Examining Factors Associated with Cannabis Use Among Sexual and Gender Minority and Cisgender Heterosexual Emerging Adults in California.

Purpose: We explored correlates of cannabis risk and examined differences between sexual and gender minority (SGM) and cisgender heterosexual emerging adults (ages 18-29) in California. Methods: We recruited 1491 participants aged 18-29 years for a cross-sectional online survey. Ordinal logistic regressions assessed associations between minority stress (discrimination and internalized homophobia [IH]), social support (perceived social support and lesbian, gay, bisexual, transgender, and queer+ [LGBTQ+] community connectedness), and cannabis risk scores (low, medium, and high risk of developing problems related to their cannabis use). We also explored differences in cannabis risk scores by sexual orientation and gender identity (SOGI). Results: Higher everyday discrimination scores were associated with increased odds of self-scoring in a higher cannabis risk range (adjusted odds ratio = 1.53, 95% confidence interval [CI] = 1.31-1.79). We found no significant associations for IH, LGBTQ+ community connectedness, or social support on cannabis risk scores. There were also no statistically significant differences by SOGI groups; however, SOGI did moderate the relationship between IH and cannabis risk score such that the slope for IH was 0.43 units higher for cisgender sexual minority women compared to cisgender sexual minority men (95% CI = 0.05-0.81). Conclusion: Our findings suggest that experiences of everyday discrimination are important contributors to developing cannabis-related problems and IH may have more pronounced effects for sexual minority women compared to sexual minority men. More research is needed to better understand risk and protective factors of cannabis risk to inform the development of culturally tailored interventions for SGM emerging adults.

"You'll Be Chased Away": Sources, Experiences, and Effects of Violence and Stigma among Gay and Bisexual Men in Kenya.

Gay and bisexual men in Kenya face extreme socio-political stigma which manifests in widespread violence and discrimination across socio-ecological levels. We conducted individual in-depth interviews with 60 gay and bisexual men in western and central Kenya. Interview transcripts were thematically analyzed using an inductive, phenomenological approach to qualitatively examine experiences of stigma and violence at the interpersonal and institutional levels. A total of seven primary themes and four sub-themes emerged from the data. At the interpersonal level, participants described stigma and violence from family, friends, and romantic/sexual partners with sub-themes for gay-baiting violence, blackmail, intimate partner violence, and commitment phobia. At the institutional level, participants described stigma and violence from religious, employment, educational, and healthcare institutions. This stigma and violence severely impacted the lives of participants including their mental health, physical health, sexual health, socioeconomic status, and ability to access health-promoting services. These data identify sources of stigma and describe how this stigma manifests in the everyday lives of gay and bisexual men in Kenya. Study findings and quotes from participants highlight the severity of violence, stigma, and discrimination faced by this community and emphasize the need for decriminalization of same-sex sexualities as well as interventions to support health and wellbeing.

Experiences of Violence and Mental Health Concerns Among Sexual and Gender Minority Adults in Western Kenya.

Purpose: Sexual and gender minority (SGM) populations throughout Kenya as well as other sub-Saharan African countries face systemic discrimination and substantial human rights violations, yet scant literature documents the potentially harmful mental health effects of these experiences. This study sought to understand the relationship among experiences of violence, social support, and mental health among SGM adults in Kenya. Methods: Members of a local LGBT community-based organization collected survey data in Western Kenya from October 2017 to April 2018, recruiting 527 SGM participants through an array of community outreach methods. Respondents in this cross-sectional study completed a survey regarding their mental health and other psychosocial factors. Multiple linear regression analyses were conducted to assess associations between experiences of violence (SGM violence and intimate partner violence [IPV]) and mental health outcomes (depressive symptoms and post-traumatic stress symptoms [PTSSs]) and to examine the potential moderating effect of social support on these relationships. Results: Relative to those who had never faced violence, participants who experienced IPV and/or violence based on their sexual orientation, gender identity, or gender expression (SGM violence) reported significantly higher levels of depressive symptoms and PTSSs. Emotional support was associated with lower levels of PTSSs. Social support did not moderate the relationship between SGM violence and mental health symptoms. Conclusions: These findings suggest that there may be a relationship between experiences of violence and poor mental health among SGM Kenyans. More studies are needed to better understand SGM-specific risk factors for poor mental well-being among SGM people in Kenya and the types of interventions that may help mitigate these challenges.

