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91.
92.
Ashley Lacombe-Duncan PhD MSW Hannah Kia PhD MSW Carmen H. Logie PhD MSW Kieran P. Todd BA Yasmeen Persad Gabrielle Leblanc Kelendria Nation Ayden I. Scheim PhD Tara Lyons PhD Chavisa Horemans MES BFA Mona Loutfy MD FRCPC MPH 《Health & social care in the community》2021,29(5):e33-e46
Transgender (trans) women experience barriers to access to HIV care, which result in their lower engagement in HIV prevention, treatment and support relative to cisgender people living with HIV. Studies of trans women's barriers to HIV care have predominantly focused on perspectives of trans women, while barriers are most often described at provider, organisation and/or systems levels. Comparing perspectives of trans women and service providers may promote a shared vision for achieving health equity. Thus, this qualitative study utilised focus groups and semi-structured interviews conducted 2018–2019 to understand barriers and facilitators to HIV care from the perspectives of trans women (n = 26) and service providers (n = 10). Barriers endorsed by both groups included: (a) anticipated and enacted stigma and discrimination in the provision of direct care, (b) lack of provider knowledge of HIV care needs for trans women, (c) absence of trans-specific services/organisations and (d) cisnormativity in sexual healthcare. Facilitators included: (a) provision of trans-positive trauma-informed care, (b) autonomy and choice for trans women in selecting sexual health services and (c) models for trans-affirming systems change. Each theme had significant overlap, yet nuanced perspective, between trans women and service providers. Specific recommendations to improve HIV care access for trans women are discussed. These recommendations can be used by administrators and service providers alike to work collaboratively with trans women to reduce barriers and facilitators to HIV care and ultimately to achieve health equity for trans women. 相似文献
93.
Age as a prognostic factor in the malignant melanoma population 总被引:3,自引:0,他引:3
Paul F. Austin MD C. Wayne Cruse MD Gary Lyman MD MPH Kenneth Schroer MD Frank Glass MD Dr. Douglas S. Reintgen MD 《Annals of surgical oncology》1994,1(6):487-494
Background: The incidence of malignant melanoma is increasing faster than any other cancer, and the state of Florida has one of the highest incidence of melanoma in the United States. This increased incidence is thought to be due to the intense sunlight exposure and ultraviolet radiation exposure in the elderly population. With the increased emphasis on issues of aging, it is appropriate to study the role of age as a prognostic factor for malignant melanoma in the Florida population.
Methods: A retrospective, computer-aided search identified 442 consecutively registered patients with malignant melanoma at the Cutaneous Oncology Program. All patients had stage 1 or 2 disease (cutaneous disease only) at diagnosis. Prognostic variables analyzed included the most powerful factors for stage 1 and 2 melanoma, tumor thickness, ulceration, and Clark level of invasion. Other prognostic variables included in the analysis were the clinical variables of sex and primary site (axial vs. extremity). The population was divided into patients 65 and >65 years of age.
Results: Significant disease-free survival differences were encountered in the older population, with only 55% of the elderly population being disease free at 5 years compared with 65% for the younger population (p=0.0073). However, a greater percentage of patients with melanoma who were >65 years of age had ulcerated lesions (17.5% vs. 12.9%) and a greater percentage of thick lesions at diagnosis (67.2% vs. 62.7%). Both of these prognostic factors would bias the older population with a poorer survival. A stepwise regression analysis of the entire population was performed, treating age as a continuous variable. Surprisingly, increasing age along with tumor thickness were the only significant predictors for disease-free survival. After inclusion of these two prognostic variables, none of the other prognostic factors, including Clark level, ulceration, sex, and primary site, added to the prognostic model.
Conclusions: From this analysis, it is apparent that geriatric patients with melanoma have a worse prognosis than a younger control population, even after the correction for the more commonly cited prognostic factors. This information should be used in mathematical modeling to identify high-risk populations who are candidates for perhaps more aggressive primary or adjuvant therapies.Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993. 相似文献
94.
