SARS-CoV-2 infection during pregnancy: clinical characteristics and vertical transmission in a referral hospital in Peru. / Infección por SARS-CoV-2 en el embarazo: características clínicas y trasmisión vertical en un hospital de referencia de Perú.

Motivation for the study. There is a gap in knowledge about vertical transmission of SARS- CoV-2 and its implications for maternal and neonatal health, despite evidence of multisystem involvement in pregnant women with COVID-19. Main findings. The study results suggest low incidence of vertical transmission during pregnancy, with only one PCR-positive case in the placenta and one asymptomatic neonate. Implications. Our results can inform strategies for prevention and management of COVID-19 in pregnant women, as well as guide the development of health policies aimed at protecting maternal and neonatal health during the pandemic. The aim of this study was to analyze the vertical transmission of SARS-CoV-2 in pregnant women with COVID-19 in the Gynecology and Obstetrics Department of the Edgardo Rebagliati Martins National Hospital (HNERM). Twelve pregnant women who met the inclusion criteria were included. Real-time PCR (RT-PCR) tests for SARS-CoV-2 were performed when each woman was admitted to the hospital, placenta samples were collected for pathological evaluation as well. The results showed that vertical transmission of the virus was rare, with an overall low positivity rate in newborns. Although the study has limitations, such as the small number of cases and the lack of electron microscope analysis, it is the first attempt to evaluate vertical transmission in Peru. It is concluded that more research is needed to better understand the relationship between COVID-19 infection and complications during pregnancy.

Se realizó un estudio en el departamento de Ginecología y Obstetricia del Hospital Nacional Edgardo Rebagliati Martins (HNERM) con el objetivo analizar la transmisión vertical del SARS-CoV-2 en mujeres embarazadas con COVID-19. Se incluyeron 12 gestantes que cumplían con los criterios de inclusión. Se realizaron pruebas diagnósticas de PCR en tiempo real (RT-PCR) para SARS-CoV-2 durante la admisión de cada gestante y se recolectaron muestras de placenta para su evaluación anatomopatológica. Los resultados mostraron que la transmisión vertical del virus fue poco común, con una tasa general de positividad baja en los recién nacidos. Aunque el estudio presenta limitaciones, como el número reducido de casos y la falta de análisis con microscopio electrónico, constituye el primer intento en Perú de evaluar la transmisión vertical. Se concluye que se necesita más investigación para comprender mejor la relación entre la infección por la COVID-19 y las complicaciones durante el embarazo. Motivación para realizar el estudio. A pesar de la evidencia de una afectación multisistémica en mujeres embarazadas con la COVID-19, existe un vacío de conocimiento sobre la transmisión vertical del virus y sus implicancias en la salud materna y neonatal. Principales hallazgos. Los resultados del estudio sugieren una baja incidencia de transmisión vertical durante el embarazo, con solo un caso positivo de PCR en la placenta y un neonato asintomático. Implicancias. Este resultado pueden informar las estrategias de prevención y manejo de la COVID-19 en mujeres embarazadas, así como guiar el desarrollo de políticas sanitarias dirigidas a proteger la salud materna y neonatal durante la pandemia.

Infección por SARS-CoV-2 en el embarazo: características clínicas y trasmisión vertical en un hospital de referencia de Perú / SARS-CoV-2 infection in pregnancy: clinical characteristics and vertical transmission in a reference hospital in Peru

Se realizó un estudio en el departamento de Ginecología y Obstetricia del Hospital Nacional Edgardo Re-bagliati Martins (HNERM) con el objetivo analizar la transmisión vertical del SARS-CoV-2 en mujeres embarazadas con COVID-19. Se incluyeron 12 gestantes que cumplían con los criterios de inclusión. Se realizaron pruebas diagnósticas de PCR en tiempo real (RT-PCR) para SARS-CoV-2 durante la admi-sión de cada gestante y se recolectaron muestras de placenta para su evaluación anatomopatológica. Los resultados mostraron que la transmisión vertical del virus fue poco común, con una tasa general de posi-tividad baja en los recién nacidos. Aunque el estudio presenta limitaciones, como el número reducido de casos y la falta de análisis con microscopio electrónico, constituye el primer intento en Perú de evaluar la transmisión vertical. Se concluye que se necesita más investigación para comprender mejor la relación entre la infección por la COVID-19 y las complicaciones durante el embarazo.