The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score.

AIMS: Pulmonary embolism severity index (PESI) has been developed to help physicians make decisions about the treatment of patients with pulmonary embolism (PE). The combination of echocardiographic parameters could potentially improve PESI's mortality prediction. To assess the additional prognostic value of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) when combined with the PESI score in patients with PE to predict short-term mortality. METHODS AND RESULTS: A multicentric prospective study database of patients admitted with PE in 75 academic centres in Argentina between 2016 and 2017 was analysed. Patients with an echocardiogram at admission with simultaneous measurement of TAPSE and PASP were included. PESI risk score was calculated blindly and prospectively, and in-hospital all-cause mortality was assessed. Of 684 patients, 91% had an echocardiogram, PASP and TAPSE could be estimated simultaneously in 355 (57%). All-cause in-hospital mortality was 11%. The receiver operating characteristic analysis showed an area under the curve (AUC) [95% confidence interval (CI)] of 0.76 (0.72-0.81), 0.74 (0.69-0.79), and 0.71 (0.62-0.79), for the PESI score, PASP, and TAPSE parameters, respectively. When PESI score was combined with the echocardiogram parameters (PESI + PASP-TAPSE = PESI-Echo), an AUC of 0.82 (0.77-0.86) was achieved (P = 0.007). A PESI-Echo score ≥128 was the optimal cut-off point for predicting hospital mortality: sensitivity 82% (95% CI 67-90%), specificity 69% (95% CI 64-74%). The global net reclassification improvement was 9.9%. CONCLUSIONS: PESI-Echo score is a novel tool for assessing mortality risk in patients with acute PE. The addition of echocardiographic parameters to a validated clinical score improved the prediction of hospital mortality.

[External validation of prognostic scores for in-hospital and 30-day mortality in patients with pulmonary embolism in Argentina]. / Validación externa de puntajes pronósticos para mortalidad hospitalaria y a treinta días en pacientes con tromboembolismo pulmonar en Argentina.

Prognostic models have been developed to help make decisions in the treatment of pulmonary embolism (PE). Among them, the Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI), however they have not been validated in our setting. The objective was to evaluate PESI and sPESI scores ability to predict in-hospital mortality in patients with PE in Argentina. We analyzed a database of 75 academic centers in Argentina that included consecutive patients with PE from 2016 to 2017. The scores were prospectively calculated, and in-hospital and 30 days mortality were assessed. The validation of the models was assessed through discrimination using the area under the ROC curve (AUC), and calibration with the Hosmer-Lemeshow (HL) test. The cohort included 684 patients. In-hospital mortality was 12% and at 30 days an additional 3.2% mortality was registered. The AUC (95% CI) for in-hospital mortality was 0.75 (0.69-0.81) for PESI and 0.77 (0.71-0.82) for sPESI (p = 0.2 between scores). AUC of 30-day mortality 0.75 (0.68-0.8) and 0.78 (0.74-0.83) for PESI and sPESI (p = 0.2 between scores). Both models presented good calibration. The PESI and sPESI risk scores demonstrated similar performance and good accuracy in predicting hospital and 30-day mortality. Both scores can be established as simple prediction tools for PE patients in Argentina.