S. J. Rosansky MD R. Rhinehart MD D. Whittman MPH S. J. Menachery 《Clinical autonomic research》1995,5(3):151-154
In published studies of chronic haemodialysis patients, the frequency of autonomic dysfunction varies widely. One reason for the variation may be the time of testing with respect to time of dialysis. The current study tests the hypothesis that autonomic function — as measured by heart rate responses to the Valsalva manoeuvre (Valsalva ratio) and 30:15 electrocardiogram (ECG) R—R interval to upright posture (postural ratio) — is different when patients are above dry weight (predialysis) than when they are at or below dry weight (postdialysis). The study also reviews available literature to analyze other factors that may affect the results of autonomic testing in this population. A total of 25 chronic haemodialysis patients underwent standard Valsalva and 30:15 R—R interval postural autonomic testing prior to and after haemodialysis. In addition, pre- and postdialysis orthostatic responses were measured and compared with a control population. The 30:15 ratio increased after dialysis (p = 0.001). The Valsalva ratio did not change with dialysis. Out of 25 subjects, seven had an abnormal 30:15 ratio prior to dialysis decreasing to two out of 25 patients postdialysis (p < 0.03). Orthostatic responses predialysis did not differ from those in the control group. Review of the literature shows great variability in definition of normal Valsalva and postural (30:15 R—R interval) ratios. Diabetic patients in the current and prior studies were more likely to have abnormal responses. In conclusion, the prevalence of autonomic dysfunction in chronic dialysis patients as determined by Valsalva and 30:15 ECG postural ratios may be influenced by the following factors: when subjects are studied with respect to their dialysis treatment; the number of subjects with diabetes; and the cut-off point used to define abnormal test results. Abnormal Valsalva ratios are less frequent when measured postdialysis. 相似文献
95.
John William Hayden MD FACEP Claudette Laney RN CCHP Arthur L Kellermann MD MPH FACEP
《Annals of emergency medicine》1995,26(6)
Study objective: The alteration of a knee immobilizer into a sharp weapon by a prisoner prompted us to survey neighboring penal institutions to determine the frequency of such events. Design: We mailed a nine-item survey to all detention facilities in Tennessee, Arkansas, and Mississippi. A second survey was sent to nonresponding institutions 6 weeks after the initial mailing. Setting: The Regional Medical Center at Memphis, the designated facility for evaluation and treatment of prisoners from the county jail and state penitentiary. Participants: Survey respondents included 25 state penitentiaries, 31 county jails, 1 state minimum-security facility, 1 state maximum-security facility, 1 work-release center, 1 county detention center for drunken-driving offenders, and 1 federal penitentiary. Results: Of the 81 institutions surveyed, 77% responded to one of the two mailings. Forty percent responded in the affirmative when asked whether stolen or unauthorized medical equipment from outside their institutions had been discovered among inmates. When respondents were questioned as to whether medical equipment, prescribed or not, had been used or altered in a criminal manner, 34% responded "yes." Medications and medical appliances were listed in the responses. Conclusion: A survey of 81 local and neighboring penal institutions in a three-state area revealed that the illicit use of medicine and medical devices by prisoners is a legitimate safety concern of prison personnel and health care workers when medical care for inmates must be sought outside the security of their institutions. The modification of medical equipment into weapons by incarcerated patients, although clearly recognized as a security and safety problem by police authorities, appears to be unappreciated by health care workers providing episodic care to inmates. [Hayden JW, Laney C, Kellermann AL: Medical devices made into weapons by prisoners: An unrecognized risk. Ann Emerg Med December 1995;26:739-742.] 相似文献
96.
Background: Vitamin B12 deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B12 from protein foodstuffs and to a failure of absorption of crystalline vitamin B12 in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin
B12 was most effective in treating vitamin B12 deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B12 < 100 pmol L −1, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m−2. Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received
350 μg per day of crystalline vitamin B12 and all increased their serum vitamin B12 levels to over 100 pmol L−1. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B12-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B12 levels were greater than 150 pmol L−1 after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2%
after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B12 after gastric surgery for obesity to correct low serum vitamin B12 levels in 95% of patients. 相似文献
97.
