Stigmatizing policies’ influence on HIV risk through their effect on internalized homonegativity and health behaviors among men who have sex with men in Europe

Background

Men who have sex with men (MSM) in Europe are most affected by HIV disparities. Complex systems theory proposes that many health behaviors and risks arise from numerous cascading and interacting processes. Our aim was to explore how stigmatizing policies at the European country-level create pathways to HIV risk and disparities among MSM in Europe.

Methods

We used data from the 2017 European Men Who Have Sex with Men Internet Survey (EMIS-2017). The anonymous online survey recruited 126,090 European MSM. We assessed condom use with steady & non-steady partners as the outcome. Condom use was categorized from zero to 10 (10 or more partners). Abuse was scored zero to three and internalized homonegativity from zero to six. We used the International Gay and Lesbian Association's Rainbow Index as the main predictor, which ranks European countries' laws and policies regarding LGBTQ+ legal protections from zero (worst) to 100 (best). We used structural equation and multi-level modeling for analyses.

Results

The mean Rainbow Index score was 50.8 with a range from 6 to 88. The Rainbow Index scores were the highest in Western European (mean=62.5), then Central European (mean=45.9), then Eastern Europe (mean=21.4) (p < 0.000). Unadjusted regression models suggested that for every one-unit improvement in the Rainbow Index the number of condomless sexual acts with steady sexual partners was reduced [β=-0.0012, 95% CI (-0.0016, -0.0009)]. The unadjusted structural equation model showed that the relationship between the Rainbow Index and condom use with steady partners was mediated by 30% because of internalized homonegativity (p < 0.000).

Conclusions

The policy context influences HIV risk, especially through the policies' effects on condom use. HIV research and prevention efforts must recognize that structural determinants can shape people's risk for HIV and that the best individual and local efforts may be undermined by structural factors such as policies.

Lessons from the past, policies for the future: resilience and sustainability in past crises

This article surveys some examples of the ways past societies have responded to environmental stressors such as famine, war, and pandemic. We show that people in the past did think about system recovery, but only on a sectoral scale. They did perceive challenges and respond appropriately, but within cultural constraints and resource limitations. Risk mitigation was generally limited in scope, localized, and again determined by cultural logic that may not necessarily have been aware of more than symptoms, rather than actual causes. We also show that risk-managing and risk-mitigating arrangements often favored the vested interests of elites rather than the population more widely, an issue policy makers today still face.

The Justinianic Plague: An inconsequential pandemic?

Existing mortality estimates assert that the Justinianic Plague (circa 541 to 750 CE) caused tens of millions of deaths throughout the Mediterranean world and Europe, helping to end antiquity and start the Middle Ages. In this article, we argue that this paradigm does not fit the evidence. We examine a series of independent quantitative and qualitative datasets that are directly or indirectly linked to demographic and economic trends during this two-century period: Written sources, legislation, coinage, papyri, inscriptions, pollen, ancient DNA, and mortuary archaeology. Individually or together, they fail to support the maximalist paradigm: None has a clear independent link to plague outbreaks and none supports maximalist reconstructions of late antique plague. Instead of large-scale, disruptive mortality, when contextualized and examined together, the datasets suggest continuity across the plague period. Although demographic, economic, and political changes continued between the 6th and 8th centuries, the evidence does not support the now commonplace claim that the Justinianic Plague was a primary causal factor of them.

Abstract P2-10-16: Quantitative HER3 protein expression and PIK3CA mutation status in matched samples from primary and metastatic breast cancer tissues and correlation with time to recurrence

Background: HER3 is thought to play a prominent role in resistance to HER2-directed breast cancer therapies. Recent data suggest that HER3 levels also influence HER2-normal breast tumor biology. HER3 and PI3K signaling are linked in that in HER3 signaling activates PI3K and inhibition of PI3K activity can upregulate HER3 expression. Here, we measured quantitative HER3 protein expression levels and PIK3CA mutation status in matched tissues from the primary tumor and site of metastasis to assess correlations with time to recurrence.

