Implementation of a safer conception programme for HIV-affected men and women in rural Uganda.

We integrated safer conception care into a Ugandan HIV clinic. People with HIV (PWH), or partnered with a PWH, and desiring children were eligible for the Healthy Families Clinic Program. Clients completed quarterly safer conception counselling visits and questionnaires to provide information around method preferences and outcomes (partner pregnancy, partner seroconversion). We used clinic level data to evaluate longitudinal viral suppression among PWH. Between November 2016 and January 2020, 361 clients (53% men) accessed services. 75% were PWH (51% women, 96% men): 99% were on antiretroviral therapy (ART) and most reported HIV-sero-different partnerships (97%). Frequently selected safer conception methods included ART (86%), timed condomless sex (74%), and PrEP (40%) with important differences by HIV-serostatus and gender. 22.5% reported pregnancy. Most (97%) PWH were virally suppressed at enrolment and 81% of non-virally suppressed PWH were virally suppressed at 15 months. Two HIV-negative clients (2%) had HIV seroconversion. There is demand for safer conception care in a public sector HIV-clinic in Uganda. Men and women have unique safer conception care preferences. The majority of clients engaged in safer conception care had viral suppression at follow up.

Oxidative stability and physicochemical changes of dark chocolates with essential oils addition.

This research aimed to evaluate the oxidative stability and rheological properties of dark chocolates with the addition of essential oils (EO) of Cymbopogon citratus, Pimpinella anisum, and Mintostachys mollis. For this purpose, before the inclusion in chocolates, the EO were chemically characterized to identify the most important volatile compounds. We added essential oils of P. anisum, C. citratus and M. mollis to dark chocolates (cocoa 70%) at doses of 10, 12 and 14 µL per 500 g, separately. These chocolates were evaluated for oxidative activity, hardness, microstructure, rheological and melting properties and antioxidant capacity. It was found that C. citratus EO (10 µL/500 g of chocolate) improve the oxidative stability of the chocolates at 90 days of storage at 25 °C (230 meq O2/kg), while higher concentrations promote lipid oxidation. The incorporation of essential oils improves the antioxidant capacity, likewise, it changes the rheological, thermal, and microstructural properties. Therefore, essential oils can improve the physicochemical characteristics of dark chocolates allowing greater stability in oxidative fat and thus increase the shelf life.

Pregnancy, Opioid Use Disorder and COVID-19: An Evaluation of Acute Care Presentations During a Pandemic.

INTRODUCTION: The opioid epidemic has been exacerbated by the COVID-19 pandemic, resulting in increased acute care opioid-related and overdose visits. We sought to assess how the pandemic may have impacted an obstetric cohort impacted by opioid misuse in the acute care context. METHODS: A retrospective review of acute care presentations of patients with concomitant pregnancy (Z33.1) and opioid-related diagnostic codes (T10 codes and/or F11) was conducted over a 24-month period (pre-COVID = March 2019 through February 2020, post-COVID = March 2020 through February 2021). Descriptive statistics and χ2 analysis of pre- versus post-COVID presentations were performed. RESULTS: A total of 193 individuals, 104 (53.9%) pre- and 89 (46.1%) post-COVID, accounting for 292 total encounters, 160 (54.8%) pre- and 132 (45.2%) post-COVID, were seen for acute care visits ( P = 0.84). Age ( P = 0.15), race ( P = 0.59), and insurance status ( P = 0.17) were similar pre- versus post-COVID. The majority of presentations, pre- (40.4%) and post-COVID (44.9%), were for opioid withdrawal ( P = 0.74). Although post-COVID individuals were more likely to lack prenatal care (48.3% versus 39.4% pre-COVID), this trend was not significant ( P = 0.19). Similar proportions of individuals were affected by pregnancy complications (51.9% pre-, 44.9% post-COVID; P = 0.30). Similar proportions of individuals were affected by adverse pregnancy outcomes (44.2% pre-, 48.3% post-COVID; P = 0.64). CONCLUSION: The COVID-19 pandemic did not have a statistically significant effect on opioid-related acute care presentations or outcomes for obstetric patients. In this acute care cohort, however, opioid misuse had significant general impact on pregnancy complications and outcomes, suggesting unmet needs in this population.

Impact of wild solanaceae rootstocks on morphological and physiological response, yield, and fruit quality of tomato (Solanum lycopersicum L.) grown under deficit irrigation conditions.