Longitudinal Examination of an Ethnic Paradox of Stress and Mental Health in Older Black and Latinx Adults.

OBJECTIVES: To explain the ethnic paradox of mental health in aging, we evaluated whether Black and Latinx older adults experience (1) fewer depressive symptoms (DepSx), but more physical problems, and (2) greater psychological resilience as a result of life stressors than White older adults. METHODS: DepSx, physical health, and recent stress were obtained biennially from 25,893 older adults (77% White, 15% Black, 9% Latinx) in the U.S. Health and Retirement Study, across 16 years. Psychological resilience, lifetime stress, and discrimination experiences were available for 13,655 individuals. We conducted mixed-effects and linear regression analyses. RESULTS: For Blacks and Latinxs, experiencing more-than-usual stress events was associated with less increase in DepSx compared to Whites, although on average Blacks and Latinxs experience more DepSx. Black adults showed worse physical health than White adults and weaker effects of stress on psychological resilience despite experiencing more stress of all types. Findings were mixed for Latinxs. CONCLUSIONS: Studying effects of time-varying stress on changes in health and multiple stressors on psychological resilience by race/ethnicity elucidates mechanisms for later-age health disparities. CLINICAL IMPLICATIONS: Cross-sectional evaluations of stress and psychological health in a clinical setting may provide incomplete appraisals of health risks for Black and Latinx older Americans.

Acceptability of a Tenofovir Disoproxil Fumarate Intravaginal Ring for HIV Pre-Exposure Prophylaxis Among Sexually Active Women.

INTRODUCTION: Vaginal ring delivery of antiretroviral drugs may provide protection against acquisition of HIV-1 when used as Pre-Exposure prophylaxis. As part of a randomized placebo-controlled safety trial of a tenofovir disoproxil fumarate (TDF) intravaginal ring (IVR), we assessed product acceptability through surveys of women after continuous ring use. METHODS: Sexually active, HIV-negative women were enrolled to investigate the safety and pharmacokinetics of 3 months of continuous TDF IVR use. The study was designed to include 40 US participants randomly assigned (3:1) to a TDF or placebo IVR. Twelve were randomized to TDF and 5 to the placebo group before the study was electively discontinued because of the development of vaginal ulcerations in 8 women in the TDF group. Acceptability data were gathered via self-administered, computer-based questionnaires. RESULTS: The average age of the 17 participants was 31 years (range, 18-42 years). Sixteen participants (94%) completed all questions at 2 study visits. When asked about ring likeability after 1 month of ring use, 12 (75%) of 16 reported overall liking the ring, including 6 (75%) of 8 who developed ulcerations. In addition, 10 (83%) of 12 who had their menses during the first month of ring use were not bothered by the ring, and 11 (69%) of 16 stated that the ring was not bothersome with use during sex. CONCLUSIONS: Despite unanticipated ulcers, TDF and placebo IVRs were acceptable to some women, even when used with menses and during sex, which is promising for continued development of IVRs for HIV prevention.

Tenofovir disoproxil fumarate intravaginal ring for HIV pre-exposure prophylaxis in sexually active women: a phase 1, single-blind, randomised, controlled trial.

