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Poteat TC, Humes E, Althoff KN, Cooney EE, Radix A, Cannon CM, Wawrzyniak AJ, Schneider JS, Beyrer C, Mayer KH, Brinkley-Rubinstein L, Reisner S, Wirtz AL. Characterizing Arrest and Incarceration in a Prospective Cohort of Transgender Women. J Correct Health Care 2023; 29:60-70. [PMID: 36037064 PMCID: PMC9931624 DOI: 10.1089/jchc.21.10.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study characterized arrest, incarceration, and risk factors for incident incarceration among transgender women (TW) in the northeastern and southern United States. During semiannual study visits over 24 months in a multicenter cohort study, TW completed HIV testing and self-administered surveys. In total, 1571 TW completed baseline survey; 1,312 HIV-negative TW enrolled in the cohort and contributed 2134.3 person-years to the analysis. At baseline, 37% had been arrested and 21% had been incarcerated. Incident incarceration was 23.4 per 1,000 person-years (95% confidence interval [CI]: 16.9-29.9). Sex work was significantly associated with baseline and incident incarceration (p < .01). A history of incarceration at enrollment was the strongest predictor of incident incarceration (adjusted odds ratio [aOR] 6.99; 95% CI: 3.43-14.24). Living in the South (aOR 2.69, 95% CI: 1.22-5.93), income below the federal poverty level (aOR 2.65 95% CI: 3.43-14.24), and having a recent partner who had been incarcerated (aOR 2.62, 95% CI: 1.20-5.69) also increased the odds of incident incarceration in multivariable modeling. Structural interventions to reduce poverty and decriminalize sex work have the potential to reduce incarceration rates among TW.
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Affiliation(s)
- Tonia C. Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Humes
- Department of Epidemiology and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erin E. Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Christopher M. Cannon
- Research Department, Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Andrew J. Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jason S. Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chris Beyrer
- Department of Epidemiology and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrea L. Wirtz
- Department of Epidemiology and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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2
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Voss RV, Kuhns LM, Phillips G, Wang X, Wolf SF, Garofalo R, Reisner S, Beach LB. Physical Inactivity and the Role of Bullying Among Gender Minority Youth Participating in the 2017 and 2019 Youth Risk Behavior Survey. J Adolesc Health 2023; 72:197-206. [PMID: 36369113 DOI: 10.1016/j.jadohealth.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/15/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Evidence from small-scale studies suggests that transgender youth are less physically active than nontransgender youth, putting them at risk for worse health outcomes. This study examined the relationship between gender modality and participation in physical activity, physical education (PE), and sports teams in a multistate sample of high school youth and assessed whether bullying impacted this relationship. METHODS Multiple regression was used to analyze data from the state and local Youth Risk Behavior Survey from 2017 to 2019 to examine the relationship between the gender modality and participation in physical activity, PE, and sports teams. The sample was stratified by sex and adjusted for demographics and in-school and online bullying victimization. RESULTS Transgender participants who reported a male or female sex, respectively, reported lower odds of physical activity (adjusted odds ratio [aOR] 0.46, p < .001; aOR 0.46, p < .001, respectively) but similar odds of PE participation. Female transgender students were less likely to participate in sports (aOR 0.55, p = .007); however, this relationship was not seen in adjusted models. Adjusting for demographics, male transgender students were significantly more likely to participate in sports (aOR 2.1, p = .002). Adjusting for bullying experiences did not significantly change these results. DISCUSSION Transgender youth are less likely to participate in physical activity but participate similarly or more than cisgender peers in PE and sports. Factors other than bullying may limit physical activity among transgender youth, and the Youth Risk Behavior Survey may not capture experiences of trans-specific victimization. Increased inclusion and safety may help increase physical activity and amplify its benefits for transgender students.
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Affiliation(s)
- Raina V Voss
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Xinzi Wang
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sigrid F Wolf
- Department of Orthopedic Surgery and Sports Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.
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3
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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4
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Restar A, Dusic EJ, Garrison-Desany H, Lett E, Everhart A, Baker KE, Scheim AI, Beckham SW, Reisner S, Rose AJ, Mimiaga MJ, Radix A, Operario D, Hughto JM. Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults. Humanit Soc Sci Commun 2022; 9:304. [PMID: 36636110 PMCID: PMC9833814 DOI: 10.1057/s41599-022-01291-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/25/2022] [Indexed: 06/17/2023]
Abstract
Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less. Taking more hormones than prescribed was significantly associated with having the same provider for primary and gender-affirming care and gender-based discrimination. Income and insurance coverage barriers were significantly associated with taking less hormones than prescribed. Differences by gender identity were also observed. Addressing barriers to hormone access and cost could help to ensure safe hormone-dosing behaviors and the achievement trans people's gender-affirmation goals.
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Affiliation(s)
- Arjee Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Applied Transgender Studies, Chicago, IL, USA
| | - E. J. Dusic
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Henri Garrison-Desany
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Avery Everhart
- Center for Applied Transgender Studies, Chicago, IL, USA
- Population, Health, & Place Program, Spatial Sciences Institute, Dornsife College of Letters, Arts, & Sciences, University of Southern California, Los Angeles, CA, USA
| | - Kellan E. Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Whitman-Walker Institute, Washington, DC, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Adam J. Rose
- Hebrew University School of Public Health, Jerusalem, Israel
| | - Matthew J. Mimiaga
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Asa Radix
- Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Don Operario
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jaclyn M.W. Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
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5
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Hill BJ, Motley DN, Rosentel K, VandeVusse A, Fuller C, Bowers SM, Williams M, Kipke M, Kuhns L, Pashka N, Reisner S, DeMonte JB, Goolsby RW, Rupp BM, Slye N, Strader LC, Schneider JA, Razzano L, Garofalo R. Employment as HIV Prevention: An Employment Support Intervention for Adolescent Men Who Have Sex With Men and Adolescent Transgender Women of Color. J Acquir Immune Defic Syndr 2022; 91:31-38. [PMID: 35551157 PMCID: PMC9377485 DOI: 10.1097/qai.0000000000003020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to adapt and pilot-test an employment support, primary HIV intervention tailored to the needs of adolescent men who have sex with men and adolescent transgender women of color. SETTING The intervention was implemented in 2 settings: controlled environment (Phase 1) and real-world community-based (Phase 2) setting in Chicago, IL. METHODS Eighty-seven adolescent men who have sex with men and adolescent transgender women of color ages 16-24 participated in Work2Prevent , a 4-session employment and HIV prevention intervention, designed to increase job-readiness and reduce HIV risk. Intervention sessions consisted of group activities: educational games, roleplaying/modeling behavior, and self-regulation exercises. Participants were assessed at baseline, postintervention, and 8-month (Phase 1) or 3-month follow-up (Phase 2). RESULTS Participants evaluated Work2Prevent as feasible and acceptable, rating intervention quality, usefulness, and satisfaction highly. Overall, 59.6% (Phase 1) and 85.0% (Phase 2) participants attended 2 or more sessions. At 8 months, Phase 1 participants reported a mean increase of 11.4 hours worked per week. Phase 2 participants reported a mean increase of 5.2 hours worked per week and an increase in job-seeking self-efficacy. Phase 2 participants also reported a decrease in transactional sex work. CONCLUSION Work2Prevent is one of the first structural primary HIV interventions to specifically focus on adolescent employment readiness. Findings suggest Work2Prevent is feasible and acceptable, improved adolescent employment outcomes, and reduced HIV risk associated with transactional sex work. Our study underscores the need for alternative pathways, such as addressing socioeconomic determinants, to prevent adolescent HIV infection.
