King K. Holmes

BackgroundAfrican immigrants in the U.S. are more likely to have a late HIV diagnosis than U.S.-born people, potentially leading to onward transmission. We sought to determine the proportion of African-born people living with HIV (APLWH) who (1) had tested HIV negative prior to diagnosis, and (2) likely acquired HIV in the U.S.MethodsWe interviewed APLWH from 2014 to 2017 and estimated the proportion with post-migration HIV acquisition based on clinical data, HIV testing history, immigration date, and behavioral data.ResultsOf 179 participants, 113 (63%) were women. Less than half (44%) reported a negative HIV test prior to diagnosis. Among 142 (79%) participants with sufficient data to evaluate post-migration HIV acquisition, we estimate that 29% acquired HIV post-migration. Most APLWH acquire HIV prior to immigration.DiscussionApproximately one-quarter of APLWH acquire HIV post-migration and …

ImportanceIn children undergoing heart surgery, nitric oxide administered into the gas flow of the cardiopulmonary bypass oxygenator may reduce postoperative low cardiac output syndrome, leading to improved recovery and shorter duration of respiratory support. It remains uncertain whether nitric oxide administered into the cardiopulmonary bypass oxygenator improves ventilator-free days (days alive and free from mechanical ventilation).ObjectiveTo determine the effect of nitric oxide applied into the cardiopulmonary bypass oxygenator vs standard care on ventilator-free days in children undergoing surgery for congenital heart disease.Design, Setting, and ParticipantsDouble-blind, multicenter, randomized clinical trial in 6 pediatric cardiac surgical centers in Australia, New Zealand, and the Netherlands. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized between …

Some historical context helps set the stage. Roughly 13,000 years ago, the Younger Dryas cooling at the end of the Pleistocene gave way to postglacial warming, marking the beginning of the Holocene. Our ancestors shifted from hunting and gathering to what we recognize as civilization—agriculture and manufacturing, art and culture, and towns and cities. Human well-being improved in countless ways, although there were also costs, such as less diverse diets and less contact with nature. 1Recent industrial history provides further context. The current human situation dates back just two or three centuries, when we learned how to unleash vast amounts of energy that had been locked in fossil fuels over geologic time. This ushered in a time of unprecedented growth in population, energy use, manufacturing, agriculture, and travel—indeed, in almost every measure of human activity—called the Great Acceleration. 2 These changes are shown in Fig. 17-1.

Covid-19, Ebola, and HIV Our response to the Covid-19 pandemic should build on lessons from the HIV and Ebola epidemics, including the importance of basing interventions on sound science and of involving affected communities in planning and implementation of research and care.

The objective of the study was to determine the seroprevalence of celiac disease (CD) in urban areas of Peru using a population-based sample. A random sample of women and men 18 to 29 years old from 26 cities in Peru was screened. An anti-tissue transglutaminase IgA kit was used for the detection of CD. Results higher than 20 AU/ml were considered positive. The weighted prevalence of celiac disease was 1.2%(CI 95%: 0.0%-2.4%), thus the estimated number of people living with CD in Peru was 341,783. CD prevalence in Peru is similar to the world average.

El objetivo del estudio fue determinar la seroprevalencia de la enfermedad celiaca (EC) en zonas urbanas del Perú, utilizando una muestra de base poblacional. Se tamizó una muestra aleatoria de mujeres y varones de 18 a 29 años de 26 ciudades del Perú. Para la detección de la EC se utilizó el kit anti-transglutaminasa tisular IgA. Los resultados mayores a 20 AU/ml fueron considerados positivos. La prevalencia ponderada de la EC fue de 1,2% (IC 95%: 0,0‒2,4) y se estima que el número de personas viviendo con EC en el Perú fue de 341 783. La prevalen cia de la EC en el Perú resultó ser similar al promedio mundial.

Several barriers can hamper successful integration of behavioural interventions into existing services. Health systems are complex and introducing new strategies is not easy, especially when they relate to sexual issues and require additional contact between providers and clients. Strategic planning is often inadequate due to insufficient understanding of how an intervention works, how it fits into existing procedures and what synergies may exist with other interventions already in place. The economic implications of providing behavioural interventions and making them accessible must be considered to ensure that sexual health services are affordable. However, research on this cost is scarce. A recent literature review on the cost–effectiveness of prevention interventions of sexually transmitted infections in low-and middle-income countries yielded only one behavioural intervention study. That study assessed an …