Methods: 44 pairs (8 HER2+ by HERmark®) of matched tissues from the primary tumor and the site of metastasis were evaluated for HER3 protein expression using a sensitive, quantitative assay for HER3 protein expression in FFPE tissue sections (VeraTag®). Matched samples were also evaluated for quantitative HER2 expression (HERmark) and for PIK3CA mutations at exon 9 (E542K and E545K) and exon 20 (H1047R).

Results: HER3 protein expression at the metastatic site was largely independent of HER3 levels at the primary site (Spearman p = 0.50) in contrast to HER2 expression (Spearman p = 0.0004). HER3 expression in the primary tumor correlated with time to recurrence (TTR) (HR = 2.0 per 2-fold increase in HER3; p < 0.0001). Conversely, HER3 expression measured at the site of metastasis was not correlated with TTR (p = 0.55). Estrogen receptor negative tumors were less likely to have PIK3CA mutations (p = 0.023). In cases of primary tumors with PIK3CA mutations, no reversions to wild-type PIK3CA were observed in the metastatic sites. In metastatic tumors, mutations detected in the primary tumor as well as new mutations were observed. A gain of an exon 9 mutation at the metastatic site correlated with shorter TTR (HR = 2.5; p = 0.043). Excluding the 8 samples that were HER2+ by HERmark, longer TTR was observed for patients with PIK3CA mutations in the primary tumor (HR = 0.47; p = 0.042), which is consistent with previous reports. Interestingly, the longer TTR for those with PIK3CA mutations appeared to be dependent on quantitative HER3 protein level (interaction p = 0.065).

Conclusions: HER3 protein expression in matched primary and metastatic breast cancer tissues were unrelated. This may indicate that HER3 protein is influenced by the different tumor microenvironments of the primary and metastatic sites. PIK3CA mutations were either maintained or acquired at metastatic sites. Both low HER3 protein expression and the presence of PIK3CA mutations in the primary tumor but not the metastatic tumor were associated with longer TTR. These observations suggest that HER3 protein expression may be an important prognostic factor for breast cancer progression.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-16.

Latino values in the context of palliative care: illustrative cases from the Family Focused Grief Therapy trial

BACKGROUND

Clinicians meet a variety of ethnicities among patients and families in hospice programs. This article focuses on Latino families.

METHODS

Within a controlled trial of family therapy in the context of palliative care, 17 families identified as Hispanic. Five were examined qualitatively herein.

RESULTS

A synopsis of each family's narrative is presented here. Patterns of strong family loyalty (Familismo), the gender roles of Machismo and Marianismo, the importance of family tradition, expectations about caregiving, and the place of faith and religion emerged as prominent and able potentially to impact on the therapy.

CONCLUSIONS

Family therapists need to be thoughtful about cultural issues as they strive to support families.

Biomedical engineering education through global engineering teams

Most industrial projects require a team of engineers from a variety of disciplines. The team members are often culturally diverse and geographically dispersed. Many students do not acquire sufficient skills from typical university courses to function efficiently in such an environment. The Global Engineering Teams (GET) programme was designed to prepare students such a scenario in industry. This paper discusses five biomedical engineering themed projects completed by GET students. The benefits and success of the programme in educating students in the field of biomedical engineering are discussed.

Acute anti-emetic withdrawal associated with a hemorrhagic cerebellar arteriovenous malformation

We present a 67-year-old right-handed male with a brachium pontis arteriovenous malformation on continuous anti-emetic therapy who demonstrated acute withdrawal symptoms after the abrupt discontinuation of ondansetron, a 5-HT(3) receptor antagonist. Removal of anti-emetic therapy led to the development of extreme flushing and tremor, but subsequent return of ondansetron resulted in the resolution of these symptoms. This is the first clinical report demonstrating acute withdrawal from an anti-emetic agent and we further highlight the need for future studies evaluating not only arterial supply with pressure gradients and anatomical location, but also the association with periventricular venous drainage, venous drainage stenosis, and mass effect from venous stasis as this may contribute partly to the sensitivity of the serotonergic receptors seen here.

Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: results from a national survey

The goal of this study was to identify differences in the sexual health behaviors (condom use and number of sexual partners) between college students with same-sex sexual experiences and those with only opposite-sex partners. Data from a random sample of American university students were gathered as part of the 1997 College Alcohol Study. Odds ratios were estimated for consistent condom use and multiple sex partners for students with same-sex or both-sex sexual partners compared to those with exclusively heterosexual contacts. Five percent of respondents reported ever having a same-sex partner. Significant differences in safer-sex practices were found between groups. Females with both-sex experience and males with both-sex or only same-sex experiences were more likely to report multiple recent sexual partners than their peers with only opposite-sex partners. Odds ratios of consistent condom use were lower for men with only same-sex experience than among those with only opposite-sex partners. Findings have implications for sexual health education on the college campus. Consistent condom use remains low among college students. Education programs should emphasize the importance of limiting the number of lifetime sex partners, especially among students with same-sex experiences.

Social influences, social norms, social support, and smoking behavior among adolescent workers

PURPOSE

To examine the relationships between worksite interpersonal influences and smoking and quitting behavior among adolescent workers.

DESIGN

The cross-sectional survey assessed factors influencing tobacco use behavior.

SETTING

During the fall of 1998, data were collected from 10 grocery stores in Massachusetts that were owned and managed by the same company.

SUBJECTS

Eligible participants included 474 working adolescents ages 15 to 18. Eighty-three percent of workers (n = 379) completed the survey.

MEASURES

The self-report questionnaire assessed social influences, social norms, social support, friendship networks, stage of smoking and quitting behavior, employment patterns, and demographic factors.

RESULTS

Thirty-five percent of respondents were never smokers, 21% experimental, 5% occasional, 18% regular, and 23% former smokers. Using analysis of variance (ANOVA), results indicate that regular smokers were 30% more likely than experimental or occasional smokers to report coworker encouragement to quit (p = .0002). Compared with regular smokers, never smokers were 15% more likely to report greater nonacceptability of smoking (p = .01). chi 2 tests of association revealed no differences in friendship networks by stage of smoking.

CONCLUSIONS

These data provide evidence for the need to further explore social factors inside and outside the work environment that influence smoking and quitting behavior among working teens. Interpretations of the data are limited because of cross-sectional and self-report data collection methods used in one segment of the retail sector.

Cardiac arrest in medical and dental practices: implications for automated external defibrillators

BACKGROUND

To determine the need for placing automated external defibrillators (AEDs) in medical and dental practices, we identified cardiac arrests at these locations.

METHODS

Locations of cardiac arrest were abstracted from Emergency Medical Services data from January 1, 1990, through December 31, 1996. We calculated the annual incidence of cardiac arrest per type of practice.

RESULTS

There were 142 cardiac arrests in medical or dental practices. Dialysis centers had a relatively high incidence of cardiac arrest (>/=0.746 per practice annually). Cardiology, internal and family medicine, and urgent care centers had a medium incidence (>/=0.01 per practice annually). All other medical and dental practices had a low incidence (</=0.002 annually).

CONCLUSIONS

Placement of 779 AEDs in the high- and medium-incidence practices would have provided treatment for 112 patients with cardiac arrest in 7 years. To provide for the 16 cardiac arrests in low-incidence practices, an additional 1928 AEDs would be required.

Emergency medical services telephone referral program: an alternative approach to nonurgent 911 calls

OBJECTIVE

To examine the effects of transferring nonurgent 911 calls to a telephone consulting nurse. It was hypothesized that the telephone referral program would result in fewer basic life support (BLS) responses with no adverse patient outcome or decrease in patient satisfaction.

METHODS

A two-phased prospective study was conducted in an urban and rural setting with a population of 650,000. During phase I, a BLS unit was dispatched on all calls and a nurse intervention was simulated. During phase II, no BLS unit was dispatched for calls meeting study criteria. Callers were transferred to the nurse, and consulting nurse protocols were used to direct care. Data were collected from dispatch, BLS, nurse, and hospital records and patient self-assessment.