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Affiliation(s)
- Brandon J. Hill
- Howard Brown Health, Center for Education, Research, & Advocacy, Chicago, IL
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, IL
| | - Darnell N. Motley
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Medicine, Chicago Center for HIV Elimination (CCHE), The University of Chicago, Chicago, IL
| | - Kris Rosentel
- Department of Sociology, Northwestern University, Evanston, IL
| | | | - Charlie Fuller
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Shannon M.E. Bowers
- Office for Research, Division of Biomedical Research, Northwestern University, Chicago, IL
| | - Meghan Williams
- Howard Brown Health, Center for Education, Research, & Advocacy, Chicago, IL
| | - Michele Kipke
- Division of Research on Children Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA
| | - Lisa Kuhns
- Division of Adolescent & Young Adult Medicine, Ann & Robert H Lurie Children's Hospital, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Justin B. DeMonte
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Rachel W. Goolsby
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Betty M. Rupp
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Nicole Slye
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Lisa C. Strader
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - John A. Schneider
- Howard Brown Health, Center for Education, Research, & Advocacy, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Medicine, Chicago Center for HIV Elimination (CCHE), The University of Chicago, Chicago, IL
| | - Lisa Razzano
- Department of Research, Thresholds, Chicago, IL
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Robert Garofalo
- Division of Adolescent & Young Adult Medicine, Ann & Robert H Lurie Children's Hospital, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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6
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Tordoff DM, Zangeneh S, Khosropour CM, Glick SN, McClelland RS, Dimitrov D, Reisner S, Duerr A. Geographic Variation in HIV Testing Among Transgender and Nonbinary Adults in the United States. J Acquir Immune Defic Syndr 2022; 89:489-497. [PMID: 35001041 PMCID: PMC9058176 DOI: 10.1097/qai.0000000000002909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender and nonbinary (TNB) populations are disproportionately affected by HIV and few local health departments or HIV surveillance systems collect/report data on TNB identities. Our objective was to estimate the prevalence of HIV testing among TNB adults by US county and state, with a focus on the Ending the HIV Epidemic (EHE) geographies. METHODS We applied a Bayesian hierarchical spatial small area estimation model to data from the 2015 US Transgender Survey, a large national cross-sectional Internet-based survey. We estimated the county- and state-level proportion of TNB adults who ever tested or tested for HIV in the last year by gender identity, race/ethnicity, and age. RESULTS Our analysis included 26,100 TNB participants with valid zip codes who resided in 1688 counties (54% of all 3141 counties that cover 92% of the US population). The median county-level proportion of TNB adults who ever tested for HIV was 44% (range 10%-80%) and who tested in the last year was 17% (range 4%-44%). Within most counties, testing was highest among transgender women, black respondents, and people aged ≥25 years. HIV testing was lowest among nonbinary people and young adults aged <25 years. The proportion of TNB adults who tested within the last year was very low in most EHE counties and in all 7 rural states. CONCLUSIONS HIV testing among TNB adults is likely below national recommendations in the majority of EHE geographies. Geographic variation in HIV testing patterns among TNB adults indicates that testing strategies need to be tailored to local settings.
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Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Sahar Zangeneh
- RTI International, Seattle WA
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Sara N. Glick
- School of Medicine, University of Washington, Seattle, WA
| | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA
- School of Medicine, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Sari Reisner
- Departments of Medicine and Epidemiology, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Global Health, University of Washington, Seattle, WA
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7
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Clark J, Reisner S, Perez-Brumer A, Huerta L, Sanchez H, Moriarty K, Luque MM, Okochi H, Salazar X, Mimiaga M, Sanchez J, Gandhi M, Mayer KH, Lama JR. TransPrEP: Results from the Pilot Study of a Social Network-Based Intervention to Support PrEP Adherence Among Transgender Women in Lima, Peru. AIDS Behav 2021; 25:1873-1883. [PMID: 33385279 PMCID: PMC8084919 DOI: 10.1007/s10461-020-03117-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/02/2023]
Abstract
We conducted a pilot randomized controlled trial of a social network-based intervention to promote PrEP adherence among transgender women (TW) in Lima, Peru. We enrolled 89 TW from six social networks and cluster-randomized them 1:1 to standard of care (n = 44) or the TransPrEP intervention (n = 45). Core workshops discussed strategies to support PrEP adherence and defined group adherence objectives. Maintenance workshops discussed participants' experiences taking PrEP and collective adherence goals. At 3-month follow-up, we evaluated 40 participants and obtained 29 hair samples for tenofovir level measurements. Though no significant differences were observed, 36.4% (4/11) of participants of TransPrEP participants and 10.0% (1/10) of control participants had tenofovir levels > 0.023 ng/mg, consistent with ≥ 4 doses per week. 81.8% (9/11) of intervention and 40.0% (4/10) of control participants had any detectable tenofovir in their hair. Pilot assessment of our network-based intervention suggested a trend towards improved PrEP adherence, measured objectively, for TW in Peru.
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Affiliation(s)
- Jesse Clark
- UCLA Geffen School of Medicine, Los Angeles, CA, USA.
| | - Sari Reisner
- The Fenway Institute, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | | | | | | | - Ximena Salazar
- Instituto de Estudios de Salud Sexual y Derechos Humanos, Lima, Peru
| | - Matthew Mimiaga
- The Fenway Institute, Boston, MA, USA
- Brown University School of Public Health, Providence, RI, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Universidad Nacional San Marcos, Lima, Peru
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
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8
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Mayer KH, Nelson L, Hightow-Weidman L, Mimiaga MJ, Mena L, Reisner S, Daskalakis D, Safren SA, Beyrer C, Sullivan PS. The persistent and evolving HIV epidemic in American men who have sex with men. Lancet 2021; 397:1116-1126. [PMID: 33617771 PMCID: PMC9639667 DOI: 10.1016/s0140-6736(21)00321-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 01/06/2023]
Abstract
Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.
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Affiliation(s)
- Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Fenway Health, Boston, MA, USA.
| | - LaRon Nelson
- School of Nursing, Yale University, New Haven, CT, USA
| | | | - Matthew J Mimiaga
- Fielding School of Public Health and David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leandro Mena
- Medical Center, University of Mississippi, Jackson, MS, USA
| | - Sari Reisner
- Boston Children's Hospital, Fenway Health, Boston, MA, USA
| | | | | | - Chris Beyrer
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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9
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Poteat T, Hanna DB, Rebeiro PF, Klein M, Silverberg MJ, Eron JJ, Horberg MA, Kitahata MM, Mathews WC, Mattocks K, Mayor A, Rich AJ, Reisner S, Thorne J, Moore RD, Jing Y, Althoff KN. Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis. Clin Infect Dis 2021; 70:1131-1138. [PMID: 31573601 DOI: 10.1093/cid/ciz322] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes and cross-sectional designs. We sought to characterize the HIV care continuum comparing TW to CW and CM in the United States and Canada. METHODS We analyzed annual HIV care continuum outcomes by gender status from January 2001 through December 2015 among adults (aged ≥18 years) in 15 clinical cohorts. Outcomes were retention in care and viral suppression. RESULTS The study population included TW (n = 396), CW (n = 14 094), and CM (n = 101 667). TW had lower proportions retained in care than CW and CM (P < .01). Estimates of retention in care were consistently lower in TW, with little change over time within each group. TW and CW had similar proportions virally suppressed over time (TW, 36% in 2001 and 80% in 2015; CW, 35% in 2001 and 83% in 2015) and were lower than CM (41% in 2001 and 87% in 2015). These differences did not reach statistical significance after adjusting for age, race, HIV risk group, and cohort. CONCLUSIONS TW experience challenges with retention in HIV care. However, TW who are engaged in care achieve viral suppression that is comparable to that of CW and CM of similar age, race, and HIV risk group. Further research is needed to understand care engagement disparities.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina-Chapel Hill, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Peter F Rebeiro
- Department of Medicine, Division of Infectious Diseases & Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marina Klein
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Joseph J Eron
- Department of Social Medicine, University of North Carolina-Chapel Hill, Baltimore, Maryland
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | | | - W C Mathews
- Department of Medicine, University of California-San Diego, Worcester
| | - Kristin Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Angel Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Ashleigh J Rich
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sari Reisner
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer Thorne
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Yuezhou Jing
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Hill BJ, Motley DN, Rosentel K, VandeVusse A, Garofalo R, Kuhns LM, Kipke MD, Reisner S, Rupp B, West Goolsby R, McCumber M, Renshaw L, Schneider JA. Work2Prevent, an Employment Intervention Program as HIV Prevention for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 3): Protocol for a Single-Arm Community-Based Trial to Assess Feasibility and Acceptability in a Real-World Setting. JMIR Res Protoc 2020; 9:e18051. [PMID: 32915162 PMCID: PMC7519435 DOI: 10.2196/18051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the United States, young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth face elevated rates of HIV infection. However, racial and ethnic disparities in adolescent HIV infection cannot be attributed to individual-level factors alone and are situated within larger social and structural contexts that marginalize and predispose sexual and gender minority youth of color to HIV. Addressing broader ecological factors that drive transmission requires interventions that focus on the distal drivers of HIV infection, including violence exposure, housing, food insecurity, educational attainment, and employment. Given the ways that economic instability may make YMSM, YTW, and GNC youth of color vulnerable to HIV exposure, this study focuses on employment as an HIV prevention intervention. More specifically, the intervention, called Work2Prevent (W2P), targets economic stability through job readiness and employment as a means of preventing behaviors and factors associated with adolescent and young adult HIV, such as transactional sex work and homelessness. The intervention was adapted from iFOUR, an evidence-based employment program for HIV-positive adults in phase 1 of this study, and pilot tested in a university-based setting in phase 2. OBJECTIVE This paper aims to describe the protocol for the community-based test phase of W2P. The purpose of this phase was to pilot test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color within a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community setting. METHODS The employment intervention was pilot tested using a single-arm pretest-posttest trial design implemented among a sample of vulnerable YMSM, YTW, and GNC youth of color using services within a community-based LGBTQ center. Assessments will examine intervention feasibility, acceptability, and preliminary estimates of efficacy. RESULTS Phase 3 of W2P research activities began in May 2019 and was completed in December 2019. Overall, 41 participants were enrolled in the community-based pilot. CONCLUSIONS This study will assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce vulnerability to HIV when implemented in a community-based setting serving LGBTQ youth of color. Testing the intervention in a community setting is an opportunity to evaluate how recruitment, retention, and other outcomes are impacted by delivery in a venue akin to where this intervention could eventually be used by nonresearchers. If W2P demonstrates feasibility and acceptability, a larger multisite trial implemented in multiple community settings serving YMSM, YTW, and GNC youth of color is planned. TRIAL REGISTRATION ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18051.