It has been established that climate change has a direct impact on water availability, an essential resource for agricultural development. As a result, controlling, mitigating, and adapting to water deficit requires the advancement of research on promising wild flora species. As recent studies have shown, wild relatives of certain cultivars are tolerant to adverse factors, enabling the development of sustainable and resilient agriculture. The present study evaluated the morpho-physiology and productivity of tomato scions grafted on wild Solanaceae (Datura stramonium, Solanum sisymbriifolium, Solanum quitoense, and Cyphomandra betacea) grown under water deficit conditions (100% ETc - high level, 75% ETc - moderate level, 50% ETc - medium level, and 25% ETc - low level). The results showed that tomato plants grafted on Datura stramonium rootstocks performed better morpho-physiologically under deficit irrigation. The improved osmoregulation caused by a higher relative water content (98.49%) allowed the scion to be more tolerant to water stress. In addition, these scions showed high water potential during their phenological stages (vegetative -0.47 MPa, flowering -0.59 MPa, and production -0.64 MPa), as well as improved photosynthetic efficiency. The overall tolerance of the scion resulted in better yield (8.14 kg/plant) with higher number of commercially valuable fruits. The D. stramonium rootstock allowed better management and use of irrigation water, increasing productivity (54.95 kg/m3); that is, it is presented as a species with potential for establishing tomato production areas in scenarios of water scarcity or cultivation under deficit irrigation.

Physical, functional and sensory properties of bitter chocolates with incorporation of high nutritional value flours.

Due to the growing demand for healthy food products, the industry is seeking to incorporate inputs with high nutritional potential to traditional products. The objective of this research was to evaluate the effect of incorporating Lepidium meyenii, Chenopodium pallidicaule, Amaranthus caudatus, Sesamum indicum and Salvia hispanica flours on the physical, chemical, rheological, textural and thermal characteristics, and the degree of sensory acceptance of dark chocolate bars (65% cocoa). To this end, chocolate bars were made with the incorporation of five flours in four doses (1, 2, 3 and 4%), obtaining 20 different formulations compared with a control treatment (without flour addition). It was found that as flour incorporation levels increased, viscosity, antioxidants and particle size of the chocolates increased, but hardness and pH decreased. The addition of the flours also affected the acceptability and microstructure of the chocolate bars. The incorporation of up to 4% of the flours studied improved the degree of acceptance of the chocolates. Consequently, the incorporation of grain flours with high nutritional value can enhance the characteristics of dark chocolates, becoming a technological alternative for the chocolate industry.

"We Feel Like Everybody's Going to Judge us": Black Adolescent Girls' and Young Women's Perspectives on Barriers to and Opportunities for Improving Sexual Health Care, Including PrEP, in the Southern U.S.

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the southern U.S.; however, PrEP prescriptions to Black AGYW remain scarce. We conducted in-depth interviews (IDIs) with Black AGYW ages 14-24 in Alabama to explore opportunities for and barriers to sexual health care including PrEP prescription. Twelve AGYW participated in IDIs with median age 20 (range 19-24). All reported condomless sex, 1-3 sexual partners in the past 3 months, and 6 reported prior STI. Themes included: 1) Stigma related to sex contributes to inadequate discussions with educators, healthcare providers, and parents about sexual health; 2) Intersecting stigmas around race and gender impact Black women's care-seeking behavior; 3) Many AGYW are aware of PrEP but don't perceive it as an option for them. Multifaceted interventions utilizing the perspectives, voices, and experiences of Black cisgender AGYW are needed to curb the HIV epidemic in Alabama and the U.S. South.

Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care.

Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.

Decidual stromal cell-derived PGE2 regulates macrophage responses to microbial threat.

