Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis.

Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.

High levels of thyroid-stimulating hormone are associated with aortic wall thickness in the general population.

OBJECTIVES: Our aim was to investigate the association of thyroid function defined by serum concentrations of thyroid-stimulating hormone (TSH) with thoracic aortic wall thickness (AWT) as a marker of atherosclerotic processes. METHODS: We pooled data of 2,679 individuals from two independent population-based surveys of the Study of Health in Pomerania. Aortic diameter and AWT measurements were performed on a 1.5-T MRI scanner at the concentration of the right pulmonary artery displaying the ascending and the descending aorta. RESULTS: TSH, treated as continuous variable, was significantly associated with descending AWT (ß = 0.11; 95 % confidence interval (CI) 0.02-0.21), while the association with ascending AWT was not statistically significant (ß = 0.20; 95 % CI -0.01-0.21). High TSH (>3.29 mIU/L) was significantly associated with ascending (ß = 0.12; 95 % CI 0.02-0.23) but not with descending AWT (ß = 0.06; 95 % CI -0.04-0.16). There was no consistent association between TSH and aortic diameters. CONCLUSIONS: Our study demonstrated that AWT values increase with increasing serum TSH concentrations. Thus, a hypothyroid state may be indicative for aortic atherosclerosis. These results fit very well to the findings of previous studies pointing towards increased atherosclerotic risk in the hypothyroid state. KEY POINTS: • Serum TSH concentrations are positively associated with aortic wall thickness. • Serum TSH concentrations are not associated with the aortic diameters. • Serum 3,5-diiodothyronine concentrations may be positively associated with aortic wall thickness.

Thoracic and abdominal aortic diameters in a general population: MRI-based reference values and association with age and cardiovascular risk factors.

OBJECTIVES: To generate reference values for thoracic and abdominal aortic diameters determined by magnetic resonance imaging (MRI) and analyse their association with cardiovascular risk factors in the general population. METHODS: Data from participants (n = 1759) of the Study of Health in Pomerania were used for analysis in this study. MRI measurement of thoracic and abdominal aortic diameters was performed. Parameters for calculation of reference values according to age and sex analysis were provided. Multivariable linear regression models were used for determination of aortic diameter-related risk factors, including smoking, blood pressure (BP), high-density lipoprotein cholesterol (HDL-C). RESULTS: For the ascending aorta (ß = -0.049, p < 0.001), the aortic arch (ß = -0.061, p < 0.001) and the subphrenic aorta (ß = -0.018, p = 0.004), the body surface area (BSA)-adjusted diameters were lower in men. Multivariable-adjusted models revealed significant increases in BSA-adjusted diameters with age for all six aortic segments (p < 0.001). Consistent results for all segments were observed for the positive associations of diastolic BP (ß = 0.001; 0.004) and HDL (ß = 0.035; 0.087) with BSA-adjusted aortic diameters and for an inverse association of systolic BP (ß = -0.001). CONCLUSIONS: Some BSA-adjusted median aortic diameters are smaller in men than in women. All diameters increase with age, diastolic blood pressure and HDL-C and decrease as systolic BP increases. KEY POINTS: • Median aortic diameter increases with age and diastolic blood pressure. • Median aortic diameter is larger in men than in women. • Some BSA-adjusted median aortic diameters are smaller in men than in women.

Thoracic and abdominal aortic diameter measurement by MRI using plain axial volumetric interpolated breath-hold examination in epidemiologic research: a validation study.

RATIONALE AND OBJECTIVES: This study evaluates the validity and reliability of measuring the diameters of the thoracic and abdominal aorta from plain volumetric interpolated breath-hold examination (VIBE) images. MATERIALS AND METHODS: The study included 50 male subjects from the population-based Study of Health in Pomerania. They underwent imaging of the thoracic and abdominal aorta at 1.5 Tesla using a contrast-enhanced magnetic resonance angiography (CE-MRA) and plain VIBE sequence. Diameters were measured at five predefined anatomic sites from reformatted orthogonal CE-MRA images and axial plain VIBE images. The measurements were validated using Pearson correlation and Bland-Altman analysis. The Bland-Altman method was also used to assess reliability. RESULTS: Comparison of the diameters measured from CE-MRA and VIBE images revealed strong correlation for the ascending, descending, suprarenal, and infrarenal aorta with r = 0.95 (P < .0001), r = 0.88 (P < .0001), 0.92 (P < .0001), and 0.87 (P < .0001), respectively. Measurement for the aortic arch was moderately correlated with r = 0.78 (P < .0001). Mean bias did not exceed 0.1 cm (6%). The 95% limits of agreement (LOA) were less than 0.5 cm (15%). Intra- and interobserver agreement showed a mean bias of less than 2%; the 95% LOA were less than 11%. CONCLUSIONS: Axial measurement of the diameters of the thoracic and abdominal aorta using a plain axial VIBE sequence is highly valid and reliable, making it suitable for use in epidemiologic research.