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Affiliation(s)
- Brandon J Hill
- Planned Parenthood Great Plains, Overland Park, KS, United States
| | - Darnell N Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Kris Rosentel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | | | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sari Reisner
- Fenway Health, The Fenway Institute, Boston, MA, United States
| | - Betty Rupp
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rachel West Goolsby
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Micah McCumber
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura Renshaw
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States
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11
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Hill BJ, Motley DN, Rosentel K, VandeVusse A, Garofalo R, Schneider JA, Kuhns LM, Kipke MD, Reisner S, Rupp BM, Sanchez M, McCumber M, Renshaw L, Loop MS. An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 1): Protocol for Determining Essential Intervention Components Using Qualitative Interviews and Focus Groups. JMIR Res Protoc 2020; 9:e16384. [PMID: 32773383 PMCID: PMC7445600 DOI: 10.2196/16384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/13/2019] [Accepted: 02/24/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people's proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure. OBJECTIVE This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years. METHODS The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)-inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth. RESULTS In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway. CONCLUSIONS Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16384.
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Affiliation(s)
- Brandon J Hill
- Planned Parenthood Great Plains, Overland Park, KS, United States
| | - Darnell N Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Kris Rosentel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | | | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sari Reisner
- Fenway Health, The Fenway Institute, Boston, MA, United States
| | - Betty M Rupp
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Sanchez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Micah McCumber
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura Renshaw
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Shane Loop
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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12
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Hill BJ, Motley DN, Rosentel K, VandeVusse A, Garofalo R, Schneider JA, Kuhns LM, Kipke MD, Reisner S, Rupp BM, Sanchez M, McCumber M, Renshaw L, West Goolsby R, Loop MS. An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 2): Protocol for a Single-Arm Mixed Methods Pilot Test to Assess Feasibility and Acceptability. JMIR Res Protoc 2020; 9:e16401. [PMID: 32773376 PMCID: PMC7445605 DOI: 10.2196/16401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors. OBJECTIVE The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study. METHODS The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy. RESULTS Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot. CONCLUSIONS Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group. TRIAL REGISTRATION ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16401.
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Affiliation(s)
- Brandon J Hill
- Planned Parenthood Great Plains, Overland Park, KS, United States
| | - Darnell N Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Kris Rosentel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | | | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sari Reisner
- Fenway Health, The Fenway Institute, Boston, MA, United States
| | - Betty M Rupp
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Sanchez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Micah McCumber
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura Renshaw
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rachel West Goolsby
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Shane Loop
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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13
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Orihuela CA, Mrug S, Davies S, Elliott MN, Tortolero Emery S, Peskin MF, Reisner S, Schuster MA. Neighborhood Disorder, Family Functioning, and Risky Sexual Behaviors in Adolescence. J Youth Adolesc 2020; 49:991-1004. [PMID: 32096008 DOI: 10.1007/s10964-020-01211-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
Adolescent risky sexual behaviors can result in negative consequences such as sexually transmitted infection. However, much research effort has been placed on understanding individual characteristics, rather than the role of neighborhood environment. This study addressed the prospective effects of neighborhood and family functioning in preadolescence on risky sexual behaviors. Participants included 4179 youth (Mage = 11.01 years, range 8.64-13.83; 51% female) and their caregivers. Using objective and self-reported measures of neighborhood and family functioning, results from multilevel regression analyses indicated that youth residing in disordered neighborhoods or had poorer family functioning in preadolescence were more likely to initiate sexual intercourse at younger ages 5 years later. Specifically, neighborhood poverty and decay were linked to early sexual initiation, whereas neighborhood social and family processes were protective against early sexual initiation. Males were more likely to engage in risky sexual behaviors in neighborhoods with greater poverty or decay; neighborhood poverty was linked with sexual initiation in White but not African American youth. Finally, parental monitoring moderated relationships between neighborhood social resources and contraceptive use, with neighborhood social resources linked with greater contraceptive use at low levels of parental monitoring, but lower contraceptive use at high levels of parental monitoring. These findings underscore the importance of neighborhood and family contexts in adolescents' risky sexual behavior, suggesting that males and White youth are more vulnerable to the effects of neighborhood poverty and that more research is needed on the possible counterproductive function of parental monitoring in neighborhoods with greater social resources.
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Affiliation(s)
- Catheryn A Orihuela
- The University of Alabama at Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA.
