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OBJECTIVE: People living with HIV have an increased risk of heart failure (HF). There are different subtypes of HF. Knowledge about the factors differentiating HF subtypes in people with HIV is limited but necessary to guide preventive measures and treatment. METHODS: A retrospective review of medical records was undertaken in people with HIV aged ≥18 years who received care at the University of Miami/Jackson Memorial HIV Clinic between January 2017 and November 2019 (N = 1166). Patients with an echocardiogram available for review (n = 305) were included. HF was defined as a documented diagnosis of any HF subtype (n = 52). We stratified those with HF by their ejection fraction (EF) into HF with preserved EF (HFpEF), HF with borderline EF, or HF with reduced EF (HFrEF). RESULTS: The prevalence of HF was 4.5%. The cohort included 46.2% females and 75% self-identified African Americans. Those with HF had a higher prevalence of hypertension, prior myocardial infarction, angina, coronary artery disease, percutaneous coronary intervention, coronary artery bypass grafting, diastolic dysfunction, and left ventricle hypertrophy. People with HIV with HF with borderline EF exhibited more coronary artery disease than those with HFpEF. CONCLUSIONS: We characterize HF in people with HIV in South Florida and report the prevalence of HF and HF subtypes. Only a small percentage of patients had echocardiograms performed, suggesting an ongoing need for recognition of the increased risk of HF in people living with HIV, and raising the concern about lack of awareness contributing to underdiagnosis and missed treatment opportunities in this population.
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The syndemic theoretical framework has been used in health disparities research to explain several co-occurring epidemics, particularly in populations facing disparate health conditions. A prominent example of this is seen in Singer's Substance Abuse, Violence and HIV/AIDS (SAVA) syndemic theory. However, even though numerous studies support some of the theoretical underpinnings of the SAVA syndemic, the empirical applications of the theory remain methodologically underdeveloped. The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), to present the state of the science of methodologies examining SAVA constructs using the syndemic framework. Seven bibliographic databases were searched with no language or date restrictions. Studies were synthesized by author, year of publication, study location, total sample size, study population, SAVA outcomes, analytic method of SAVA measurement, intervention type, level of influence, disease interaction and concentration, main findings of the study, and possible future areas of research. Our search yielded a total of 967 articles, and 123 were included in the review. Methodologic and statistical innovation is needed to elevate the impact of syndemic theory for elucidating the synergistic effects of determinants leading to health disparities.
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Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Humanos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/epidemiologia , Sindemia , Violência , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
The current cross-sectional study examined the effect of coronavirus disease 2019 (COVID-19) household isolation on household conflict and cohesion in one-, two-, and three-generation households with older adults (aged ≥65 years). Participants were 757 adults (aged ≥18 years) with at least one older adult in their household. Respondents were from 51 countries. Study variables were measured with the COVID-19 Household Environmental Scale. Non-parametric tests were used to assess differences between groups. Most participants (n = 437, 57.7%) lived in three-generation homes. Three-generation homes reported greater increases in conflict (p < 0.001) and cohesion (p < 0.001) during household isolation compared to oneand two-generation homes. Findings suggest that older adults living in multigenerational households experienced more cohesive and conflictive household environments as a function of the COVID-19 pandemic. Further research should explore how family or health care interventions could better support older adults and families as a unit of care to avoid adverse outcomes and boost resilience. [Journal of Gerontological Nursing, 49(4), 47-56.].
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COVID-19 , Humanos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Características da FamíliaRESUMO
INTRODUCTION: Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high-impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. DISCUSSION: A group of IS experts affiliated with NIMH-funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH-related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence-based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. CONCLUSIONS: HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high-impact HIV/MH implementation research.
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Infecções por HIV , Ciência da Implementação , Humanos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Estados Unidos/epidemiologia , Saúde Mental , National Institute of Mental Health (U.S.)RESUMO
Introduction: The COVID-19 pandemic has dramatically altered the functioning of households. Because of the vulnerability of high-risk groups, such as older adults and people with compromised immune systems, households caring for these vulnerable adults may be facing elevated levels of caregiving-related stress and burden. The current study sought to examine the impact of the pandemic on conflict and cohesion in households with adults requiring caregiving versus noncaregiving households. Methods: Respondent demographic, household level, and family functioning data were collected anonymously from an international sample (N = 4,241). Responses were examined using descriptive and bivariate analyses. Results: Overall, respondents in caregiving households (n = 667) reported a significantly greater negative impact of social distancing on their family functioning, with greater increase in conflict than nonadult caregiving households (n = 3,574). Significantly more caregiving households also reported that someone had stopped working due to the pandemic. No differences were observed for cohesion between the two groups, with both reporting a little bit more cohesion when compared with the period before social distancing. Conclusions: Our findings add to a body of literature demonstrating that caregiving families experience greater disruption and strain during disaster situations such as the COVID-19 pandemic. Future research is needed to establish the causality of the collected proximal factors, such as job loss and education, with pandemic related family functioning among homes caring for adults, and examining the impact of contextual factors, such as level of caregiving need and caregiving support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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COVID-19 , Pandemias , Idoso , Características da Família , Humanos , SARS-CoV-2RESUMO
The COVID-19 pandemic is a worldwide event that has exacerbated stress and caused significant disruptions in the day-to-day living of families. Of particular concern are socially vulnerable families, which have felt the impacts of the pandemic most acutely. Because stress can alter family dynamics, it is important to understand which stressors impact families the most, and what resources can be leveraged to strengthen family functioning. The current study examined the impacts of COVID-19 on the conflict and cohesion of households with children compared to households without children. Additionally, we sought to assess how conflict and cohesion are related to social vulnerabilities in the context of the pandemic. Using an international sample, we analyzed responses to the COVID-19 Household Environment Scale (N = 4122) using descriptive and bivariate analyses. Latent class analysis was used to identify patterns of family functioning in households with and without children. We found that social vulnerability was associated with more disrupted family functioning, and that households with children (n = 2666) reported less disrupted family functioning when compared to households without children (n = 1456), despite having higher social vulnerability scores. Our exploratory latent class analysis identified a 5-class model among both subgroups. Conflict, cohesion, family functioning and social vulnerability varied significantly by subgroup and class membership. Our findings add to a body of evidence that argues that despite facing greater vulnerability, households with children have many strengths to draw from. Family interventions that help to promote family cohesion and conflict resolution can foster resilience in stressful circumstances.