Sharing Injecting Equipment and Sexual Behavior in Ambulatory Intravenous Drug Users: A National Survey (Spain)

This article examines the relationship between sharing and sexual behavior in a nationwide sample of 1,074 intravenous drug users (IVDUs) in ambulatory treatment in Spain. Of our sample, 31.9% shared or had shared injecting equipment. Sharing was associated with sex-less frequent in males-and yielded an inverse relationship with age, years of education, and age at first intravenous drug use. Sharers, especially women, engaged more frequently in sex in exchange for money. A small proportion (6.3%) of male IVDUs had bisexual or homosexual relations. Condoms were always used by 18.4% of males and 15.9% of females. The sharing of injecting equipment was not generally as- sociated with a particular type of penetrative sexual encounter, although condom use was less frequent among IVDUs who shared injecting equipment. The limitations of the present study are discussed.     

A systematic review of autistic children’s prosocial behaviour

BackgroundProsocial behaviour (e.g., comforting, helping, sharing) is associated with important positive life outcomes. Historical and recent theory, evidence and personal accounts within the autism community present a mixed picture regarding Autistic children’s prosocial engagement. This systematic review consolidates, for the first time, how empirical studies have been measuring Autistic children’s prosocial behaviour to date (objective one). This review clarifies what knowledge the evidence provides, specifically how the type (e.g., comforting, helping, sharing), target (e.g., parent, experimenter, Autistic or neurotypical peer) and timing (e.g., young, middle, and late childhood) affect Autistic children’s prosocial behaviour (objective two).MethodsRelevant published records were identified through systematic searches of three electronic databases: PsychINFO, PubMED and Embase. Thirty studies presented in 29 articles met eligibility criteria and were included for data-extraction, quality assessment and narrative synthesis.ResultsThe most common methodologies used were found to be: in-person paradigms, games, informant reports, and self-reports. Reliability and validity efforts were inconsistent. It is hoped these findings will act as a benchmark for development of future research in the area. Outcomes were found to be much more positive about Autistic children’s engagement in prosocial behaviour than diagnostic criteria and historical theory suggests, with Autistic children often engaging in prosocial behaviour to the same frequency as comparison groups despite unfamiliar and neurotypical targets. Narrative synthesis revealed moderating variables and differing patterns and styles of Autistic children’s prosocial behaviour.ConclusionsFindings encourage Autistic strengths-based approaches and caution is expressed regarding findings possibly linked to Autistic masking.     

Local and regional variability in utilization and allocation of hepatitis C virus–infected hearts for transplantation

With the advent of direct‐acting antiviral agents, there has been a rapid rise in hepatitis C virus–infected (HCV+) heart transplantation. We aimed to understand local and regional differences in utilization and allocation of HCV+ hearts. Using United Network for Organ Sharing (UNOS) de‐identified data from January 1, 2016 to September 30, 2019 we compared trends in the utilization rates (hearts transplanted/donors recovered) of HCV‐uninfected (HCV?) to those of HCV+ nonviremic (HCV‐NV) and viremic (HCV‐V) hearts nationally and by UNOS region. We also evaluated allocation rates (hearts successfully allocated/donors recovered) by organ procurement organization (OPO). We found that (1) in 2019, national utilization rates for HCV‐NV and HCV‐V hearts were the same as HCV? hearts (27.6% for HCV‐NV, 30.9 for HCV‐V, and 31.7% for HCV?, P = .277); (2) utilization rates of HCV‐NV hearts were low in regions 3 and 4 and of HCV‐V hearts in regions 3, 4, and 8 even in the contemporary period since 2018; and (3) there was marked variability in allocation of HCV+ hearts at the OPO level even within the same UNOS region. We conclude that despite national strides in the utilization of HCV+ hearts for transplantation, more aggressive allocation of HCV+ hearts at the OPO level may still significantly affect the organ shortage.     

Diagnosis and treatment of hepatocellular carcinoma

The diagnosis and treatment of hepatocellular carcinoma (HCC) have witnessed major changes over the past decade. Until the early 1990s, HCC was a relatively rare malignancy, typically diagnosed at an advanced stage in a symptomatic patient, and there were no known effective palliative or therapeutic options. However, the rising incidence of HCC in several regions around the world coupled with emerging evidence for efficacy of screening in high-risk patients, liver transplantation as a curative option in select patients, ability to make definitive diagnosis using high-resolution imaging of the liver, less dependency on obtaining tissue diagnosis, and proven efficacy of transarterial chemoembolization and sorafenib as palliative therapy have improved the outlook for HCC patients. In this article, we present a summary of the most recent information on screening, diagnosis, staging, and different treatment modalities of HCC, as well as our recommended management approach.     

Waitlist mortality in patients with autoimmune liver diseases

Introduction and ObjectivesAutoimmune liver diseases such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis are the primary indication for ～24% of total liver transplants. The liver transplant allocation system is currently based upon the Model for End-Stage Liver Disease and it often underestimates the severity of autoimmune liver diseases. We aim to compare the rate of adverse waitlist removal among patients with all autoimmune liver diseases and other indications for liver transplant in the Model for End-Stage Liver -Na era.Materials and MethodsUsing the United Network for Organ Sharing database, we identified all patients listed for liver transplant from 2016 to 2019. The outcome of interest was waitlist survival defined as the composite outcome of death or removal for clinical deterioration. Competing risk analysis was used to evaluate the waitlist survival.ResultsPatients with autoimmune hepatitis had a higher risk of being removed from the waitlist for death or clinical deterioration (SHR 1.37, 95% CI 1.08–1.72; P<0.007), followed by primary biliary cholangitis (SHR 1.34, 95% CI 1.07–1.68; P<0.011).ConclusionsHigh waitlist death or removal for clinical deterioration was observed in patients with PBC and AIH when compared to other etiologies. It may be useful to reassess the process of awarding MELD exception points to mitigate such disparity.