| | - Sylvie Mrug
- The University of Alabama at Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Susan Davies
- The University of Alabama at Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401-3208, USA
| | - Susan Tortolero Emery
- University of Texas Prevention Research Center, 7000 Fannin Ste. 2600, Houston, TX, 77030, USA
| | - Melissa F Peskin
- University of Texas Prevention Research Center, 7000 Fannin Ste. 2600, Houston, TX, 77030, USA
| | - Sari Reisner
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Mark A Schuster
- Kaiser Permanente School of Medicine, 98S. Los Robles Avenue, Pasadena, CA, 91101, USA
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14
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Rich AJ, Williams J, Malik M, Wirtz A, Reisner S, DuBois LZ, Juster RP, Lesko CR, Davis N, Althoff KN, Cannon C, Mayer K, Elliott A, Poteat T. Biopsychosocial Mechanisms Linking Gender Minority Stress to HIV Comorbidities Among Black and Latina Transgender Women (LITE Plus): Protocol for a Mixed Methods Longitudinal Study. JMIR Res Protoc 2020; 9:e17076. [PMID: 32281542 PMCID: PMC7186865 DOI: 10.2196/17076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background Black and Latina transgender women (TW) experience a disparate burden of HIV and related comorbidities, including poor mental health and cardiovascular disease (CVD) risks. Pervasive multilevel stigma and discrimination operate as psychosocial stressors for TW living with HIV and shape health disparities for this population. Gender-affirming hormone therapy (GAHT) is commonly used by TW to facilitate alignment of the body with gender identity; in the context of stigma, GAHT may both improve mental health and increase CVD risks. Objective This study aims to quantify the longitudinal relationship between stigma and chronic stress among black and Latina TW living with HIV. Secondary objectives include identifying pathways linking chronic stress to HIV comorbidities and exploring chronic stress as a mediator in the pathway linking stigma and GAHT to CVD comorbidities. Methods This US-based mixed methods longitudinal study will enroll a prospective cohort of 200 black and Latina TW living with HIV, collecting quantitative survey data, qualitative interviews, and biomarkers of chronic stress. Interviewer-administered surveys will include validated psychosocial measures of self-reported stigma and discrimination, perceived stress, CVD risk factors, mental health, access to gender-affirming care, coping, and social support. Medical record abstraction will collect data on GAHT use, CD4 count, HIV viral load, antiretroviral therapy, treatment, and comorbid conditions. Clinical measures will include physiological biomarkers as well as salivary and blood-based biomarkers of chronic stress. Survey data will be collected every 6 months (baseline, and 6, 12, 18, and 24 months), and biospecimens will be collected at baseline and at 12 and 24 months. A purposive subsample (stratified by use of GAHT and presence of depressive symptoms) of 20 to 30 TW living with HIV will be invited to participate in in-depth interviews at 6 and 18 months to explore experiences of intersectional stigma, chronic stress, and the role of GAHT in their lives. Results This study was funded by the National Institute on Minority Health and Health Disparities in December 2018. The study community advisory board and scientific advisors provided critical input on study design. Recruitment began in October 2019 (n=29 participants as of submission) and data collection will continue through 2022, with publication of baseline results anticipated summer 2021. Conclusions This study will focus on black and Latina TW living with HIV, an understudied health disparities population, advance both stigma and intersectionality research, and move chronic stress physiology research toward a more nuanced understanding of sex and gender. The comprehensive methodology will support the exploration of the role of exogenous estrogen in the pathways between stress and HIV comorbidities, elucidating the role of GAHT in the stress-health relationship. Finally, this study will provide longitudinal evidence of the impact of stigma-related chronic stress on the lives of black and Latina TW living with HIV integrating qualitative and quantitative data with psychosocial, clinical, and biological measures. International Registered Report Identifier (IRRID) DERR1-10.2196/17076
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Affiliation(s)
- Ashleigh J Rich
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Williams
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Mannat Malik
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Andrea Wirtz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sari Reisner
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - L Zachary DuBois
- Department of Anthropology, University of Oregon, Eugene, OR, United States
| | - Robert Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
| | - Catherine R Lesko
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Nicole Davis
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Kenneth Mayer
- TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Ayana Elliott
- National LGBT Health Education Center, Boston, MA, United States
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
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15
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Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, Conron K, Harper CR, Johns MM, Avripas SA, Michaels S, Dunville R. Transgender Youth Experiences and Perspectives Related to HIV Preventive Services. Pediatrics 2020; 145:peds.2019-2204. [PMID: 32184336 DOI: 10.1542/peds.2019-2204] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services. METHODS Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis. RESULTS A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care). CONCLUSIONS Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and (3) expanding sexual health education to be inclusive of all gender identities, sexual orientations, and definitions of sex and sexual activity.
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Affiliation(s)
- Holly B Fontenot
- The Fenway Institute, Fenway Health, Boston, Massachusetts; .,W.F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Sean R Cahill
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,School of Public Health, Boston University, Boston, Massachusetts; and.,Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Timothy Wang
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Sophia Geffen
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Bradley P White
- W.F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Division of Endcrinology, Diabetes, and Hypertension, Brigham and Women's Hosptial, Boston, Massachusetts
| | - Kerith Conron
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,The Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy, University of California, Los Angeles, Los Angeles, California
| | - Christopher R Harper
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle M Johns
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Van Gerwen OT, Brady D, Reisner S, Muzny CA. 426. Prevalence of Human Papilloma Virus, Anal, and Cervical Dysplasia in Transgender Persons: A Systematic Review of the Literature. Open Forum Infect Dis 2019. [PMCID: PMC6810451 DOI: 10.1093/ofid/ofz360.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Human papilloma virus (HPV) is the most common sexually transmitted infection (STI) in the United States (US) and is associated with the development of cervical and anal dysplasia; however, little is known about the epidemiology of HPV in transgender persons. The objective of this study was to conduct a systematic review of the literature to evaluate the existing epidemiologic data on HPV infection prevalence as well as anal and cervical dysplasia in transgender persons. Methods The PubMed and Scopus databases were queried using the keyword “transgender” in combination with one of the following: PAP, cervical cancer, anogenital warts. The search generated 86 articles, when accounting for duplicates across searches. We included original research articles published from January 1969 to March 2019. Excluded were non-English articles, studies that did not have HPV or cytology testing data, and studies that did not have disaggregated transgender data. Results In total, 13 articles were included in the review, of which 9 focused on transgender women (TW), 3 on transgender men (TM), and 1 on both TW and TM. HPV DNA testing was performed in 10 studies, with 7 of those offering prevalence data for specific HPV genotypes. Overall, HPV prevalence in TW ranged from 15%-97.4%, with High Risk-HPV (HR-HPV) prevalence ranging from 13%-82.5%. Anal cytology data for TW was presented in 2 studies, both of which cited a 42% prevalence of abnormal cytology. Cervical or vaginal cytology was evaluated in 4 articles, 3 of which involved TM and 1 of which involved TW with neovaginas. Among TM, the prevalence of abnormal cervical cytology ranged from 6%-42%. Conclusion Our review highlights the lack of HPV research and the high variability of the existing data about the transgender population. Further study is needed to better understand not only the epidemiology of HPV and resultant dysplastic sequelae, but also to inform the development of transgender sensitive diagnostic methods for this infection. The diverse genital anatomy represented in the transgender community as well as the gender dysphoria these patient’s experience during testing pose myriad diagnostic challenges that will need to be considered in the development of screening and diagnostic practices. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Sari Reisner
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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17
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Frank J, Restar A, Kuhns L, Reisner S, Biello K, Garofalo R, Mimiaga MJ. Unmet Health Care Needs Among Young Transgender Women at Risk for HIV Transmission and Acquisition in Two Urban U.S. Cities: The LifeSkills Study. Transgend Health 2019; 4:1-8. [PMID: 30671544 PMCID: PMC6340789 DOI: 10.1089/trgh.2018.0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: The physical health care needs of transgender women are not being adequately addressed in the United States. The current study adds to the literature on the state of health care among young transgender women (YTW) by describing the occurrence of unmet health needs among a sample of YTW and providing unique data on psychosocial and demographic factors associated with access to adequate care. Methods: Baseline data were analyzed from Project LifeSkills, an intervention study funded by the National Institutes of Health (NIH). YTW (N=300) between the ages of 16 and 29 were recruited from the Boston and Chicago metropolitan areas between 2012 and 2015. Data were collected on health care experiences, indicators of social marginalization, and sociodemographic information. The final analytic sample (N=273) was restricted to participants with complete data; participants that were removed did not significantly differ demographically from the final analytic sample retained. Bivariate logistic regression models examined the association between having unmet health care needs and sociodemographics, social marginalization, and health care utilization indicators. A final adjusted multivariable logistic regression model was constructed with independent variables that were statistically significant in bivariate models. Results: Overall, nearly a quarter (23%) of YTW indicated that they had unmet health care needs. In the final multivariable model adjusted for enrollment city, avoiding health care due to cost (adjusted odds ratio [aOR]=1.98, 95% confidence interval [CI]=1.05-3.76) and experiencing prior transgender-specific discrimination in a medical setting (aOR=4.54, 95% CI=2.30-8.95]) were associated with a greater odds of having unmet health care needs. Conclusion: YTW face significant barriers to accessing health care in the United States. Among this sample, prior experiences of discrimination and inability to afford health care increased YTW odds of having unmet health care needs. Efforts to improve the unmet health care needs among YTW should promote access to affordable, gender-affirming care.