RESULTS

During phase I, 38 callers were transferred to the consulting nurse with no nurse intervention. During phase II, 133 cases were transferred to the nurse line. There were no adverse outcomes detected. The nurse recommended home care for 31%, physician referral for 24%, referral back to 911 for 17%, community resource for 11%, and other referral for 17%. Nurses contacted 85 patients for telephone follow-up. Ninety-four percent of the patients reported feeling better, 6% felt the same, and none felt worse. Patients were satisfied with the outcome in 96% of the cases.

CONCLUSION

Transferring 911 calls to a nurse line resulted in fewer BLS responses and no adverse patient outcomes, while maintaining high patient satisfaction. Dispatch criteria correctly identified cases with minimal medical needs. A high percentage of the patients reported feeling better after the intervention. This study has major implications for communities interested in efficient use of emergency medical services resources.

Workplace tobacco policy: progress on a winding road

This is a report of a pre- and post-intervention telephone survey to track changes in workplace tobacco policy in Pima County, Arizona, from 1997 to 1999. During this period, an extensive effort was made to assist workplaces to establish and enforce formal tobacco use policies. A random sample of 1134 workplaces, stratified by workforce size, was surveyed in 1997. Complete interviews were conducted with 934 (82.4%) workplaces. All 934 workplaces were contacted for the follow-up survey that was conducted in 1999. Of these, 824 (88.2%) completed follow-up surveys. The analyses presented were conducted on businesses that were included in both the baseline and follow-up surveys, and that reported having at least one employee on-site (n = 813). Tobacco policies and smoke-free policies were more likely to be found in larger businesses and businesses with a predominantly female workforce. There was no clear policy progression from having no policy, to having a policy, to becoming smoke-free. There was a small but significant overall decrease (4.8%) in the proportion of businesses having policies in the last two years. We found that 10.3% (75) of businesses that had policies in 1997 had dropped their policies by 1999, and that 13.4% (73) of worksites that were smoke-free in 1997 retained tobacco policies but were not smoke-free in 1999. However, formalization of policy in writing and the number of enforcement strategies utilized increased. These findings suggest that efforts to encourage businesses to establish workplace tobacco policies must be sustained even after policies have been established.

The effect of warm water on the spasticity of the cerebral paralyzed child

This study investigated the effect of warm water on spasticity in children with cerebral palsy. The sample was taken from the population of spastic cerebral palsy children at Bel Porto School. Ten children who met the inclusion criteria were randomly selected. The methodology included an assessment of each child’s spasticity according to the Motor Assessment Scale(MAS). Two variables were tested prior to and after the child was exposed to warm water. These were the distance each child could reach and the time it took to passively lengthen the biceps muscle. The exposure to warm water was 15 minutes long at a temperature of 31 degrees C. Measurements were taken for both arms and a more affected and a less affected arm were identified.The data were analysed using the Wilcoxon Sign-Ranked Test (<0,05). The percentage improvement for each arm was computed. The results showed a significant improvement in both the reach distance and the time it took to passively lengthen biceps for both arms.

Prevalence of pain related to schoolbag carriage in adolescents

Study design: A descriptive qualitative and quantitative cross sectional study design was chosen.Objective: To investigate the prevalence of lower back, neck, and shoulder pain in 13 to 15 year old scholars in Pretoria, South Africa, and how it related to methods of school bag carriage and perceived weight of school bags.Summary of background data: Unilateral loading has been linked to scoliotic type curves in the adolescent spine. More recent studies have also found that the weight of school bags may be related to the experience of pain, but very little research has been done on the prevalence of this pain.Methods and materials: A stratified random sample of nine schools was drawn from a total of 98 schools in the Pretoria District of the Gauteng Department of Education. The sample of 250 Grade 8 and 9 scholars was randomly selected. A questionnaire of open and closed ended questions was administered with five main sections, namely: demographics, method of carrying school bag, perceived school bag weight, areas of experienced pain, and awareness of adverse postural effects of carrying a school bag.Results: Thirty two percent of the sample reported pain either in the lower back, neck and/or shoulders. Principle Component Analysis and Chi-square tests showed no relationship between how the school bag was carried (over one/two shoulders; in one hand; swopping sides) and scholars’ reports of pain. A high level of significance (0.001 <p<0.042) was found when perceived bag weight was compared to the scholars’ reports of pain.Conclusion: Scholars in the Pretoria area present with a 32% prevalence of pain in the lower back, neck and/or shoulders. This is strongly correlated with the perceived weight of their school bags, regardless of how the school bag is carried.

