bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of multiple frailty profiles on institutionalization and all‐cause mortality in community‐living older adults
Authors: Lee Yunhwan , Kim Eunsaem , Yun Jihye , Chuck Kumban Walter 
Published: July 2022

AbstractBackgroundFrailty in older adults is associated with adverse geriatric outcomes. Physical frailty is often accompanied by problems in the cognitive, psychological, and social domains. This study investigated the ability of physical frailty combined with other health domains to predict institutionalization and mortality.MethodsA national sample of 9171 Koreans aged 65 years or older were surveyed at baseline in 2008 and 3 year follow‐up. Those who were prefrail or frail according to the Fried criteria were conceived to have physical frailty. Psychological frailty, cognitive frailty, and social frailty were defined as having depressive symptoms, cognitive impairment, and social vulnerabilities, respectively, in addition to physical frailty. Using Cox proportional hazards and competing‐risks regression, the risk of mortality and institutionalization by the number and profiles of different frailty domains was analysed.ResultsAt baseline, the 9171 participants were aged 73.1 (±6.8) years on average (median: 72, range: 65 to 103), and 59.2% were women. Multidomain frailty was highly prevalent (49.3%), with 6.1% concurrently displaying frailty in all four domains (mixed frailty). The risk of negative health outcomes increased with frailty in a higher number of domains with a subhazard ratio (SHR) of 3.48 (95% confidence interval [CI]: 1.83, 6.62; P < 0.001) for institutionalization and a hazard ratio (HR) of 3.95 (95% CI: 2.62, 5.93; P < 0.001) for mortality among those presenting mixed frailty. Psychological frailty (depressive symptoms combined with physical frailty) was strongly predictive of institutionalization (SHR = 2.85; 95% CI: 1.45, 5.59; P = 0.002) and mortality (HR = 2.47; 95% CI: 1.61, 3.78; P < 0.001). When combined with physical frailty and either depressive symptoms or social vulnerabilities, cognitive impairment also exhibited a significantly elevated risk of negative events. Physical frailty alone was not a strong predictor of adverse events, especially for mortality (HR = 1.13; 95% CI: 0.77, 1.67; P = 0.53).ConclusionsCo‐occurrence of physical frailty with other domains is common in late life. The presence of frailty in multiple domains raises the risk of adverse outcomes, with the effects varying by multidimensional profiles.
Frameworks and measures for HIV‐related internalized stigma, stigma and discrimination in healthcare and in laws and policies: a systematic review
Authors: Ferguson Laura , Gruskin Sofia , Bolshakova Maria , Yagyu Sachi , Fu Ning , Cabrera Nicky , Rozelle Mary , Kasoka Kasoka , Oraro‐Lawrence Tessa , Stackpool‐Moore Lucy , Motala Aneesa , Hempel Susanne 
Published: July 2022

AbstractIntroductionThere is strong global commitment to eliminate HIV‐related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used.MethodsBuilding on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository.Results and discussionSixty‐nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV‐related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV‐related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions.ConclusionsThis systematic review provides an evidence base of current understandings of HIV‐related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV‐related stigma on people's health and quality of life.
Telling the story of intersectional stigma in HIV‐associated Kaposi's sarcoma in western Kenya: a convergent mixed‐methods approach
Authors: Collier Sigrid , Singh Rhea , Semeere Aggrey , Byakwaga Helen , Laker‐Oketta Miriam , McMahon Devon E. , Chemtai Linda , Grant Merridy , Butler Lisa , Bogart Laura , Bassett Ingrid V. , Kiprono Samson , Maurer Toby , Martin Jeffrey , Busakhala Naftali , Freeman Esther E. 
Published: July 2022