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Affiliation(s)
- John Frank
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island.,Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.,Center for Health Equity Research, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Arjee Restar
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island.,Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.,Center for Health Equity Research, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Lisa Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katie Biello
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island.,Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.,Center for Health Equity Research, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J Mimiaga
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, Rhode Island.,Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.,Center for Health Equity Research, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.,Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Jin H, Restar A, Biello K, Kuhns L, Reisner S, Garofalo R, Mimiaga MJ. Burden of HIV among young transgender women: factors associated with HIV infection and HIV treatment engagement. AIDS Care 2018; 31:125-130. [PMID: 30380926 DOI: 10.1080/09540121.2018.1539213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Young transgender women (YTW) are disproportionately affected by HIV, however, little is known about the factors associated with HIV infection and treatment engagement. We examined correlates of HIV infection and the steps of the HIV treatment cascade, specifically, being aware of their HIV infection, linked to care, on ART, and adherent to ART. We analyzed the baseline data of Project LifeSkills, a randomized control trial of sexually active YTW recruited from Chicago, Illinois and Boston, Massachusetts. We conducted multivariable Poisson regressions to evaluate correlates of HIV infection and the steps of the HIV treatment cascade. Nearly a quarter (24.7%) of YTW were HIV-infected. Among HIV-infected YTW, 86.2% were aware of their HIV status, 72.3% were linked to care, 56.9% were on ART, and 46.2% were adherent to ART. Having avoided healthcare due to cost in the past 12 months and not having a primary care provider were associated with suboptimal engagement in HIV care. Our results suggest that improving linkage and retention in care by addressing financial barriers and improving access to primary care providers could significantly improve health outcomes of YTW as well as reduce forward transmission of HIV.
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Affiliation(s)
- Harry Jin
- a Department of Epidemiology , Brown University School of Public Health , Providence , USA
| | - Arjee Restar
- b Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , USA
| | - Katie Biello
- a Department of Epidemiology , Brown University School of Public Health , Providence , USA.,b Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , USA
| | - Lisa Kuhns
- c Department of Pediatrics, Feinberg School of Medicine , Northwestern University , Chicago , USA
| | - Sari Reisner
- d Division of General Pediatrics , Boston Children's Hospital and Harvard Medical School , Boston , USA
| | - Robert Garofalo
- e Division of Adolescent Medicine , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , USA
| | - Matthew J Mimiaga
- a Department of Epidemiology , Brown University School of Public Health , Providence , USA.,b Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , USA
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MacCarthy S, Reisner S, Hoffmann M, Perez-Brumer A, Silva-Santisteban A, Nunn A, Bastos L, Vasconcellos MTLD, Kerr L, Bastos FI, Dourado I. Mind the gap: implementation challenges break the link between HIV/AIDS research and practice. CAD SAUDE PUBLICA 2016; 32:e00047715. [PMID: 27828609 DOI: 10.1590/0102-311x00047715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 11/25/2015] [Indexed: 11/22/2022] Open
Abstract
Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic.
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Affiliation(s)
| | - Sari Reisner
- Harvard School of Public Health, Harvard University, Boston, U.S.A
| | | | | | | | - Amy Nunn
- School of Public Health, Brown University, Providence, U.S.A
| | - Leonardo Bastos
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ligia Kerr
- Faculdade de Medicina, Universidade Federal da Ceará, Fortaleza, Brasil
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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20
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Deutsch MB, Radix A, Reisner S. What's in a Guideline? Developing Collaborative and Sound Research Designs that Substantiate Best Practice Recommendations for Transgender Health Care. AMA J Ethics 2016; 18:1098-1106. [PMID: 27883301 DOI: 10.1001/journalofethics.2016.18.11.stas1-1611] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transgender medicine presents a particular challenge for the development of evidence-based guidelines, due to limitations in the available body of evidence as well as the exclusion of gender identity data from most public health surveillance activities. The guidelines that have been published are often based on expert opinion, small studies, and data gathered outside the US. The existence of guidelines, however, helps legitimate the need for gender-affirming medical and surgical interventions. Research conducted on transgender populations should be grounded in gender-affirming methodologies and focus on key areas such as health outcomes after gender-affirming interventions.
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Affiliation(s)
- Madeline B Deutsch
- Associate professor of clinical family and community medicine at the University of California, San Francisco, where she is also director of transgender care
| | - Asa Radix
- Director of research and education at the Callen-Lorde Community Health Center and a clinical assistant professor of medicine at New York University in New York City
| | - Sari Reisner
- Assistant professor of pediatrics at Harvard Medical School, an associate scientific researcher at Boston Children's Hospital, and an assistant professor of epidemiology at the T.H. Chan School of Public Health at Harvard University in Boston, and an affiliated research scientist at the Fenway Institute
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21
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Adini B, Ohana A, Furman E, Ringel R, Golan Y, Fleshler E, Keren U, Reisner S. Learning lessons in emergency management: the 4th International Conference on Healthcare System Preparedness and Response to Emergencies and Disasters. Disaster Mil Med 2016; 2:16. [PMID: 28265450 PMCID: PMC5330161 DOI: 10.1186/s40696-016-0026-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022]
Abstract
Background The International Preparedness & Response to Emergencies & Disasters (IPRED) conferences are conducted bi-annually in order to share insights and lessons learned from diverse crises. The aim of the article is to bring the IPRED conferences into better professional attention and to share the main insights that were presented in IPRED IV, which was held in January 2016. Main body The major lessons learned included: Planning, regional/global collaboration and public–private cooperation should be implemented in developing novel technologies. International humanitarian action necessitates coordination between diverse actors concerning all potential threats. Leadership/coordination and decision-making capacities of emergency response leaders should be enhanced to ensure quality of care. Ethics in disaster management: Triage decisions must not discriminate against terrorists, even when attackers and victims are treated simultaneously. Resilience management: Establishing family and community networks increases resilience of individuals and society. Training programs & exercises must be evaluated considering cost–benefits. Human resources: Teams of experts should be transformed into expert teams. Communication: A common disaster-management language needs to be established. Social media is useful due to bi-directional communication. Civil–military cooperation should be established to facilitate a coordinated response including common terminologies and exercises. Animal sheltering: First responders and pet owners are jeopardized if animals are not included in emergency planning. Re-unification of animals with their owners should be included in response models. Conclusions IPRED conferences provide a platform for sharing insights and lessons learned from diverse emergencies and disasters. The conferences offer a unique opportunity to share knowledge aimed at improving emergency preparedness, networking between various parties, and substantiates the knowledge and experience of all professionals who take part in the proceedings.
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Affiliation(s)
- B Adini
- Emergency and Disaster Management Division, Ministry of Health, Igal Alon 119, Tel Aviv, Israel
| | - A Ohana
- Home Front Command, Ramla, Israel
| | - E Furman
- Home Front Command, Ramla, Israel
| | - R Ringel
- Emergency and Disaster Management Division, Ministry of Health, Igal Alon 119, Tel Aviv, Israel
| | - Y Golan
- Home Front Command, Ramla, Israel
| | | | - U Keren
- Emergency and Disaster Management Division, Ministry of Health, Igal Alon 119, Tel Aviv, Israel
| | - S Reisner
- Rambam Medical Center, Haifa, Israel
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Abstract
INTRODUCTION Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations. METHODS A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations. RESULTS Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations. DISCUSSION Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.
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Affiliation(s)
- Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Jessica Xavier
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, Maryland; and
| | - Sari Reisner
- Boston Children's Hospital/Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Affiliation(s)
- Sari Reisner
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, California, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Affiliation(s)
- Sam Winter
- School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia.
| | - Edmund Settle
- UNDP Bangkok Regional Hub, United Nations Development Programme, Bangkok, Thailand
| | - Kevan Wylie
- Porterbrook Clinic and Royal Hallamshire Hospital, Sheffield, UK; Department of Neurosciences, University of Sheffield, Sheffield, UK
| | - Sari Reisner
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Mauro Cabral
- Global Action for Trans Equality, Buenos Aires, Argentina; Global Action for Trans Equality, New York, USA
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W, Reisner S, Sevelius J, Ettner R. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes 2016; 23:188-97. [PMID: 26835800 PMCID: PMC4809047 DOI: 10.1097/med.0000000000000232] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research. RECENT FINDINGS Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking. SUMMARY Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.