John P. Sciacca PhD MPH CHES David A. Dube MPH RD Brenda L. Phipps BS CLE Michael I. Ratliff PhD 《Journal of community health》1995,20(6):473-490
This study was undertaken to determine the effects of a partner-support, incentive-baed educational program on breast feeding knowledge, attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women. Women who expressed a willingness to participate in the intervention were randomly assigned to intervention and usual breast feeding (control) groups. Sixty-eight primipara women, with expected due dates between May and December, 1992, volunteered to participate in the study. Of these, 34 were randomly assigned to each of the two groups. Approximately 81 percent of the women completed the study, leaving n=29 in the control group and n-26 in the intervention group. The intervention consisted of special incentives (prizes) for women and their partners to participate in several breast feeding education and promotion activities. Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes. Furthermore, the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions. In addition, the partners of intervention group women were perceived to be more supportive of, breast feeding than control group partners. These findings suggest that incentives, such as donated prizes, can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions. Participation in such interventions can produce positive changes in breast feeding knowledge, attitudes, and support, and can have a dramatic effect in promoting breast feeding.This study was supported through contract no. 59-3198-1-050 from the Food and Nutrition Service, U.S. Department of Agriculture. 相似文献
98.
Drs. Christopher Williams PhD Ms. Jennifer A. Epstein PhD Gilbert J. Botvin PhD Michelle Ifill-Williams MPH 《Journal of urban health》1999,76(1):85-101
Youths residing in public housing developments appear to be at markedly heightened risk for drug use because of their constant
exposure to violence, poverty, and drug-related activity. The purpose of this study was to develop and test a model of marijuana
etiology with adolescents (N=624) residing in public housing. African-American and Hispanic seventh graders completed questionnaires
about their marijuana use, social influences to smoke maijuana, and sociodemographic and psychosocial characteristics. Results
indicated that social influences, such as friends' marijuana use and perceived ease of availability of marijuana, significantly
predicted both occasional and future use of marijuana. Individual characteristics such as antimarijuana attitudes and drug
refsul skills also predicted marijuana use. The findings imply that effective prevention approaches that target urban youths
residing in public housing developments should provide them with an awareness of social influences to use marijuana, correct
misperceptions about the prevalence of marijuana smoking, and train adolescents in relevant psychosocial skills. 相似文献
99.
SOO-KYUNG LEE PhD RD JEFFEREY SOBAL PhD MPH EDWARD A FRONGILLO Jr PhD 《Journal of the American Dietetic Association》1999,99(9):1084-1089
OBJECTIVE: Examine variation in dietary practices and nutritional intakes of Korean Americans at different acculturation levels. DESIGN: Cross-sectional mail survey. SUBJECTS/SETTING: US national sample of 348 Korean Americans (46% of the Korean American sample to whom questionnaires were delivered). STATISTICAL ANALYSIS PERFORMED: Analysis of variance, Pearson correlation, Spearman rank correlation, chi 2 test, and multiple regression analysis. RESULTS: Korean Americans who were more acculturated consumed more American food and less Korean food. American foods such as oranges, low-fat milk, bagels, tomatoes, and bread were consumed regularly by Korean Americans; Korean foods such as rice, kimchi, garlic, green onions, and Korean soup were also consumed regularly. American foods were adopted the most at breakfast and the least at dinner. Bicultural people regularly incorporated more different types of foods into their diet. Despite significant differences in dietary practices, dietary quality did not vary by acculturation status. APPLICATION/CONCLUSIONS: Acculturation was influential in the dietary patterns of Korean Americans. Specific information about Korean diet related to acculturation status can be used by dietitians who work with Korean Americans. Dietitians can benefit from gathering and applying specific information about Korean diets and diets of other ethnic groups; they also need to recognize the changing nature of dietary patterns as acculturation occurs. 相似文献
100.
Background: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this
surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. Methods: As a modification
of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients
underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded
stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding
excess weight loss and complications of the gastric pouch during the first year after surgery were compared. Results: Age,
sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also
similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis
of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding
from the staple-line. Conclusions: These preliminary data suggest that complications of the gastric pouch can be reduced by
interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are
pending. 相似文献