AbstractIntroductionThe experience of stigma can be multifaceted for people with HIV and cancer. Kaposi's sarcoma (KS), one of the most common HIV‐associated cancers in sub‐Saharan Africa, often presents with visible skin lesions that may put people at risk for stigmatization. In this way, HIV‐associated KS is unique, as people with KS can experience stigma associated with HIV, cancer, and skin disease simultaneously. The aim of this study is to characterize the intersectionality of HIV‐related, cancer‐related and skin disease‐related stigma in people living with HIV and KS.MethodsWe used a convergent mixed‐methods approach nested within a longitudinal study of people with HIV‐associated KS in western Kenya. Between February 2019 and December 2020, we collected quantitative surveys among all participants and conducted semi‐structured interviews among a purposive sample of participants. Quantitative surveys were adapted from the abridged Berger HIV Stigma Scale to assess overall stigma, HIV‐related stigma, cancer‐related stigma, and skin disease‐related stigma. Qualitative data were coded using stigma constructs from the Health Stigma and Discrimination Framework.ResultsIn 88 semi‐structured interviews, stigma was a major barrier to KS diagnosis and treatment among people with HIV‐associated KS. Participant's stories of stigma were dominated by HIV‐related stigma, more than cancer‐related or skin disease‐related stigma. However, quantitative stigma scores among the 117 participants were similar for HIV‐related (Median: 28.00; IQR: 28.0, 34.0), cancer‐related (Median: 28.0; IQR: 28.0, 34.8), and skin disease‐related stigma (Median: 28.0; IQR: 27.0, 34.0). In semi‐structured interviews, cancer‐related and skin disease‐related stigma were more subtle contributors; cancer‐related stigma was linked to fatalism and skin‐related stigma was linked to visible disease. Participants reported resolution of skin lesions contributed to lessening stigma over time; there was a significant decline in quantitative scores of overall stigma in time since KS diagnosis (adjusted β = –0.15, p <0.001).ConclusionsThis study highlights the role mixed‐method approaches can play in better understanding stigma in people living with both HIV and cancer. While HIV‐related stigma may dominate perceptions of stigma among people with KS in Kenya, intersectional experiences of stigma may be subtle, and quantitative evaluation alone may be insufficient to understand intersectional stigma in certain contexts.
“I was still very young”: agency, stigma and HIV care strategies at school, baseline results of a qualitative study among youth in rural Kenya and Uganda
Authors: Johnson‐Peretz Jason , Lebu Sarah , Akatukwasa Cecilia , Getahun Monica , Ruel Theodore , Lee Joi , Ayieko James , Mwangwa Florence , Owino Lawrence , Onyango Anjeline , Maeri Irene , Atwine Frederick , Charlebois Edwin D. , Bukusi Elizabeth A. , Kamya Moses R. , Havlir Diane V. , Camlin Carol S. 
Published: July 2022

AbstractIntroductionAdolescents and young adults living with HIV (AYAH) have the lowest rates of retention in HIV care and antiretroviral therapy (ART) adherence, partly due to the demands of school associated with this life stage, to HIV‐related stigma and to fears of serostatus disclosure. We explore the implications of school‐based stigma and disclosure on the development of agency during a critical life stage in rural Kenya and Uganda.MethodsWe conducted a qualitative study in the baseline year of the SEARCH Youth study, a combination intervention using a life‐stage approach among youth (15–24 years old) living with HIV in western Kenya and southwestern Uganda to improve viral load suppression and health outcomes. We conducted in‐depth, semi‐structured interviews in 2019 with three cohorts of purposively selected study participants (youth [n = 83], balanced for sex, life stage and HIV care status; recommended family members of youth [n = 33]; and providers [n = 20]). Inductive analysis exploring contextual factors affecting HIV care engagement revealed the high salience of schooling environments.ResultsStigma within school settings, elicited by non‐consensual serostatus disclosure, medication schedules and clinic appointments, exerts a constraining factor around which AYAH must navigate to identify and pursue opportunities available to them as young people. HIV status can affect cross‐generational support and cohort formation, as AYAH differ from non‐AYAH peers because of care‐related demands affecting schooling, exams and graduation. However, adolescents demonstrate a capacity to overcome anticipated stigma and protect themselves by selectively disclosing HIV status to trusted peers and caregivers, as they develop a sense of agency concomitant with this life stage. Older adolescents showed greater ability to seek out supportive relationships than younger ones who relied on adult caregivers to facilitate this support.ConclusionsSchool is a potential site of HIV stigma and also a setting for learning how to resist such stigma. School‐going adolescents should be supported to identify helpful peers and selectively disclose serostatus as they master decision making about when and where to take medications, and who should know. Stigma is avoided by fewer visits to the clinic; providers should consider longer refills, discreet packaging and long‐acting, injectable ART for students.
Tackling structural stigma: a systems perspective
Authors: Brown Graham , Reeders Daniel , Cogle Aaron , Allan Brent , Howard Chris , Rule John , Chong Susan , Gleeson Deborah 
Published: July 2022

