HIV, STI and Behavioral Risk Among Men Who have Sex with Men in a Setting of Elevated HIV Prevalence Along Ecuador's Pacific Coast.

We assessed HIV and STI prevalence, risk behaviors and factors associated with HIV infection in men who have sex with men (MSM) in Guayaquil, Ecuador. Respondent-driven sampling was used to recruit 400 MSM in 2011-2012. Participants completed a computer-assisted self-interview and provided blood samples. Statistical analysis accounted for differential probability of selection and for recruitment patterns. HIV prevalence was 11.3 %, HSV-2 30.2 %, active syphilis 6.9 % and hepatitis B 1.2 %. In the previous 12 months, 84 % of MSM reported casual male sex partners and 25 % sex work. Only 48 % of MSM consistently used condoms with male partners and 54 % had ever been tested for HIV. Of 17 % of MSM reporting a female partner, consistent condom use was 6 %. HIV infection was associated with age 25 or older, active syphilis and homosexual self-identification. Findings suggest continuing HIV risk and a need to strengthen prevention and testing among MSM.

A continuing HIV epidemic and differential patterns of HIV-STI risk among MSM in Quito, Ecuador: an urgent need to scale up HIV testing and prevention.

This study characterized the HIV epidemic among men who have sex with men (MSM) in Quito, Ecuador and contrasted risk patterns with other STI's. 416 MSM ages 15 years and older were recruited using respondent-driven sampling in 2010-2011. Biological testing and a self-interview survey assessed HIV and STI infections and risk behaviors. Analysis incorporated recruiter-level variables and clustering adjustments to control for recruitment patterns. We identify high levels of HIV (11 %), HSV-2 (14 %) and active syphilis (5.5 %) infections, low levels of lifetime HIV testing (57 %), limited knowledge of HIV and STI's (<48 %) and limited consistent condom use independent of partner type (<40 %). Sex work was associated with all infections while associations with residential location, how casual partners are met and other variables, varied. Scale-up of behavioral prevention and HIV testing is urgently needed. Interventions should target male sex workers and exploit differential patterns of HIV-STI risk to stay ahead of the epidemic.

Racial similarities in response to standardized offer of influenza vaccination. A MetroNet study.

BACKGROUND: Despite known benefits of influenza vaccination and coverage by Medicare Part B, elderly minority patients are less likely to receive influenza vaccination than whites. OBJECTIVES: To test whether a nonphysician-initiated standardized offer of influenza vaccination to all elderly primary care patients would result in similar proportions of African-American and white patients accepting vaccine. DESIGN: In 7 metropolitan Detroit primary care practices during the 2003 influenza vaccination season, medical assistants assessed influenza immunization status of all patients 65 years and older and collected limited demographic data. Eligible patients were offered vaccination. MEASUREMENTS: Proportion of patients accepting influenza vaccination by race and predictors of vaccine acceptance. RESULTS: Four hundred and fifty-four eligible patients with complete racial information were enrolled: 40% African American, 52% white, 8% other race/ethnicity. Similar proportions of African Americans and whites had already received the 2003 vaccine (11.6% and 11.0%, respectively) or stated vaccination as the reason for visit (23.8% and 30.5%, respectively). Among the remainder, there also were similar proportions who accepted vaccination: 68.9% white and 62.1% African-American patients. History of previous vaccination was the only statistically significant predictor of vaccine acceptance (odds ratio [OR] 8.64, 95% confidence interval [CI] 4.17, 17.91, P<.001). After adjusting for history of previous vaccination, age, gender, and education, the odds of vaccine acceptance were no different for whites and African Americans (OR 1.20, 95% CI 0.63, 2.29, P=.57). CONCLUSIONS: Vaccination acceptance differed little between African-American and white elderly patients. Using nonphysician personnel to identify and offer influenza vaccine to eligible patients is easily accomplished in primary care offices and has the potential to eliminate racial disparities in influenza vaccination.

Intervención fonoaudiológica en quemados: relato de un caso en el Hospital de Urgencia Asistencia Pública, Chile / Speech Language Pathologist intervention in burns: a case report of Hospital de Urgencia Asistencia Pública, Chile / Intervenção fonoaudiológica em queimados: relato de caso no Hospital de Urgencia Asistencia Pública, Chile

Introducción: En la área de fonoaudiología, una quemadura puede producir secuelas en deglución, comunicación (habla y voz) y motricidad orofacial. La inclusión del fonoaudiólogo en el trabajo con quemados ha sido paulatina y con escasa evidencia científica. El objetivo fue describir la intervención fonoaudiológica en un paciente adulto gran quemado internado en la UCI del Hospital de Urgencia Asistencia Pública (HUAP) en Santiago de Chile. Presentación del caso: Paciente masculino de 44 años, con intento de autolisis, 53% de superficie corporal quemada por fuego, con quemadura orofacial e injuria inhalatoria. Resultados: La evaluación fonoaudiológica evidenció trastorno deglutorio, vocal y de la motricidad orofacial. Posteriormente se inició terapia en estas tres áreas. Luego de dos meses, al momento del alta, paciente recuperó en su totalidad función deglutoria y vocal, con mínimas secuelas en motricidad orofacial. Conclusión: La intervención fonoaudiológica precoz favorece la recuperación de la persona quemada y ayuda a disminuir las secuelas posteriores. Es fundamental la inclusión de este profesional en el equipo de rehabilitación del paciente quemado, tanto a nivel nacional como internacional

Introdução: Na área da fonoaudiologia, uma queimadura, uma queimadura pode produzir sequelas na deglutição, comunicação (fala e voz) e motricidade orofacial. A inclusão do fonoaudiólogo no trabalho com queimados tem sido paulatina e com escassa evidência científica. O objetivo foi descrever a intervenção fonoaudiológica em um paciente adulto grande queimado internado na unidade de terapia intensiva do Hospital de Urgencia Asistencia Pública (HUAP), em Santiago do Chile. Relato do caso: paciente, do sexo masculinho, com 44 anos de idade, com tentativa de autoextermínio, 53% da superfície corporal queimada por fogo, com queimadura orofacial e lesão inalatória. Resultados: Avaliação fonoaudiológica evidenciou alteração na deglutição, vocal e da motricidade orofacial. Foi iniciada terapia nestas três áreas. Após dois meses, na alta hospitalar, o paciente recuperou em totalidade sua função deglutativa e vocal, com mínimas sequelas em motricidade orofacial. Conclusão: A intervenção fonoaudiológica precoce favorece a recuperação da pessoa queimada e ajudana diminuição as sequelas posteriores. Torna-se fundamental a inclusão deste profissional na equipe de reabilitação ao paciente queimado, tanto em nível nacional como internacional.

Introduction: Burns can produce Speech-Language Pathology disorders which can include difficulty in swallowing, communication (speech and voice) and orofacial motricity. The inclusion of speech therapist in burn people intervention has been gradual and with limited scientific evidence. The aim was to describe the speech-language intervention in a adult burn interned in the ICU of Hospital de Urgencia Asistencia Pública (HUAP) in Santiago, Chile. Case report: 444-year old male patient, due to attempt suicide, 53% of body surface burned by fire, with orofacial burn and inhalation injury. Results: A speech-language assessment revealed swallowing, voice and orofacial motricity disorders. Subsequently, therapy was started in these three areas. After two months, at discharge, the patient recovered his entirety deglutory and vocal function, with minimal sequelae in orofacial motricity. Conclusion: Early speech therapy favors the recovery of the burned person and helps to reduce subsequent sequelae. It is fundamental the inclusion of this professional in the burn patient rehabilitation team, both nationally and internationally.