BACKGROUND: An intravaginal ring that releases the tenofovir prodrug, tenofovir disoproxil fumarate, provided 100% protection in macaques against simian HIV and was safe in a 14-day clinical trial in sexually abstinent women. We aimed to assess the safety and pharmacokinetics of this intravaginal ring over 90 days in sexually active women. METHODS: We did a phase 1, single-blind, randomised, placebo-controlled trial to assess safety, pharmacokinetics, and acceptability of a tenofovir disoproxil fumarate intravaginal ring used continuously with monthly ring changes for 3 months. Sexually active women who were HIV negative were randomly assigned (3:1) to a tenofovir disoproxil fumarate ring or placebo ring. Primary safety endpoint was the proportion of women who had grade 2 or higher genitourinary adverse events judged related to study product and any grade 2 or higher adverse event as defined by the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events. We quantified tenofovir disoproxil fumarate and tenofovir concentrations in cervicovaginal fluid, tenofovir in plasma, and tenofovir diphosphate, the active metabolite, in cervical tissue and dried blood spots 1 month after each ring insertion. We compared changes over time in cervicovaginal fluid cytokine and chemokine concentrations and vaginal microbiota. The study was electively stopped early and is registered with ClinicalTrials.gov, number NCT02762617. FINDINGS: Between Feb 24 and July 20, 2017, 17 women were enrolled before study termination. 12 were assigned to receive the tenofovir disoproxil fumarate ring and five were assigned to receive the placebo ring. Two participants in the tenofovir disoproxil fumarate ring group completed 3 months of continuous ring use; eight were asked to discontinue ring use early because of ulcerations (grade 1) near the ring; in the remaining two women, rings were electively removed by study staff on day 20 and day 23. Ulcers were detected a mean of 32 days after ring use (range 23-56). Four of eight participants with ulcers were symptomatic with vaginal discharge; four had ulcers identified when examined; three had two ulcers; all ulcers resolved after ring removal. No participants in the placebo group developed ulcers. No grade 2 product-related adverse events were reported in either group and four non-product-related grade 2 adverse events were reported in the tenofovir disoproxil fumarate ring group. Cervicovaginal fluid tenofovir concentrations did not differ at day 14 (p=0·14) comparing the eight patients who did (median 1·0 × 105 ng/mL [IQR 9·1 × 104-1·1 × 105]) with the four who did not (6·0 × 104 ng/mL [5·6 × 104-1·1 × 105]) develop ulcers. No significant changes in vaginal microbiota were detected in either group. Concentrations of multiple inflammatory cytokines and chemokines were significantly higher at days 14 and 28 compared with baseline in the tenofovir disoproxil fumarate ring group but not the placebo group. INTERPRETATION: Future studies are needed to establish whether the unanticipated finding of ulcerations is specific to this tenofovir disoproxil fumarate ring or generalisable to other sustained topical release formulations of tenofovir or its prodrugs. FUNDING: National Institutes of Health.

Impact of Herpes Simplex Virus Type 2 and Human Immunodeficiency Virus Dual Infection on Female Genital Tract Mucosal Immunity and the Vaginal Microbiome.

BACKGROUND: Mechanisms linking herpes simplex virus type 2 (HSV-2) with human immunodeficiency virus (HIV) are not fully defined. We tested the hypothesis that HSV-2 and HIV dual infection is associated with cervicovaginal inflammation and/or vaginal dysbiosis. METHODS: Genital tract samples were obtained weekly over a 12-week period from 30 women seropositive (+) for HIV and HSV-2 and 15 women each who were seropositive for one or seronegative (-) for both viruses. Immune mediators, antimicrobial activity, and microbial composition and diversity were compared. RESULTS: Significant differences in the concentrations of interferon-γ (P = .002), tumor necrosis factor-α (P = .03), human beta defensin 1 (P = .001), secretory leukocyte protease inhibitor (P = .01), and lysozyme (P = .03) were observed across the 4 groups (Kruskal-Wallis). There were also significant differences in vaginal microbial alpha diversity (Simpson index) (P = .0046). Specifically, when comparing HIV-1+/HSV-2+ to HIV-1-/HSV-2- women, a decrease in Lactobacillus crispatus and increase in diverse anaerobes was observed. The number of genital HSV outbreaks was greater in HIV+ versus HIV- women (39 versus 12) (P = .04), but there were no significant differences when comparing outbreak to non-outbreak visits. CONCLUSIONS: Increased microbial diversity and cervicovaginal inflammation in HIV and HSV-2 dually infected women may adversely impact genital health and, in the absence of antiretroviral therapy, facilitate HIV shedding.