AbstractIntroductionStructural stigma in the global HIV response is a “moving target” that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present findings from a study adopting a systems perspective to understand how to tackle structural stigma via the Meaningful Involvement of People with HIV/AIDS (MIPA), while highlighting the challenges in demonstrating peer leadership from people living with HIV (PLHIV).MethodsThrough a long‐term ongoing community‐research collaboration (2015–2023), the study applied systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organizations. We used hypothetical narratives, affinity methods and causal loop diagrams to co‐create system maps that visualize the factors that influence the extent to which peer leadership is expected, respected, sought‐out and funded in the Australian context. We then developed draft indicators of what we should see happening when PLHIV peer leadership and MIPA is enabled to challenge structural stigma.ResultsParticipants in the collaboration identified the interactions at a system level, which can enable or constrain the quality and influence of PLHIV peer leadership. Participants identified that effective peer leadership is itself affected by structural stigma, and peer leaders and the programmes that support and enable peer leadership must navigate a complex network of causal pathways and strategic pitfalls. Participants identified that indicators for effective PLHIV peer leadership in terms of engagement, alignment, adaptation and influence also required indicators for policy and service organizations to recognize their own system role to value and enable PLHIV peer leadership. Failing to strengthen and incorporate PLHIV leadership within broader systems of policy making and health service provision was identified as an example of structural stigma.ConclusionsIncorporating PLHIV leadership creates a virtuous cycle, because, as PLHIV voices are heard and trusted, the case for their inclusion only gets stronger. This paper argues that a systems perspective can help to guide the most productive leverage points for intervention to tackle structural stigma and promote effective PLHIV leadership.
Impact of the COVID‐19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic‐based data
Authors: McFall Allison M. , Menezes Neia Prata , Srikrishnan Aylur K. , Solomon Sunil S. , Anand Santhanam , Baishya Jiban J. , Lucas Gregory M. , Celentano David D. , Mehta Shruti H. 
Published: July 2022

AbstractIntroductionThe COVID‐19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource‐limited settings. We aimed to understand the pandemic's impact on HIV‐related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India.MethodsBeginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18‐month period covering 2 months preceding the pandemic (January–February 2020) and over the first and second COVID‐19 waves in India (March 2020–June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June–August 2020).ResultsOverall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre‐pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre‐pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre‐pandemic levels. Positivity then increased steadily, eventually becoming higher than pre‐pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing.ConclusionsThe COVID‐19 pandemic led to significant decreases in HIV‐related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV.
Hybrid fractional laser treatment for photodamaged facial skin rejuvenation 6 years following fractional CO2: Comparison of clinical outcome and patients' satisfaction
Authors: Fusano Marta , Bencini Pier Luca , Galimberti Michela Gianna 
Published: July 2022

AbstractObjectivesFractional carbon dioxide (CO2) laser resurfacing is considered an effective treatment for skin rejuvenation. The request for clinical effectiveness with shorter downtime has led to the development of new hybrid technologies, including a traditional Er:YAG (erbium‐doped yttrium aluminium garnet) fractional laser 2940 nm combined with a simultaneous nonablative 1470 nm wavelength. The aim of this study is to compare clinical outcomes and patients' satisfaction with face resurfacing performed with both the CO2 laser and the hybrid laser.MethodsNineteen women underwent ultrapulsed CO2 fractional resurfacing for photodamaged facial skin; the same patients underwent the hybrid laser after almost 6 years. Clinical outcomes and patients' satisfaction were evaluated 6 months after the treatment and compared between the two technologies.ResultsAfter both CO2 and hybrid treatment a significant improvement was found in terms of fine lines (p < 0.001 and p = 0.004, respectively), tactile roughness (p < 0.001 and p = 0.002, respectively), and mottled pigmentation (both p < 0.001). Healing times and complications were greater with the CO2 laser. Comparing the two technologies, patients showed better results with the CO2 laser for each score's item, but greater satisfaction with the hybrid laser (p = 0.012).ConclusionsThe present study confirms CO2 laser as the most effective treatment; however, the new hybrid technology revealed good results associated with faster healing and less discomfort.
Development of a mathematical formula and online tool to calculate the potential maximum flap width to allow for primary anterolateral thigh donor‐site closure in Caucasians
Authors: Thomas Benjamin , Cordts Tomke , Lange Willy , Falkner Florian , Haug Valentin , Aman Martin , Böcker Arne , Vollbach Felix , Gazyakan Emre , Harhaus Leila , Kneser Ulrich , Bigdeli Amir K. 
Published: July 2022