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Affiliation(s)
- Walter Bockting
- aDivision of Gender, Sexuality, and Health New York State Psychiatric Institute/Columbia Psychiatry and the School of Nursing, Columbia University Medical Center, New York bProgram in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota cSchool of Medicine, University of California, San Francisco, California dDepartment of Psychobiology, National Distance Education University, Madrid, Spain eThe Williams Institute, University of California, Los Angeles School of Law, Los Angeles, California fDivision of Psychiatry, University of Texas Medical Branch, Galveston, Texas gFenway Institute, Fenway Health hDepartment of Epidemiology, Harvard T.H. Chan School of Public Health iDivision of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts jSchool of Medicine, University of California, San Fransisco, California kPrivate Practice, Evanston, Illinois
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Reisner S, Mimiaga M, Bland SE, Driscoll MA, Cranston K, Mayer KH. Pathways to embodiment of HIV risk: black men who have sex with transgender partners, Boston, Massachusetts. AIDS Educ Prev 2012; 24:15-26. [PMID: 22339142 DOI: 10.1521/aeap.2012.24.1.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A dearth of research to date has explored HIV risk among Black men who report sex with transgender partners. In 2008, 197 Black men residing in Massachusetts were recruited via modified respondent-driven sampling and completed an interviewer-administered survey. Overall, 8% reported sex with a transgender partner in the past 12 months. Over half (56%) reported unprotected sex during their last encounter with transgender partners. Factors significantly associated with having a transgender sex partner: history of substance abuse, incarceration, PTSD symptoms, lower levels of perceived social support, not having been exposed to HIV prevention services in the past 12 months, and endorsement of mobile van services as a comfortable location to access health care. These formative data suggest that Black men who partner with transgender individuals may be at elevated risk for an array of poorer health-related outcomes, including HIV sexual risk, substance abuse, incarceration, psychosocial vulnerability, and lack of access to health care. Theory-driven interventions that consider the broader context affecting the embodiment of HIV risk are warranted for men who have sex with transgender partners.
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Affiliation(s)
- Sari Reisner
- Fenway Institute, Fenway Health, Boston, MA 02215, USA.
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27
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Bahouth F, Mutlak D, Furman M, Musallam A, Hammerman H, Lessick J, Dabbah S, Reisner S, Agmon Y, Aronson D. Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction. Heart 2010; 96:683-8. [DOI: 10.1136/hrt.2009.183822] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
16-slice multidetector CT (MDCT) cardiac findings of a middle-aged man with known apical hypertrophic cardiomyopathy (AHC) and recent atypical chest pain are presented. MDCT enabled comprehensive evaluation of the coronary arteries, diagnosing myocardial bridging of the left anterior descending (LAD) and first diagonal arteries. It also enabled dynamic evaluation of myocardial thickness and left ventricular global and regional function. This case illustrates the full capabilities of MDCT in the evaluation of AHC.
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Affiliation(s)
- E Ghersin
- Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel
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Abstract
OBJECTIVES To describe the effect of the level of religiousness on infants' sleep position in the Jewish population. METHODS A longitudinal telephone survey of randomly selected 608 2-month-old Jewish infants repeated at 4 and 6 months. Results were analyzed versus the four levels of Jewish religion observance. RESULTS A significant correlation was found between the level of religious practice and sleep position (P < or = 0.002). 56.8% (50/88) of ultra-orthodox parents put their babies to sleep in the non-prone position, compared with 79% (411/520) in the other three groups (P < 0.001). Non-prone sleeping decreased when infants grew. Higher parity correlated with the level of religiousness and with prone sleeping in religious families (OR = 1.15, 95% CI 1.00-1.33, P < 0.001). CONCLUSIONS Jews and especially the ultra-orthodox families comply significantly less with recommendations to avoid prone sleeping. Specific measures may be required in this population that rely more on personal experience and belief than on health care provider advice.
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Affiliation(s)
- Y Sivan
- Institute of Pediatric Critical Care, Pulmonology and Sleep Disorders, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv 64239, Israel.
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Abstract
OBJECTIVES We tested the hypothesis that spatial association of low-amplitude intracardiac electrograms can identify the presence, location and extent of dysplastic regions in arrhythmogenic right ventricular dysplasia (ARVD). BACKGROUND Arrhythmogenic right ventricular dysplasia is a right ventricular (RV) cardiomyopathy characterized pathologically by fibrofatty infiltration and clinically by a spectrum of arrhythmias, sudden cardiac death and RV failure. Diagnosis of ARVD still remains a clinical challenge. METHODS A three-dimensional electroanatomic mapping technique was used to map the RV of two groups of patients: 1) those with ARVD presenting with typical clinical, electrocardiographic and echocardiographic or magnetic resonance imaging (MRI) findings; and 2) those with structurally normal ventricles. RESULTS The dysfunctional RV area could be identified only in the first group and was characterized by the presence of discrete areas of abnormally low-amplitude electrograms. Hence, the normal voltage values observed in the control group (unipolar: 11.9 +/- 0.3 mV; bipolar: 4.6 +/- 0.2 mV [mean +/- SEM]) and in the nonaffected zones in the ARVD group (unipolar: 10.4 +/- 0.2 mV; bipolar: 4.6 +/- 0.2 mV) were reduced significantly (p < 0.05) in the dysplastic areas (unipolar: 3.3 +/- 0.1 mV; bipolar: 0.5 +/- 0.1 mV). The pathologic process mainly involved the RV anterolateral free wall, apex and inflow and outflow tracts and ranged from patchy areas to uniform and extensive involvement. Concordance between electroanatomic findings and MRI or echocardiographic findings was noted in all patients. CONCLUSIONS The pathologic substrate in ARVD can be identified by spatial association of low-amplitude endocardial electrograms, reflecting replaced myocardial tissue. The ability to accurately identify the presence, location and extent of the pathologic substrate may have important diagnostic, prognostic and therapeutic implications.
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Affiliation(s)
- M Boulos
- Cardiology Department, Rambam Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Rozin A, Lorber M, Ben-Ami H, Reisner S, Kaftori JK, Edoute Y. Acute acalculous cholecystitis and cardiac tamponade in a patient with drug-induced lupus. Rheumatology (Oxford) 2001; 40:709-11. [PMID: 11426036 DOI: 10.1093/rheumatology/40.6.709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Guttmann H, Weiner Z, Nikolski E, Ish-Shalom S, Itskovitz-Eldor J, Aviram M, Reisner S, Hochberg Z. Choosing an oestrogen replacement therapy in young adult women with Turner syndrome. Clin Endocrinol (Oxf) 2001; 54:159-64. [PMID: 11207629 DOI: 10.1046/j.1365-2265.2001.01181.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hormone replacement therapy (HRT) is prescribed to most patients with Turner syndrome (TS) although its use in adult TS patients has not been scientifically evaluated. The present study was performed to compare the short-term effects in adult women with Turner syndrome of low-dose oral conjugated oestrogen (0.625 mg, CE) with relatively high dose ethinyl oestradiol (30 microg, EE2); both combined with an oral progestin. DESIGN AND PATIENTS After 4 months off HRT, 17 young, otherwise healthy women with TS were enrolled in a random, unblinded, crossover study of the two oestrogenic preparations, each given for 6 months. MEASUREMENTS We compared parameters of oestrogenic activity that would cover immediate changes in hormone levels, biochemistry, bone turnover, uterine and cardiac variables, which constitute risk factors for later development of diabetes, atherosclerosis, osteoporosis and aortic dissection. RESULTS Serum FSH returned to normal follicular phase levels only on the EE2 regimen. The hypotrophic endometria normalized with either of the two oestrogen regimens with no excessive hypertrophy. Hyperinsulinaemia was suppressed to normal by both EE2 and CE. PTH and 1,25-dihydroxyvitamin D levels increased on HRT (EE2 > CE), and phosphorus decreased. Alkaline phosphatase, osteocalcin and urinary deoxypyridinoline cross-links (DPD) were high off therapy; the former two suppressed to high-normal levels on the EE2 regimen, but not on CE, and DPD did not normalize with either HRT. Lipid profiles in these young TS patients were normal. Liver enzymes were mildly elevated off therapy and suppressed to normal levels on both regimens, but more so with EE2. CONCLUSIONS The risk factors embodied in hyperinsulinaemia and enhanced bone turnover which, ultimately, have consequences for TS morbidity, are minimized by HRT. In the short term, neither regimen is effective for bone turnover in adult women with Turner syndrome.