Adolescent Substance Use and Sensation-Seeking on Sexual Behaviors Among Young Adults from Continuation High Schools.

BACKGROUND: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. OBJECTIVE: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. METHODS: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. RESULTS: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. Conclusions/Importance: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.

Role of Interleukin 32 in Human Immunodeficiency Virus Reactivation and Its Link to Human Immunodeficiency Virus-Herpes Simplex Virus Coinfection.

Background: Herpes simplex virus type 2 (HSV-2; herpes) exacerbates human immunodeficiency virus type 1 (HIV) by unclear mechanisms. These studies tested the impact of HSV-2 on systemic T-cells and HIV reservoirs. Methods: Peripheral blood mononuclear cells from HIV-infected women on antiretroviral therapy who were HSV-2 seropositive or seronegative and HIV-uninfected controls were analyzed by flow cytometry. Cell-associated HIV DNA and RNA were quantified in the absence or presence of activating stimuli, recombinant interleukin 32γ (IL-32γ), and a RUNX1 inhibitor. RNA was assessed by nanostring. Results: CD4, but not CD8, T-cell phenotypes differed in HIV+/HSV-2+ versus HIV+/HSV-2- (overall P = .002) with increased frequency of CCR5+, CXCR4+, PD-1+, and CD69+ and decreased frequency of CCR10+ and CCR6+ T-cells. The changes were associated with higher HIV DNA. Paradoxically, IL-32, a proinflammatory cytokine, was lower in subpopulations of CD4+ T-cells in HSV-2+ versus HSV-2- women. Recombinant IL-32γ blocked HIV reactivation in CD4+ T-cells and was associated with an increase in RUNX1 expression; the blockade was overcome by a RUNX1 inhibitor. Conclusions: Herpes is associated with phenotypic changes in CD4+ T-cells, including a decrease in IL-32, which may contribute to increased HIV reservoirs. Blocking IL-32 may facilitate HIV reactivation to improve shock and kill strategies.

Longitudinal Assessment of Systemic and Genital Tract Inflammatory Markers and Endogenous Genital Tract E. coli Inhibitory Activity in HIV-Infected and Uninfected Women.

PROBLEM: Stability over time of systemic and mucosal immunity and their associations with bacterial vaginosis (BV) and HIV-specific parameters were assessed. METHOD OF STUDY: Immune mediators and HIV viral load in plasma and cervicovaginal lavage (CVL), E. coli inhibition, and Nugent score were measured at three semiannual visits among 94 participants in the Women's Interagency HIV Study. Mixed models identified the factors associated with immune mediators. RESULTS: There was higher E. coli inhibition and lower inflammation over time in the genital tract and systemically. BV was consistently associated with higher CVL inflammatory mediators and lower CVL E. coli inhibition. HIV-infected women with higher CD4 counts had lower systemic and genital inflammatory mediators, and genital HIV shedding was associated with higher CVL inflammatory mediators. Use of antiretroviral therapy (ART) was associated with lower plasma and CVL mediators, but higher E. coli inhibition. CONCLUSION: HIV and BV are linked to inflammation, and ART may be associated with improved vaginal health.

A phase 1 randomized placebo-controlled safety and pharmacokinetic trial of a tenofovir disoproxil fumarate vaginal ring.