AbstractBackgroundPrimary anterolateral thigh (ALT) flap donor‐site closure is crucial to achieve patient satisfaction, avoid burdensome secondary surgeries, and avert poor outcomes. Only vague maximum flap width recommendations have been suggested, which fall short of acknowledging individual patient habitus and thigh morphology. Therefore, we aimed at identifying a user‐friendly preoperative calculation of maximum flap width for primary closure.MethodsA total of 429 ALT free flaps performed between 2009 and 2020 were analyzed. A total of 350 donor‐sites were closed primarily (82%) and 79 (18%) were split‐thickness skin‐grafted (STSG). Patient demographics including sex, age, and BMI, operative details, and flap characteristics were compared to assess their impact on the outcome variable. Receiver operating characteristic (ROC) curves were plotted for all significant predictors discriminating between closure and STSG. Areas under the curve (AUCs) were calculated for each parameter combination and optimal cutoffs were determined using Youden's Index.ResultsSex, age, BMI, and flap width alone were poor discriminators. Dividing flap width by BMI and logarithmized BMI yielded AUCs of 0.91 and 0.94, respectively. Including patient sex yielded the best fitting regression model (χ2 = 251.939, p < .0001) increasing the AUC to 0.96 (95% CI: 0.93–0.98, p < .0001). The optimal cutoff value discriminated between primary closure and STSG with 90% sensitivity and 89% specificity. An online calculator of patient‐individual maximum ALT width was then programmed.ConclusionsSex and BMI are reliable predictors of successful primary ALT donor‐site closure in Caucasians. We devised a novel formula for calculating patient‐individual maximum ALT widths preoperatively, predicting failure of primary closure with 90% sensitivity in our cohort, available at: https://kitteltaschenbuch.com/altwidth/calculate.htm
A questionnaire for physical findings of malnutrition when physical exams are not possible
Authors: Chizmar Lora , Lewis Sherri 
Published: July 2022

AbstractBackgroundWhen nutrition assessments must be performed virtually, such as during the coronavirus pandemic, it is difficult to fully assess patients for malnutrition without the ability to perform a nutrition‐focused physical exam. Practitioners may ask patients about their physical appearance, but there is currently no validated set of questions whose answers correlate with nutrition‐focused physical findings for the diagnosis of malnutrition in such situations. The aim of this study was to evaluate correlations between patients' responses to verbalized questions and physical signs of malnutrition.MethodsQuestions related to the physical findings of malnutrition were developed and evaluated for content validity. Thirty patients receiving nutrition assessments at an acute care veterans' hospital were asked the questions prior to a nutrition‐focused physical exam. Patients' responses were compared with a diagnosis of malnutrition and physical findings of muscle, fat, fluid accumulation, and handgrip strength.ResultsFour questions significantly correlated with malnutrition: “Does the area around your eyes appear sunken in?” (P = 0.03), “Are you able to see your ribs?” (P = 0.05), “Do you feel you are unusually skinny for you?” (P = 0.001), and “Do you find yourself eating less due to swelling in your belly?” (P = 0.008).ConclusionThere are relationships between patients' responses to certain verbalized questions and their physical status. Such questions can be used to identify physical signs of malnutrition when nutrition‐focused physical exams cannot be performed. Further research is needed to validate these questions in other populations.
A novel method for extracting circulating cell‐free DNA from whole blood samples and its utility in the non‐invasive prenatal test
Authors: Zhong Hongbin , Zeng Liuhong , Tao Mengyuan , Ye Yuchen , Wang Yanqi , Hou Lei , Wu Miaofeng , Liu Hui , Zhang Hongyun , Tang Meifang 
Published: July 2022

AbstractObjectiveWe verified a magnetic bead‐based, simple, and fast method for circulating cell‐free DNA (cfDNA) extraction from whole blood samples(CEWB) and characterised its utility in non‐invasive prenatal testing (NIPT).MethodWe extracted cfDNA from both plasma and whole blood of the patients using CEWB and compared it to that extracted using a Qiagen extraction kit; droplet digital polymerase chain reaction test was used to calculate the fragment size bias. In all, 304 samples were used for NIPT.ResultsThe CEWB group (mean ± standard deviation [SD]: 4.34 ± 0.41 ng/ml plasma) reported less DNA weight yield than the Qiagen group (4.90 ± 0.50 ng/ml plasma). There was no significant difference between the CEWB group and the Qiagen group in the gene fragments (136 bp: p = 0.064 and 420 bp: p = 0.534). In a parallel cohort study to characterise the utility of the CEWB method in NIPT, the treatment group extracted by CEWB showed a sensitivity of 100%, a specificity of 99.65%, and a positive predictive value of 95%.ConclusionsThis study demonstrated that CEWB achieves an acceptable yield of DNA without contamination from genomic DNA. Subsequent clinical experiments in a parallel cohort indicated its utility for NIPT.