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Affiliation(s)
- H Guttmann
- Department of Paediatrics, Rambam Medical Center, Haifa, Israel
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Milo S, Adler Z, Bar-El Y, Kertsman V, Sawaed S, Lorber A, Reisner S. No-React anticalcification tissue treatment results with stentless heart valves in two adolescents. J Thorac Cardiovasc Surg 1999; 117:1222-3. [PMID: 10343279 DOI: 10.1016/s0022-5223(99)70266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Milo
- Departments of Cardiac Surgery, Rambam Medical Center, Haifa, Haifa, Israel
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Abstract
Freud's psychoanalysis has been criticized as quintessentially “twentieth-century,” reflecting a Zeitgeist of scientism, authoritarianism, and modernism that is being challenged and transformed as we enter the twenty-first century. Yet embedded within the modernist twentieth-century Freud can be found a more radical twenty-first-century Freud, whose greatest contribution, psychoanalysis itself—a way of thinking about our ways of thinking and being—endures. In its relentless attention to the analytic process—to that which is left out of any discourse, even its own—Freud's psychoanalysis ultimately undermines all concrete valuations of authority and knowledge. In this it fits well with postmodernist notions such as perspectivism, deconstruction, and gender theory. To some extent, it is this twenty-first-century Freud hidden within the twentieth-century one who prepared the way for the readings that inform the postmodern era. Freud's concepts of drive and gender are examined here to illustrate a process within his writings that Casey (1990) termed “auto-deconstructive.” In it, theoretical positions, once asserted, are progressively undermined and subverted, leading not to a progression of thesis, antithesis, and synthesis, but rather to the evolution of multiple vectors of thought and language, which arise, disappear, and reappear transformed, progressively expanding our understanding of how we think and the terrain of what can be thought.
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Affiliation(s)
- S Reisner
- Program in Clinical Psychology, Columbia University Teachers College, USA.
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Abstract
OBJECTIVE To describe the establishment and function of a secondary pediatric ambulatory care service within the community, to assess the utilization of a pediatric community service ("The Center"), and to assess parents' degree of satisfaction with the quality of care in the center. DESIGN Personal information and information regarding all visits was recorded and analyzed. A structured telephone interview was used to evaluate parents' satisfaction with the quality of care in the center. SETTING A pediatric community centre managed by board certified pediatricians. The clinic offers primary and secondary care. PARTICIPANTS A random sampling of parents of children who visited the center (n = 615). RESULTS The number of children treated in the center increased five-fold within three years. Most visits took place during evening hours and over the weekends. The most common presenting symptoms were fever, respiratory and gastrointestinal complaints, earache, and trauma. Eighty-nine percent of parents were satisfied or very satisfied with the quality of care in the center; 95% were satisfied or very satisfied with the attitudes of physicians and nurses providing treatment. CONCLUSION The center is widely utilized by parents with a great degree of satisfaction. The availability and extended working hours of the center provided medical care for a large number of children seeking "after hours" medical attention, as well as a backup for the primary care physicians. The center, therefore, provides a model for improved quality of medical care within the community.
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Affiliation(s)
- A Shanon
- Ambulatory Care Unit, Moke Yeladim Maccabi, Ramat Hasharon, Israel
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36
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Abstract
STUDY OBJECTIVE To evaluate the effectiveness and safety of minocycline hydrochloride (minocycline) intrapericardially in patients with malignant pericardial effusion. DESIGN Consecutive patients admitted to the hospital during a 32-month period received intrapericardial minocycline. SETTING A 900-bed university hospital. PATIENTS Fourteen consecutive patients with malignant pericardial effusion. INTERVENTION Following percutaneous insertion of a pericardial drain, minocycline was administered at a dosage of 10 mg/kg every 48 h until fluid drainage stopped or until further therapy was deemed necessary. MEASUREMENTS Complications associated with therapy, total minocycline requirements, immediate and late failure of therapy, and clinical and echocardiographic follow-up of at least 6 months. RESULTS Mean amount of minocycline administered was 1.9 +/- 1.0g given in 2.4 divided doses. Total drainage time was 5.4 +/- 2.5 days. Recurrence of malignant pericardial effusion was seen in only 1 of 14 patients. Death occurred in 10 patients due to severe metastatic disease in all. Minocycline instillation was associated with severe chest pain in seven patients, and with ECG changes suggesting pericardial or subepicardial injury in two patients. CONCLUSION (1) Intrapericardial minocycline instillation is very effective in preventing recurrence of malignant pericardial effusion. (2) Minocycline is irritative to the pericardium and may cause severe chest pain with transient ECG changes, suggesting pericardial or subepicardial injury.
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Affiliation(s)
- I Lashevsky
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
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37
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Abstract
Cardiac metastases as initial presentation of disseminated germ cell tumors have rarely been reported. The hematogenous route is believed to be the most common pattern of dissemination by germ cell tumour, mainly to the lung, central nervous system and liver. We report a 33-year-old patient with embryonal cell carcinoma who presented with an intraatrial metastatic mass as the initial manifestation of metastatic disease.
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Affiliation(s)
- M Stein
- Northern Israel Oncology Center, Rambam Medical Center and Technion, Haifa
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38
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Meltzer RS, Ohad DG, Reisner S, Sucher E, Kaplinsky E, Motro M, Battler A, Vered Z. Quantitative myocardial ultrasonic integrated backscatter measurements during contrast injections. J Am Soc Echocardiogr 1994; 7:1-8. [PMID: 8155327 DOI: 10.1016/s0894-7317(14)80412-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We and others have shown that normal myocardium exhibits 4 to 5 dB diastolic-to-systolic cyclic variation (CV) of integrated backscatter. To investigate the effect of intramyocardial contrast on integrated backscatter, we injected 5% sonicated albumin, containing microbubbles in the range of 5 microns in diameter, into the left atrium in nine open-chest dogs. The dogs were anesthetized and placed in the right lateral decubitus position on a specially designed table with a cutout allowing ultrasound imaging from below. Ultrasonic data was obtained from the right precordium by use of a prototype M-mode integrated backscatter system implemented in a commercially available two-dimensional system. Usable data were obtained in eight of nine dogs. Integrated backscatter increased up to 13 dB after contrast injections. There was a significantly decreased CV of integrated backscatter during myocardial contrast in all eight dogs. The mean level of CV of integrated backscatter for the eight dogs decreased from 4.7 dB (530 beats analyzed) without contrast to 2.8 dB during contrast (436 beats analyzed). There was a trend to greater CV at higher levels of contrast. Septal excursion, as measured by M-mode echocardiography simultaneously with integrated backscatter by the same ultrasound beam, was similar with and without contrast (mean 8.2 vs 8.3 mm). Thus left atrium contrast injection produces quantitatively measurable integrated backscatter effects. Cyclic variation of integrated backscatter decreases with contrast. However, at higher contrast levels the decrease tends to be smaller. These effects should be considered during quantitative tissue characterization and myocardial contrast studies.