BACKGROUND: Tenofovir disoproxil fumarate (TDF), a prodrug of tenofovir (TFV), may be ideal for topical HIV preexposure prophylaxis because it has higher tissue and cell permeability than TFV; is not adversely impacted by seminal proteins; and its active metabolite, TFV-diphosphate (TFV-DP), has a long intracellular half-life. We engineered a TDF eluting polyurethane reservoir intravaginal ring (IVR) to provide near constant mucosal antiretroviral concentrations. METHODS: A first-in-human randomized placebo-controlled trial was conducted to assess the safety and pharmacokinetics of the TDF IVR in healthy, sexually abstinent women (15 TDF and 15 placebo). Drug concentrations were measured in cervicovaginal fluid (CVF) obtained by swab, cervical tissue, plasma, and dried blood spots (DBS) over 14 days of continuous ring use. RESULTS: There were 43 total, 23 reproductive tract, and eight product-related grade 1 adverse events. Steady-state CVF TFV concentrations were achieved proximal (vagina, ectocervix) and distal (introitus) to the TDF IVR 1 day after ring insertion. Median tissue TFV-DP concentrations 14 days after TDF IVR placement were 120 fmol/mg (interquartile range 90, 550). CVF collected from the cervix 1 week and 2 weeks after TDF IVR insertion provided significant protection against ex-vivo HIV challenge. Eleven of 14 (78%) participants had detectable TFV-DP DBS concentrations 14 days after TDF IVR placement, suggesting that DBS may provide a surrogate marker of adherence in future clinical trials. CONCLUSION: A TDF IVR is safe, well tolerated, and results in mucosal TFV concentrations that exceed those associated with HIV protection. The findings support further clinical evaluation of this TDF IVR.

Loss of Innate Host Defense Following Unprotected Vaginal Sex.

BACKGROUND: Multiple host defense mechanisms protect the female genital tract from pathogens, but the impact of sexual intercourse on defense is unknown. METHODS: As part of a hypothesis-generating study, 17 women provided cervicovaginal lavage (CVL) specimens at baseline (all had abstained from sexual intercourse, masturbation, and vaginal product use for 72 hours prior to screening), 2-6 hours and 10-14 hours after vaginal intercourse with a male condom, and 2-6 hours and 10-14 hours after vaginal intercourse without a male condom (5 visits total, including the baseline visit). Vaginal pH, concentrations of immune molecules, and antimicrobial activity at postcoital visits were compared to baseline values. RESULTS: Vaginal pH and the transforming growth factor ß1 level increased, but human beta-defensin 2 (HBD-2), HBD-3, and interleukin 8 levels decreased after unprotected sex. Median Escherichia coli inhibitory activity in CVL specimens decreased significantly from baseline at the visit 2-6 hours after unprotected sex (63% [range, -34% to 99%] vs 5% [range, -51% to 100%]; P = .02) and remained low at the visit 10-14 hours after unprotected sex (6% [range, -19% to 92%]; P = .02). Pooled human seminal plasma enhanced E. coli growth in vitro in a dose-dependent manner and, when added to CVL samples with high anti-E. coli activity, reversed the inhibition. CONCLUSIONS: Unprotected vaginal sex results in a reduction in endogenous anti-E. coli activity, which may reflect, in part, enhancement of bacterial growth by seminal plasma. This finding may contribute to the risk of E. coli vaginal colonization following sexual intercourse.

Evaluation of a Community Health Worker Intervention to Reduce HIV/AIDS Stigma and Increase HIV Testing Among Underserved Latinos in the Southwestern U.S.

OBJECTIVES: Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos. METHODS: An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200). RESULTS: From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively). CONCLUSION: Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities.

Engaging Community With Promotores de Salud to Support Infant Nutrition and Breastfeeding Among Latinas Residing in Los Angeles County: Salud con Hyland's.

The Salud con Hyland's Project: Comienzo Saludable, Familia Sana [Health With Hyland's Project: Healthy Start, Healthy Family],was developed to provide education and support to Latina mothers regarding healthy infant feeding practices and maternal health. The promotora-delivered intervention was comprised of two charlas (educational sessions) and a supplemental, culturally and linguistically relevant infant feeding and care rolling calendar. Results indicate that the intervention increased intention to breastfeed exclusively, as well as to delay infant initiation of solids by 5 to 6 months. Qualitative feedback identified barriers to maternal and child health education as well as highlighted several benefits of the intervention.

Evaluation of 3 approaches for assessing adherence to vaginal gel application in clinical trials.