PROBLEM: Bacterial chorioamnionitis causes adverse pregnancy outcomes, yet host-microbial interactions are not well characterized within gestational membranes. The decidua, the outermost region of the membranes, is a potential point of entry for bacteria ascending from the vagina to cause chorioamnionitis. We sought to determine whether paracrine communication between decidual stromal cells and macrophages shaped immune responses to microbial sensing. METHOD OF STUDY: Decidual cell-macrophage interactions were modeled in vitro utilizing decidualized, telomerase-immortalized human endometrial stromal cells (dTHESCs) and phorbol ester-differentiated THP-1 macrophage-like cells. The production of inflammatory mediators in response to LPS was monitored by ELISA for both cell types, while phagocytosis of bacterial pathogens (Escherichia coli and Group B Streptococcus (GBS)) was measured in THP-1 cells or primary human placental macrophages. Diclofenac, a non-selective cyclooxygenase inhibitor, and prostaglandin E2 (PGE2 ) were utilized to interrogate prostaglandins as decidual cell-derived paracrine immunomodulators. A mouse model of ascending chorioamnionitis caused by GBS was utilized to assess the colocalization of bacteria and macrophages in vivo and assess PGE2 production. RESULTS: In response to LPS, dTHESC and THP-1 coculture demonstrated enhancement of most inflammatory mediators, but a potent suppression of macrophage TNF-α generation was observed. This appeared to reflect a paracrine-mediated effect of decidual cell-derived PGE2 . In mice with GBS chorioamnionitis, macrophages accumulated at sites of bacterial invasion with increased PGE2 in amniotic fluid, suggesting such paracrine effects might hold relevance in vivo. CONCLUSION: These data suggest key roles for decidual stromal cells in modulating tissue responses to microbial threat through release of PGE2 .

White Coat Adherence Occurs in Adolescents With Type 1 Diabetes Receiving Intervention to Improve Insulin Pump Adherence Behaviors.

BACKGROUND: To assess the occurrence of white coat adherence, defined as an increase in adherence to treatment regimens prior to a study appointment, in adolescents with type 1 diabetes (T1D) using insulin pumps and participating in a randomized adherence intervention trial. METHODS: Blood glucose monitoring (BGM) readings, carbohydrate inputs, and insulin boluses delivered were downloaded from the insulin pumps of adolescents, aged 10-18 years, at 3 consecutive T1D study visits. Linear mixed models were used to analyze patterns of BGM, carbohydrate inputs, and insulin boluses delivered in patients who had 40 consecutive days of data stored in their insulin pumps prior to the study visit. RESULTS: Stratified linear mixed models revealed that adolescents randomized to the Tailored Feedback Intervention group increased their blood glucose monitoring ( P < .01), carbohydrate inputs ( P < .0001), and insulin bolusing ( P < .0001) prior to study appointments. In contrast, white coat adherence did not occur in adolescents randomized to the Treatment as Usual group ( Ps > .42). CONCLUSIONS: White coat adherence may occur in adolescents participating in clinical trials. Meter and insulin pump data downloads representing the 1- to 2-week period prior to a study visit are likely to overestimate actual adherence during the time frame between study visits.

Outdoor adventure therapy to increase physical activity in young adult cancer survivors.

PURPOSE: Despite the health benefits of physical activity (PA), limited research has examined PA interventions in young adult cancer survivors (YACS). This study used a two-group parallel design to examine the effects of a 7-day outdoor adventure camp vs. waitlist control on PA levels among YACS. Secondary aims examined effects on sedentary behavior and PA correlates. METHODS: 50 camp and 66 control participants were assessed at baseline, end of camp, and 3 months. RESULTS: Intent-to-treat analyses indicated that, relative to baseline, camp participants had significantly (p = 0.0001) greater increases in PA than controls during camp (+577 vs. +9 minutes/week) and 3 months post-camp (+133 vs. -75 minutes/week, p = 0.001). Camp participants also reported significantly greater improvements in TV viewing (p = 0.001), hours sitting (p = 0.001), PA variety (p = 0.0001), barriers to PA (p = 0.007), and enjoyment of structured activities (p = 0.04) during camp but not 3 months post-camp. CONCLUSION: A week-long outdoor adventure therapy camp increased PA levels during camp and 3 months after camp termination, although effects were attenuated over time. IMPLICATIONS FOR CANCER SURVIVORS: Outdoor adventure therapy camps may increase PA and its correlates in YACS, but future research should explore methods to promote sustained PA after camp termination.

White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps.

BACKGROUND: The purpose was to assess the occurrence of white coat adherence, defined as an increase in adherence to treatment regimens prior to a clinic appointment, in children and adolescents with type 1 diabetes (T1D) who use insulin pumps. METHODS: Blood glucose monitoring (BGM) data, carbohydrate inputs, and insulin boluses delivered were downloaded from the insulin pumps of children and adolescents, aged 7-19 years with T1D, at 2 consecutive routine diabetes clinic visits. Linear mixed models were used to analyze patterns of BGM, carbohydrate inputs, and insulin boluses delivered in patients who had ≥28 days of data stored in their insulin pumps. RESULTS: In general, younger children engaged in more frequent BGM, carbohydrate inputs, and insulin boluses delivered than older children and adolescents. White coat adherence occurred with frequency of BGM, carbohydrate inputs, and insulin boluses delivered, but only in younger children. CONCLUSIONS: Diabetes care providers need to be aware that white coat adherence may occur, particularly in young children. Providers routinely download meter and insulin pump data for the 1- to 2-week period before the clinic visit. For patients exhibiting white coat adherence, their data will overestimate the patient's actual adherence.