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Affiliation(s)
- R S Meltzer
- Heart Institute, Chaim Sheba Medical Center, Tel Hashomer
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39
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Hod M, Dorsman M, Friedman S, Ovadia J, Reisner S, Lapidot A. Dynamic parameters of glycine metabolism in diabetic human pregnancy measured by [15N]glycine and gas chromatography-mass spectrometry. Isr J Med Sci 1991; 27:462-8. [PMID: 1960042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study presents kinetic parameters of glycine metabolism during pregnancy and the influence of fuel availability in the maternal compartment. The effect of gestational diabetes mellitus (diet treated) and pre-gestational diabetes mellitus (diet and insulin treated), accompanied by increased fetal growth on [15N]glycine kinetic parameters, compared to normal pregnancies with normal fetal growth, has been determined. This process was measured by administration of a single-dose of [15N]glycine to post-absorptive normal and diabetic pregnant women during the third trimester of pregnancy. Gas chromatography-mass spectrometry was used to determine the 15N enrichment of plasma glycine, and to calculate the pool sizes, turnover rate constants, fluxes and metabolic clearance rates. Glycine pool sizes in pre-gestational diabetes were significantly larger than those in normal pregnancy and gestational diabetes. Glycine turnover rate constants and metabolic clearance rates were not significantly different between the normal pregnant women and the two diabetic groups of pregnant women. Glycine fluxes were significantly higher in the pre-gestational diabetic pregnant women than in gestational diabetes and normal pregnancy. The pre-gestational diabetic pregnant women delivered fetuses with higher birth weights than the other two groups.
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Affiliation(s)
- M Hod
- Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tikva, Israel
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40
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Markiewicz W, Moscovitz M, Reisner S, Hir J, Grenadier E. Diagnostic and prognostic value of oral dipyridamole test using echocardiography. Isr J Med Sci 1990; 26:601-5. [PMID: 2254074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The diagnostic and prognostic value of the oral dipyridamole test using echocardiography was evaluated in 47 consecutive patients undergoing coronary arteriography. The results of the tests were not communicated to the physicians treating the subjects during a 1-year follow-up. The test had a sensitivity of 54% and a specificity of 100% for predicting severe (greater than or equal to 70% luminal stenosis) coronary artery disease. Neither ST-T segment changes nor chest pain during the test were associated with the presence of severe coronary artery disease. In the subgroup of 34 patients with severe coronary artery disease, the appearance of left ventricular segmental systolic dysfunction or ST-T segment depression (greater than or equal to 1 mm) during the test has a strong predictive value for subsequent cardiac events during a 1-year follow-up.
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Affiliation(s)
- W Markiewicz
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
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41
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Ravid A, Koren R, Rotem C, Amir Y, Reisner S, Novogrodsky A, Liberman UA. Mononuclear cells from human neonates are partially resistant to the action of 1,25-dihydroxyvitamin D. J Clin Endocrinol Metab 1988; 67:755-9. [PMID: 2843561 DOI: 10.1210/jcem-67-4-755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
1,25-Dihydroxyvitamin D [1,25-(OH)2D] inhibits mitogen-induced proliferation of lymphocytes by a receptor-mediated mechanism. Peripheral blood lymphocytes may serve as a model for detecting hereditary defects in the response of classical target organs to 1,25-(OH)2D. Delayed bone mineralization and deficient intestinal calcium absorption are common in low birth weight formula-fed infants. The defect in calcium absorption exists despite normal or even elevated serum 1,25-(OH)2D levels, suggesting partial end-organ resistance to the hormone. We assessed the response to 1,25-(OH)2D of activated mononuclear cells obtained from cord blood of fullterm and preterm infants and from peripheral blood of adults. We found that the inhibitory effect of 1,25-(OH)2D on mitogen-induced [3H]thymidine incorporation was significantly less [mean, 34 +/- 8% (+/- SE)] in mononuclear cells from neonates (independent of gestational age) compared to mononuclear cells from adults (66 +/- 5%; P less than 0.001). This difference in the inhibitory effect was not due to a smaller number of high affinity receptors for 1,25-(OH)2D in activated cord blood lymphocytes. We conclude that the coupling between the receptors for 1,25-(OH)2D and the biological response in neonates is less efficient than that in adults.
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Affiliation(s)
- A Ravid
- Rogoff Medical Research Institute, Beilinson Medical Center, Petah-Tikva, Israel
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42
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Sivan Y, Reisner S. [Sudden infant death: search for cause]. Harefuah 1988; 115:95-6. [PMID: 3224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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43
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Rosenfeld J, Bott-Kanner G, Boner G, Nissenkorn A, Friedman S, Ovadia J, Merlob P, Reisner S, Paran E, Zmora E. Treatment of hypertension during pregnancy with hydralazine monotherapy or with combined therapy with hydralazine and pindolol. Eur J Obstet Gynecol Reprod Biol 1986; 22:197-204. [PMID: 3743860 DOI: 10.1016/0028-2243(86)90066-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Forty-four consecutive patients referred for treatment because of hypertension (greater than 150/90 mmHg) occurring during pregnancy were randomly allocated to one of two treatment groups, hydralazine alone (n = 21) or hydralazine combined with pindolol (n = 23). Satisfactory blood pressure control (diastolic pressure less than 90 mmHg) was achieved in 86% of patients receiving hydralazine alone and 91% of those on combined therapy. Although the treatment did not lower the overall incidence of hypertensive complications it appeared to delay the onset of such complications until successful surgical intervention was possible. Fetal outcome was similar in both groups and there was no perinatal mortality in this high-risk population. Although blood pressure control was similar in both groups of patients, combined therapy with hydralazine and pindolol can be considered to be superior to hydralazine monotherapy, since in patients treated with the combination the incidence and intensity of troublesome side-effects was markedly lower.
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44
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Garty B, Mammon Z, Chemke M, Reisner S. [A liveborn child with complete triploidy]. Harefuah 1985; 109:336-7. [PMID: 4093058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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45
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Altaras M, Cohen I, Reisner S, Ben Aderet N. Neonatal outcome of infants delivered at 26-28 weeks of gestation. Gynecol Obstet Invest 1985; 20:18-22. [PMID: 4043823 DOI: 10.1159/000298966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The delivery results of 42 infants born to 40 mothers at the gestational age of 26-28 weeks during a period of 5 years were analyzed. The study was evaluated in two periods of time: in the first period out of 15 infants born only 5 (33.3%) survived, while in the second period 21 (77.7%) out of 27 infants survived (p less than 0.01). 38 infants were transferred to a neonatal intensive care unit for premature infants. Only 41% of the infants transferred in the first period survived, as compared to 80.7% of those transferred during the second period (p less than 0.01). There was no significant difference in the mean birth weight at each gestational age between the survivors and those who subsequently died in both periods of the study. In the study groups, cesarean section rate rose from 13.3% in the first period to 44% in the second. Mode of delivery, regardless of the presenting part, did not seem to influence neonatal survival. Obstetrical management, including the performance of operative delivery for fetal indications and active neonatal resuscitation, seems to be reasonable for infants at the gestational age of 26 weeks or more.
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46
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Ashkenazi S, Reisner S. [Spontaneous pneumothorax in the newborn infant]. Harefuah 1984; 106:328. [PMID: 6745793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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47
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Shohat M, Alpert G, Grunbaum M, Reisner S. [Translumination of the abdomen in neonatal necrotizing enterocolitis]. Harefuah 1983; 105:65-7. [PMID: 6654240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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48
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Grünebaum M, Horodniceanu C, Ziv N, Wilunsky E, Reisner S. Incubator radiographic diagnosis of intestinal perforation in the newborn. Z Kinderchir 1982; 36:97-9. [PMID: 7124125 DOI: 10.1055/s-2008-1059870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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49
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Shohat M, Wilunsky E, Reisner S. [Ammonia metabolism and hyperammonemic states in the newborn]. Harefuah 1982; 102:158-62. [PMID: 7095646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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50
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Abstract
Traumatic oesophageal perforation may occur during the intensive care of premature infants due to trauma of the laryngoscope blade, to traumatic intubation with an endotracheal tube or to forced passing of a nasogastric tube. Over a four-year period, three infants of 787 admitted to a neonatal intensive care unit were diagnosed as having this complication. The careful analysis of the position of the nasogastric tube in relation to surrounding structures can be an early clue to the diagnosis of this condition.
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