BACKGROUND: Accurate measurement of adherence to product use is an ongoing challenge in microbicide trials. METHODS: We compared adherence estimates using 2 applicator tests (a dye stain assay [DSA] and an ultraviolet light assay [UVA]), the Wisebag (an applicator container that electronically tracks container openings), and self-reported adherence (ability, frequency, and percent missed doses). Healthy, HIV-negative, nonpregnant US women aged 23 to 45 years received a Wisebag and 32 applicators filled with placebo gel were instructed to insert 1 applicator daily for 30 days, returned the Wisebag and all applicators, and completed an exit interview. Emptied applicators were tested by UVA and then DSA, and scored by 2 blinded readers. Positive and negative controls were randomly included in applicator batches. RESULTS: Among 42 women enrolled, 39 completed the study. Both DSA and UVA yielded similar sensitivity (97% and 95%) and specificity (79% and 79%). Two participants had fully inoperable Wisebags, and 9 had partially inoperable Wisebags. The proportion of participants considered to have high adherence (≥80%) varied: 43% (Wisebag), 46% (UVA), 49% (DSA), and 62% to 82% (self-reports). For estimating high adherence, Wisebag had a sensitivity of 76% (95% confidence interval, 50%-93%) and a specificity of 85% (95% confidence interval, 62%-97%) compared with DSA. Although 28% of participants reported forgetting to open the Wisebag daily, 59% said that it helped them remember gel use. CONCLUSIONS: Dye stain assay and UVA performed similarly. Compared with these tests, self-reports overestimated and Wisebag underestimated adherence. Although Wisebag may encourage gel use, the applicator tests currently seem more useful for measuring use in clinical trials.

Developing the HIV workforce: a case study of a training model for inexperienced HIV providers.

HIV patients in a rural California community were inconsistently receiving optimum HIV care. A local primary care physician assumed the care of these patients and contacted an experienced HIV provider for assistance. This report describes a three-step onsite training program that was implemented and the ensuing successful patient outcomes.

Secondhand smoke exposure among Hispanics/Latinos living in multiunit housing: exploring barriers to new policies.

PURPOSE: Despite a high prevalence of voluntary home smoking bans and laws protecting Californians from exposure to secondhand smoke (SHS) in the workplace, many Hispanic/Latino (H/L) residents of multiunit housing (MUH) are potentially exposed to SHS from neighboring apartments. An advocacy/policy intervention was implemented to reduce tobacco-related health disparities by encouraging H/L living in MUH to implement voluntary policies that reduce exposure to SHS. This article presents findings from qualitative and quantitative data collected during development of the intervention, as well as preliminary results of the intervention. DESIGN, SETTING, AND SUBJECTS: MUH residents in Southern California participated in focus groups (n = 48), door-to-door surveys (n = 142), and a telephone survey (n = 409). MEASURES: Exposure to SHS, attitudes toward SHS, and attitudes toward policies restricting SHS in MUH were assessed. RESULTS: H/L MUH residents reported high levels of exposure to SHS and little ability to protect themselves and their families from SHS. Respondents expressed positive attitudes toward adopting antismoking policies in MUH, but they also feared retaliation by smokers. The cultural values of familismo, respeto, simpatía, and personalismo influenced their motivation to protect their families from SHS as well as their reluctance to ask their neighbors to refrain from smoking. Nonsmokers were more likely to favor complete indoor and outdoor smoking bans in MUH, whereas smokers were more likely to favor separate smoking areas. The Regale Salud advocacy/policy intervention, implemented to reduce SHS exposure, prompted the passage of seven voluntary policies in apartment complexes in Southern California to prevent smoking in MUH. CONCLUSIONS: H/L in California support voluntary policies, local ordinances, and state laws that prevent exposure to SHS in MUH, especially those that are consistent with H/L cultural values and norms for interpersonal communication.

Increasing HIV-related knowledge, communication, and testing intentions among Latinos: Protege tu Familia: Hazte la Prueba.