Se han desarrollado modelos pronósticos para guiar el tratamiento del tromboembolismo pulmonar agudo (TEP), entre ellos el Pulmonary Embolism Severity Index (PESI) y PESI simplificado (sPESI), los cuales no han sido validados en nuestro país. El objetivo fue evaluar la capacidad de los puntajes de riesgo PESI y sPESI para predecir mortalidad hospitalaria en pacientes con TEP en Argentina. Analizamos una base de datos de 75 centros académicos de Argentina que incluyeron pacientes consecutivos con TEP desde el 2016 al 2017. Las puntuaciones se calcularon de forma prospectiva y se evaluó la mortalidad hospitalaria y a 30 días. La validación de los modelos se realizó a través de discriminación mediante área bajo la curva ROC (AUC) y calibración con la prueba de Hosmer-Lemeshow (HL). La cohorte total incluyó 684 pacientes. La mortalidad hospitalaria fue 12% y a los 30 días se registró un 3.2% adicional de mortalidad. El AUC (IC 95%) para la mortalidad hospitalaria fue de 0.75 (0.69-0.81) para PESI y 0.77 (0.71-0.82) para sPESI (p = 0.25 entre puntajes). El AUC de mortalidad a los 30 días fue de 0.75 (0.68-0.8) y 0.78 (0.74-0.83) para PESI y sPESI (p = 0.2 entre puntajes). Ambos modelos presentaron buena calibración y demostraron un desempeño similar para predecir mortalidad hospitalaria y a 30 días, por lo que pueden establecerse como herramientas de predicción simples para pacientes con TEP en Argentina.

Validación externa de puntajes pronósticos para mortalidad hospitalaria y a treinta días en pacientes con tromboembolismo pulmonar en Argentina / External validation of prognostic scores for in-hospital and 30-day mortality in patients with pulmonary embolism in Argentina

Resumen Se han desarrollado modelos pronósticos para guiar el tratamiento del tromboembolismo pulmonar agudo (TEP), entre ellos el Pulmonary Embolism Severity Index (PESI) y PESI simplificado (sPESI), los cuales no han sido validados en nuestro país. El objetivo fue evaluar la capacidad de los puntajes de riesgo PESI y sPESI para predecir mortalidad hospitalaria en pacientes con TEP en Argentina. Analizamos una base de datos de 75 centros académicos de Argentina que incluyeron pacientes consecutivos con TEP desde el 2016 al 2017. Las puntuaciones se calcularon de forma prospectiva y se evaluó la mortalidad hospitalaria y a 30 días. La validación de los modelos se realizó a través de discriminación mediante área bajo la curva ROC (AUC) y calibración con la prueba de Hosmer-Lemeshow (HL). La cohorte total incluyó 684 pacientes. La mortalidad hospitalaria fue 12% y a los 30 días se registró un 3.2% adicional de mortalidad. El AUC (IC 95%) para la mortalidad hospitalaria fue de 0.75 (0.69-0.81) para PESI y 0.77 (0.71-0.82) para sPESI (p = 0.25 entre puntajes). El AUC de mortalidad a los 30 días fue de 0.75 (0.68-0.8) y 0.78 (0.74-0.83) para PESI y sPESI (p = 0.2 entre puntajes). Ambos modelos presentaron buena calibración y demostraron un desempeño similar para predecir mortalidad hospitalaria y a 30 días, por lo que pueden establecerse como herramientas de predicción simples para pacientes con TEP en Argentina.

Abstract Prognostic models have been developed to help make decisions in the treatment of pulmonary embolism (PE). Among them, the Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI), however they have not been validated in our setting. The objective was to evaluate PESI and sPESI scores ability to predict in-hospital mortality in patients with PE in Argentina. We analyzed a database of 75 academic centers in Argentina that included consecutive patients with PE from 2016 to 2017. The scores were prospectively calculated, and in-hospital and 30 days mortality were assessed. The validation of the models was assessed through discrimination using the area under the ROC curve (AUC), and calibration with the Hosmer-Lemeshow (HL) test. The cohort included 684 patients. In-hospital mortality was 12% and at 30 days an additional 3.2% mortality was registered. The AUC (95% CI) for in-hospital mortality was 0.75 (0.69-0.81) for PESI and 0.77 (0.71-0.82) for sPESI (p = 0.2 between scores). AUC of 30-day mortality 0.75 (0.68-0.8) and 0.78 (0.74-0.83) for PESI and sPESI (p = 0.2 between scores). Both models presented good calibration. The PESI and sPESI risk scores demonstrated similar performance and good accuracy in predicting hospital and 30-day mortality. Both scores can be established as simple prediction tools for PE patients in Argentina.