The 'Heart Attack Survival Kit' project: an intervention designed to increase seniors' intentions to respond appropriately to symptoms of acute myocardial infarction

The purpose of this study was to test the effectiveness of a 'Heart Attack Survival Kit', disseminated via two different delivery methods, designed to increase seniors' intentions to call 911 and take an aspirin in response to a cardiac emergency. Twelve-hundred seniors were randomly assigned to (1) receiving a Kit via a home visit by an Emergency Medical Technician (EMT), (2) receiving a Kit via direct mail or (3) a control group. All participants were telephoned and asked how they would respond to a cardiac emergency. Results showed that respondents in the intervention group (EMT and direct mail group combined) reported a greater frequency of the recommended coping response to AMI (39%) than respondents in the control group (10%) (P < 0.000). Within intervention groups, 47% in the EMT group and 30% in the direct mail group (P < 0.000) reported intentions to take the appropriate response to AMI. The results suggest that a Heart Attack Survival Kit, especially when delivered door-to-door by EMTs, can be an effective way of educating seniors about cardiac emergencies.

Sources of coercive behaviours in psychiatric admissions

OBJECTIVE

Coercion during psychiatric admissions has been a topic of debate for many years. Although there has been considerable research on patients' perceptions of coercion, there has been no work on who places pressures on patients to be admitted.

METHOD

This article integrates interview data from interviews with patients, admitting staff and family and friends to describe the pressures brought to bear on patients to be admitted.

RESULTS

Health-care professionals appear to be the most important source of pressures on patients, and to have the most impact on patients' perceptions of coercion. However, there are differences in type of pressure, and the pressures used by family and friends appear to have the most longstanding impact.

CONCLUSION

Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental-health professionals, including especially those who are not legally mandated to participate in the admission process.

The impact of television public service announcements on the rate of bystander CPR

OBJECTIVE

To determine whether televised public service announcements (PSAs) demonstrating the fundamentals of CPR were effective in increasing the rate of layperson bystander-initiated CPR.

METHODS

Two 30-second PSAs were shown 597 times from September 8, 1996, through April 12, 1997. In each, CPR was given to one member of an older couple by the other in the home. The authors measured rates of bystander CPR in communities that were exposed to the PSA and in communities that were not exposed in two time periods, a before-airing period, January 1, 1993, through September 7, 1996, and a during-airing period, September 8, 1996, through April 12, 1997. A case was defined as a patient with a nontraumatic cardiac arrest that occurred before arrival of EMS personnel, and for whom CPR was initiated by EMS personnel or lay bystanders.

RESULTS

There were 1,786 cardiac arrests in the "before" period and 289 in the "during" period. The rate of bystander CPR increased from 43% to 55% (p<0.05) in the intervention community and remained the same in the comparison community (33%).

CONCLUSION

Airing of the PSA was accompanied by an increase in the rate of bystander CPR, though the increase may be attributable to a secular trend.

What can you teach about cardiopulmonary resuscitation (CPR) in 30 seconds? Evaluation of a television campaign

This study evaluated an 8-month media campaign, implemented in western Washington, to educate people on the basic steps of cardiopulmonary resuscitation (CPR) for cardiac arrest. A telephone survey was conducted with a total of 384 adults randomly selected from two towns, one that had been exposed to the campaign (intervention town) and one that had not been exposed to the campaign (comparison town). Results showed that respondents in the intervention town were more likely than respondents in the comparison town to report (a) having heard messages on CPR in the past month, (b) having seen the CPR media campaign, and (c) knowing the three basic steps of CPR. Respondents who had seen the campaign evaluated it very favorably. There were no differences between respondent groups in self-reported CPR training or intentions to perform CPR, suggesting that the campaign had a greater impact on knowledge and awareness than on intentions and behavior.