Latinos are less likely to be aware of their HIV seropositivity than African Americans and Whites. 'Protege tu Familia: Hazte la Prueba' is a culturally and linguistically-sensitive HIV/AIDS prevention and testing program targeting Latino families. Using community-based participatory research techniques, Spanish-speaking bicultural community health workers helped develop and then used an educational flip chart and materials to conduct outreach and HIV prevention education in diverse settings. The intervention was created to increase HIV/AIDS-related knowledge, to improve communication regarding sexual risk, and to augment intentions to use condoms and test for HIV. A secondary purpose was to decrease HIV-related stigma by improving knowledge about transmission and reducing homophobia. Participants demonstrated significant increases in HIV knowledge, intention to practice safer sex and communicate sexual risk to partner(s), and intention to test for HIV. Improvements were also found in self-reported comfort levels when interacting with and caring for the HIV positive, thus decreasing HIV/AIDS-related stigma.

Factores patogénicos del embarazo complicado por hipertensión arterial, en una población de Lima, 1991-2006 / Pregnancy complicated by arterial hypertension pathogenic factors, in Lima, Peru, 1991-2006

OBJETIVOS: Determinar los factores patogénicos del embarazo complicado por hipertensión arterial. DISEÑO: Estudio clínico retrospectivo. LUGAR: Hospital Nacional Docente Madre-Niño San Bartolomé, Lima. PARTICIPANTES: Gestantes con embarazos complicados por hipertensión arterial. INTERVENCIONES: Se empleó la información materno perinatal del Sistema Informático Perinatal (SIP) del hospital, desde enero 1991 hasta diciembre 2006, con el propósito de determinar la prevalencia del embarazo complicado por hipertensión arterial, establecer los factores asociados y describir su historia natural. PRINCIPALES MEDIDAS DE RESULTADOS: Prevalencia y factores condicionantes de la hipertensión arterial en el embarazo. RESULTADOS: La hipertensión arterial en el embarazo ocurrió con una prevalencia de 8,6 por ciento (8 506/98 956). La preeclampsia y eclampsia representaron el 95 por ciento (8 085/8 506), ocurriendo la preeclampsia en 8,5 por ciento y la eclampsia en0,11 por ciento de los embarazos. Fueron factores condicionantes de preeclampsia y eclampsia: 1) vascular(100 por ciento); 2) hereditario (82 por ciento); 3) social (62,9 por ciento); 4) malnutrición (39,4 por ciento); 5) anatómico (33 por ciento); 6) metabólico (30,6 por ciento); 7) emocional (16 por ciento); y, 8) infeccioso (4 por ciento). CONCLUSIONES: La prevalencia de la preeclampsia es mayor en la mujer nulípara y en la multípara con más de 3 hijos. La aparición del cuadro clínico de preeclampsia y/o eclampsia depende de la situación social de la mujer y, la severidad, de la edad gestacional en que aparece la enfermedad y de la existencia del daño en un órgano blanco en el compartimiento materno y/o fetal.

OBJECTIVES: To determine pregnancy complicated by arterial hypertension pathogenic factors. DESIGN: Retrospective clinical study. SETTING: Hospital Nacional Docente Madre-Niño San Bartolome, Lima.PARTICIPANTS: Women with pregnancies complicated by arterial hypertension. INTERVENTIONS: The hospital’s perinatal information technology system was reviewed from January 1991 through December 2006 in order to determine the prevalence of pregnancies complicated by arterial hypertension, to establish associated factors and describe its natural history. MAIN OUTCOME MEASURES: Pregnancy arterial hypertension prevalence and conditioning factors. RESULTS: Pregnancy arterial hypertension prevalence was 8,6 per cent (8 506/98 956). Preeclampsia and eclampsia represented 95 per cent (8 085/8 506) of these cases, preeclampsia prevalence was 8,5 per cent and eclampsia, 0,11 per cent. Preeclampsia and eclampsia conditioning factors were: 1) vascular (100 per cent); 2) hereditary (82per cent); 3) social (62,9 per cent); 4) malnutrition (39,4 per cent); 5) anatomical (33 per cent); 6) metabolic (30,6 per cent); 7) emotional (16 per cent); and, 8) infectious (4 per cent). CONCLUSIONS: Preeclampsia prevalence is higher in the nulliparous woman and in the multiparous mother with more than three children. Presence of clinical preeclampsia and/or eclampsia depends on the woman’s social situation, and severity, on gestational age and the existence of target organ harm in either maternal or fetal compartment.