Tromboembolismo pulmonar agudo en la Argentina. Registro CONAREC XX / Acute Pulmonary Embolism in Argentina. XX CONAREC Registry

RESUMEN Introducción: El tromboembolismo de pulmón agudo (TEP) representa la tercera causa de mortalidad cardiovascular. Sin embargo, existen pocos datos de esta patología en nuestro país. Nuestro objetivo fue describir las características basales, evolución y tratamiento implementado en pacientes con tromboembolismo de pulmón agudo en Argentina. Material y métodos: Se trata de un registro multicéntrico prospectivo que incorporó pacientes con diagnóstico de tromboembolismo de pulmón agudo internados en centros con residencia de cardiología desde octubre de 2016 a noviembre de 2017. Se realizó un análisis convencional para estadística descriptiva y comparativa. Se consideró significativo un valor de p < 0,05. Se realizó una auditoría cruzada al 20% de los centros participantes. Resultados: Se incluyeron 684 pacientes consecutivos de 75 centros, con un promedio de edad de 63,8 años; 388 (57%) eran de sexo femenino. El TEP fue el motivo de internación en 484 (71%) de los casos. Los factores predisponentes más frecuentes fueron obesidad, hospitalización reciente, reposo transitorio y cáncer activo. Se indicó anticoagulación durante la internación en 661 (97%) pacientes y terapia de reperfusión en 91 (13%). Sin embargo, solo 50 de los 102 pacientes que se presentaron con inestabilidad hemodinámica recibieron alguna terapia de reperfusión (49%). La mortalidad hospitalaria fue del 12%, principalmente relacionada con el tromboembolismo de pulmón agudo (51%). Conclusiones: El tromboembolismo de pulmón agudo en nuestro medio constituye una patología con elevada mortalidad en la internación atribuible principalmente al evento embólico. Se observó una baja utilización de terapias de reperfusión en pacientes con inestabilidad hemodinámica.

ABSTRACT Background: Acute pulmonary embolism (PE) represents the third cause of cardiovascular mortality. However, there is lack of information about this entity in our country. Our aim was to describe baseline characteristics, clinical evolution and treatment of patients with acute PE in Argentina. Methods: This was a prospective multicenter registry including patients with acute PE hospitalized in centers with cardiology residency from October 2016 to November 2017. Conventional analysis was performed for descriptive and comparative statistics. A value of p<0.05 was considered significant. Cross audit was performed to 20% of participating centers. Results: We included 684 consecutive patients from 75 centers with an average age of 63.8 years and 388 (57%) women. Hospital admission was due to PE in 484 (71%) cases. The most frequent predisposing factors were obesity, recent hospitalization, transient rest and active cancer. Anticoagulation was indicated in 661 patients (97%) and reperfusion therapy was performed in 91 (13%). However, only 50 of the 102 patients who presented with hemodynamic instability received reperfusion therapy (49%). Global in-hospital mortality was 12%, mainly associated with acute PE (51%). Conclusions: Acute pulmonary embolism presents with high in-hospital mortality in our setting, mainly related to the embolic event. We observed a low use of reperfusion therapies in patients with hemodynamic instability.

Alcohol Use and HIV Risk Within Social Networks of MSM Sex Workers in the Dominican Republic.

To examine how alcohol-related HIV risk behaviors within MSM sex workers' social networks (SN) may be associated with individual risk behaviors, respondent-driven and venue-based sampling were used to collect demographic, behavioral and SN characteristics among MSM sex workers in Santo Domingo and Boca Chica (N = 220). The majority of participants reported problem drinking (71.0%) or alcohol use at their last sexual encounter (71.4%). Self-reported problem drinking was associated with SN characteristics (at least one member who recently got drunk aOR = 7.5, no religious/spiritual adviser aOR = 3.0, non-sexual network density aOR = 0.9), while self-reported alcohol use at last sex was associated with individual (drug use at last sex aOR = 4.4) and SN characteristics (at least one member with previous HIV/STI testing aOR = 4.7). Dominican MSM sex workers reported high alcohol use, which may increase their risk for HIV. A better understanding of SN factors associated with individual risk behaviors can help guide appropriate intervention development.