Importance of manually entering blood glucose readings when wireless-compatible meters are not being used with an insulin pump.

BACKGROUND: The objective was to determine if there were differences in blood glucose monitoring (BGM) data downloaded from insulin pumps of patients who use meters that wirelessly transmit data to their insulin pumps (i.e., wireless group) and those who do not (i.e., nonwireless group). METHODS: Blood glucose monitoring data were downloaded from the meters and insulin pumps of 47 children and adolescents with type 1 diabetes mellitus. Independent and paired t tests compared BGM data downloaded from meters and BGM data downloaded from insulin pumps. RESULTS: There were significant differences in BGM data downloaded from the insulin pumps of patients using wireless meters compared to those using nonwireless meters. Wireless patients appeared to engage in more BGM, had more low and in-range BG readings and fewer very high BG readingss than nonwireless patients. However, a comparison of BGM data downloaded from meters and insulin pumps of nonwireless patients indicated that their insulin pump data significantly underestimated the number of BGM readings conducted, as well as the number of low and in-range readings, while overestimating the number of very high BGM readings. CONCLUSIONS: Because patients who use nonwireless-compatible meters do not manually enter their low and in-range BGM readings into the insulin pump, BGM data downloaded only from pumps may provide an incomplete representation of BGM frequency or results. It is recommended that patients use meters that directly communicate with pumps or perform bolus calculations. Patients should be educated about the importance of manually entering all BGM readings if they do not use a wireless-compatible meter with their insulin pump.

Insulin bolusing software: the potential to optimize health outcomes in type 1 diabetes mellitus.

BACKGROUND: Insulin bolusing calculators alleviate the burden of having to calculate insulin bolus doses for patients with type 1 diabetes mellitus (T1DM). Three important pieces of information are needed: a blood glucose monitoring (BGM) result, carbohydrates to be consumed, and the amount of insulin bolus delivered. The purpose of this study was to describe insulin pump adherence behaviors associated with the use of bolus calculators in youth who use Medtronic insulin pumps. METHODS: Data were downloaded from the MiniMed Paradigm insulin pumps (Medtronic) of 31 youth with T1DM. Areas of adherence that were evaluated included fundamental insulin pump adherence behaviors (e.g., BGM, carbohydrate entry, and insulin bolusing), decisions about Wizard® recommendations, and three Wizard steps: BGM result-carbohydrate input-insulin bolus. RESULTS: On average, patients conducted BGM ≥4 times/day on 69% of days, inputted carbohydrates ≥3 times/day on 63% of days, and insulin bolused ≥3 times/day on 85% of days. Participants generally followed Wizard recommendations. Finally, participants completed all three Wizard steps (BGM, carbohydrate input, insulin bolus) within 30 min for an average of 29% of boluses. Almost 3% of boluses that were preceded by Wizard use were delivered without conducting BGM or inputting carbohydrates. CONCLUSION: There was substantial variability in insulin pump adherence behaviors (e.g., days when no BGM occurred, reliance on basal insulin). Interventions targeting insulin pump adherence behaviors have the potential to optimize diabetes health outcomes and glycemic control. Improving insulin pump software reports is one promising avenue for improving adherence.

Home sweet home: conceptualizing and coping with the challenges of aging and the move to a care facility.

This study sought to understand how older adults make sense of the challenges of aging. In particular, the move to a care-related facility provides a context for the study of how uncertainty, ambivalence, and other concerns connected with the aging process are conceptualized by older adults. Furthermore, how older adults communicate about and cope with these challenges was examined. Babrow's (1992, 2007) problematic integration theory provides a framework for this research. A qualitative study employing in-depth interviews with 44 older adults from two continuum-of-care facilities was conducted. Findings indicate that the participants experienced problematic integration concerning physical declines, changes in the parent-child relationship, and the decision to move to a care-related facility. In coping with these challenges, older adults focused on positive evaluations, reframing, acceptance, and adaptation. By and large most of the coping mechanisms that older adults employed help explain their success in maintaining a positive outlook, achieving satisfaction with their move and their family communication, and adapting to the challenges of aging.