Correlates of unprotected sex among adult heterosexual men living with HIV.

The correlates of unprotected sex among a sample of heterosexual men living with HIV (n = 121) were examined to determine whether patient characteristics can be used as a basis for tailoring safer sex counseling in the clinic setting. Potential correlates of self-reported unprotected oral sex (fellatio) and vaginal sex included participant demographics (e.g., age, ethnicity), disease status (CD4 counts, viral load, years since diagnosis), safer sex beliefs (e.g., condom attitudes), substance use, psychological characteristics (depressive symptoms, dispositional optimism and pessimism), and sex partner characteristics (main/casual partner, HIV status of partner, and duration of relationship). A series of logistic regression analyses were used to determine significant relationships. Correlates of reported levels of prior 3-month unprotected fellatio (24%) and vaginal (21%) sex were not associated with the type of relationship (main or casual) or perceived HIV serostatus of the partner (positive, negative, or unknown). Unprotected fellatio was positively associated with age and CD4 count and inversely associated with optimism and positive condom attitudes (all p's < 0.05). Unprotected vaginal sex was positively associated with duration of relationship and inversely associated with positive condom attitudes. Prevention efforts among sexually active adult heterosexual men living with HIV may benefit from focusing on improving attitudes towards condom use regardless of partner relationship status.

La privación social y afectiva de la madre se asocia a alteraciones anatómicas y funcionales en el feto y recién nacido / Social and emotial deprivation in the mother is associated with anatomical and functional alterations in the fetus and newborn

Objetivo: Demostrar que la privación social y afectiva en la madre se asocia a restricción del crecimiento fetal, muerte fetal, parto pretérmino, alteraciones anatómicas y funcionales en el feto y recién nacido. Materiales y Métodos: Estudio retrospectivo en el que se analizó la base de datos materno-perinatal del Hospital San Bartolomé. Se examinó tres grupos de gestantes con privación social y afectiva: 1) madres solteras (n=6561), 2) gestantes adolescentes con ausencia de control prenatal (n=2131) y 3) primigestas con talla menor de 160 cm (n=35722). Se comparó las complicaciones maternas y perinatales con las gestantes : 1) madres con unión estable (n=40629), 2) gestantes adolescentes con control prenatal (n=7644) y 3) primigestas con talla mayor de 159 cm (n=5264). Se empleó el odds ratio (OR) y el intervalo de confianza al 95 por ciento (IC). Resultados: Las madres solteras presentaron mayor riesgo de falla en la función placentaria (OR 1,92, IC95 por ciento 1,51-2,44), restricción del crecimiento fetal (OR 2,02, IC95 por ciento 1,45-2,82), rotura prematura de membranas fetales (OR 1,28, IC95 por ciento 1,00-1,63) comparadas con las madres con unión de pareja estable. Las gestantes adolescentes con ausencia de control prenatal presentaron mayor riesgo de muerte fetal (OR 2,89, CI95 por ciento 1,85-4,50), rotura prematura de membranas fetales (OR 1,38, CI95 por ciento 1,18-1,62), parto pretérmino (OR 1,63, CI95 por ciento 1,39-1,91), neonato pequeño para la edad (OR 1,25, IC95 por ciento 1,08-1,44), morbilidad neonatal (OR 1,23, IC95 por ciento 1,07-1,41), asfixia perinatal (OR 2,73, IC95 por ciento 1,33-5,58), neonato con Ápgar bajo en minuto 1 (OR 1,26, IC95 por ciento 1,05-1,52), dificultad respiratoria (OR 1,51, IC95 por ciento 1,10-2,06), sepsis neonatal (OR 1,54, IC95 por ciento 1,19-1,99), prematuridad (OR 1,50, IC95 por ciento 1,27-1,78), muerte neonatal (OR 2,56, IC95 por ciento 1,88-3,48) y muerte perinatal (OR 3,02, IC95 por cie...