring and transmitting HIV/STI in multiple scenarios.     

Influence of intra- and extrauterine factors on infant sleep in the first 6 months of life

ObjectiveInfant sleep problems can affect the child's health. Maternal characteristics have been associated with the quality of infant sleep, but few studies have investigated the impact of intrauterine conditions. The aim of the study was to evaluate the association between adverse intrauterine environments (maternal smoking, hypertension, diabetes, and intrauterine growth restriction) and extrauterine factors on infant sleep in the first 6 months of life.MethodsProspective cohort study, including singleton and at-term infants. Mothers were interviewed after delivery and at 30 days, 3 months, and 6 months of life. Socioeconomic, breastfeeding, and sleep data were self-reported by mothers using semi-structured interviews. Maternal stress (Perceived Stress Scale) and postpartum depression symptoms (Edinburgh Postpartum Depression Scale) were assessed.ResultsThere was no statistically significant association between intrauterine environments and the sleep of infants of the 359 mother–child dyads investigated. Total infant sleep time decreased from approximately 13–11 h from 30 days to 6 months of age (p < 0.001) and the longest period of uninterrupted sleep increased from approximately 4–6 h during the same period (p < 0.001). Breastfed infants slept longer in 24-h periods in the first month, but they woke up more often throughout the night when compared to infants receiving formula. Mothers with depressive symptoms reported increased sleep latency time.ConclusionsAdverse intrauterine environments did not significantly affect sleep measures in the first 6 months of life. Maternal characteristics and practices, however, were associated with infant sleep, suggesting that environmental factors significantly contribute to sleep quality early in life.     

Balancing efficacy and safety in the management of atopic dermatitis: the role of methylprednisolone aceponate

Although emollients can be sufficient to manage mild atopic dermatitis (AD), acute flares resulting in moderate‐to‐severe symptoms require treatment with anti‐inflammatory agents, such as topical corticosteroids (TCs) and topical calcineurin inhibitors (TCIs). This review examines the role of a member of the newest class of TCs, the fourth‐generation compound methylprednisolone aceponate (MPA) in AD management, with reference to the chemical structure, pharmacokinetics, efficacy in AD, safety assessed in preclinical and clinical trials and dosing considerations. MPA has an optimized efficacy/safety profile with minimal local or systemic adverse effects. In addition, it offers the opportunity for once‐daily dosing, which provides benefits in terms of patient compliance with treatment.     

Book Reviews

Background: Addressing the long-term consequences of stroke is a top 10 research priority, and understanding the views of different stakeholders is essential in designing appropriate patient-centred multidisciplinary rehabilitation.

Aims: This study reports on the perspectives of 38 individuals who live with or work with aphasia: people with aphasia (PWA), family members (FM) and friends, and speech and language therapists (SLTs), about its consequences in the daily lives of PWA.

Method &; Resources: In total, 14 PWA, 14 FM and 10 SLTs participated in the study. All participants were interviewed about the consequences of stroke and aphasia. Small focus groups were used with some participants. In-depth semi-structured interviews were used with other participants. Interviews were carried out in groups or individually in order to accommodate severe aphasic impairments or respondents with fewer years of education. Interviews were video or audio-recorded. Verbal and non-verbal communication was transcribed and analysed qualitatively using content analysis. Data was coded and mapped onto the ICF framework.

Outcomes &; Results: All three groups reported consequences in Body Functions and Body Structures, primarily in Mental Functions (Specific Mental Functions and Global Mental Functions) and Neuromusculoskeletal and Movement-Related Functions. Within Specific Mental Functions, PWA emphasised Expression of Oral Language, whereas FM and SLTs emphasised Emotional Functions. Within Global Mental Functions, PWA and FM emphasised Energy and Drive Functions, whereas SLTs emphasised Temperament and Personality Functions. Some consequences were shared between PWA and SLTs (Sensory Functions and Pain, and Functions of the Digestive, Metabolic and Endocrine Systems), whilst others were specific to SLTs alone (Voice and Speech Functions, and Cardiovascular, Haematological, Immunological and Respiratory Systems). All three groups reported consequences in Activities and Participation in Major Life Areas; Community, Social and Civic Life; Interpersonal Interactions and Relationships; Communication; and Mobility. Some consequences were shared by PWA and FM (Domestic Life), and others by FM and SLT (Self Care). Consequences in General Tasks and Demands were only described by SLTs and in Learning and Applying Knowledge by PWA. Both PWA and FM reported a general Loss of Autonomy.

Conclusions: PWA, FM and SLTs reported a considerable range of stroke and aphasia consequences in the daily life of those who live with it. They were concerned to different degrees with language, physical and emotional changes, and impact on communication, mobility, self-care, relationships, leisure and work. Professionals’ practices in Portugal need to be changed in order to consider these findings.