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1.
BMJ Open ; 11(9): e054903, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489299

RESUMO

OBJECTIVES: People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA. DESIGN: Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015. SETTING: Nine participating sites across the USA. PARTICIPANTS: 2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women. OUTCOMES: Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity. RESULTS: The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity. CONCLUSIONS: Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.


Assuntos
Insegurança Alimentar , Infecções por HIV , Estudos de Coortes , Estudos Transversais , Feminino , Abastecimento de Alimentos , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Fumar/epidemiologia , Estados Unidos/epidemiologia
2.
Nutrients ; 13(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34444974

RESUMO

The administration of broad-spectrum antibiotics is often associated with antibiotic-associated diarrhea (AAD), and impacts gastrointestinal tract homeostasis, as evidenced by the following: (a) an overall reduction in both the numbers and diversity of the gut microbiota, and (b) decreased short-chain fatty acid (SCFA) production. Evidence in humans that probiotics may enhance the recovery of microbiota populations after antibiotic treatment is equivocal, and few studies have addressed if probiotics improve the recovery of microbial metabolic function. Our aim was to determine if Bifidobacterium animalis subsp. lactis BB-12 (BB-12)-containing yogurt could protect against antibiotic-induced fecal SCFA and microbiota composition disruptions. We conducted a randomized, allocation-concealed, controlled trial of amoxicillin/clavulanate administration (days 1-7), in conjunction with either BB-12-containing or control yogurt (days 1-14). We measured the fecal levels of SCFAs and bacterial composition at baseline and days 7, 14, 21, and 30. Forty-two participants were randomly assigned to the BB-12 group, and 20 participants to the control group. Antibiotic treatment suppressed the fecal acetate levels in both the control and probiotic groups. Following the cessation of antibiotics, the fecal acetate levels in the probiotic group increased over the remainder of the study and returned to the baseline levels on day 30 (-1.6% baseline), whereas, in the control group, the acetate levels remained suppressed. Further, antibiotic treatment reduced the Shannon diversity of the gut microbiota, for all the study participants at day 7. The magnitude of this change was larger and more sustained in the control group compared to the probiotic group, which is consistent with the hypothesis that BB-12 enhanced microbiota recovery. There were no significant baseline clinical differences between the two groups. Concurrent administration of amoxicillin/clavulanate and BB-12 yogurt, to healthy subjects, was associated with a significantly smaller decrease in the fecal SCFA levels and a more stable taxonomic profile of the microbiota over time than the control group.


Assuntos
Antibacterianos/efeitos adversos , Bifidobacterium animalis/metabolismo , Ácidos Graxos Voláteis/metabolismo , Fezes , Microbioma Gastrointestinal , Trato Gastrointestinal/microbiologia , Probióticos/uso terapêutico , Adolescente , Adulto , Idoso , Colo , Diarreia/etiologia , Diarreia/microbiologia , Diarreia/prevenção & controle , Fezes/química , Fezes/microbiologia , Trato Gastrointestinal/metabolismo , Humanos , Pessoa de Meia-Idade , Iogurte/microbiologia , Adulto Jovem
3.
BMJ Open ; 11(7): e047186, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210729

RESUMO

INTRODUCTION: Acute rhinosinusitis (ARS) is a prime reason for doctor visits and among the conditions with highest antibiotic overprescribing rates in adults. To reduce inappropriate prescribing, we aim to predict the absolute benefit of antibiotic treatment for individual adult patients with ARS by applying multivariable risk prediction methods to individual patient data (IPD) of multiple randomised placebo-controlled trials. METHODS AND ANALYSIS: This is an update and re-analysis of a 2008 IPD meta-analysis on antibiotics for adults with clinically diagnosed ARS. First, the reference list of the 2018 Cochrane review on antibiotics for ARS will be reviewed for relevant studies published since 2008. Next, the systematic searches of CENTRAL, MEDLINE and Embase of the Cochrane review will be updated to 1 September 2020. Methodological quality of eligible studies will be assessed using the Cochrane Risk of Bias 2 tool. The primary outcome is cure at 8-15 days. Regression-based methods will be used to model the risk of being cured based on relevant predictors and treatment, while accounting for clustering. Such model allows for risk predictions as a function of treatment and individual patient characteristics and hence gives insight into individualised absolute benefit. Candidate predictors will be based on literature, clinical reasoning and availability. Calibration and discrimination will be evaluated to assess model performance. Resampling techniques will be used to assess internal validation. In addition, internal-external cross-validation procedures will be used to inform on between-study differences and estimate out-of-sample model performance. Secondarily, we will study possible heterogeneity of treatment effect as a function of outcome risk. ETHICS AND DISSEMINATION: In this study, no identifiable patient data will be used. As such, the Medical Research Involving Humans Subject Act (WMO) does not apply and official ethical approval is not required. Results will be submitted for publication in international peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42020220108.


Assuntos
Rinite , Sinusite , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Humanos , Metanálise como Assunto , Atenção Primária à Saúde , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico
4.
J Int AIDS Soc ; 24(6): e25751, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34128343

RESUMO

INTRODUCTION: Frailty is frequently observed among people with HIV, and food insecurity is associated with frailty in the general population. Evidence is scarce on the associations between food insecurity and frailty among women with HIV who may be particularly vulnerable to the impacts of food insecurity. The goal of this study was to assess associations between food insecurity and frailty among women with and without HIV. METHODS: There were 1265 participants from the Women's Interagency HIV Study who participated in frailty assessments in 2017. Frailty was measured using the Fried Frailty Phenotype, and women were subsequently categorized as robust, pre-frail or frail. Food insecurity was assessed using the U.S. Household Food Security Survey Module, with women categorized as having high, marginal, low or very low food security. Multinomial logistic regression models were conducted to examine cross-sectional associations between food insecurity and frailty while adjusting for socio-demographic, behavioural and HIV status covariates. RESULTS AND DISCUSSION: Approximately one-third (31.9%) of the women had marginal, low or very low food security, and the proportions of women who met the criteria for frailty or pre-frailty were 55.6% and 12.4% respectively. In the adjusted model, the relative risk ratio (RRR) of frailty for women with very low food security versus women with high food security was 3.37 (95% CI [1.38 to 8.24], p < 0.01); the corresponding RRR of pre-frailty was 3.63 (95% CI [1.76 to 7.51], p < 0.001). Higher annual household income was associated with lower RRRs of frailty or pre-frailty (p < 0.01). Similarly, older age was associated with more frequent frailty (RRR=1.06, 95% CI [1.03 to 1.09], p < 0.001). HIV serostatus was not significantly associated with either pre-frailty (RRR=0.97, 95% CI [0.71 to 1.31]) or frailty (RRR=0.75, 95% CI [0.48 to 1.16]). CONCLUSIONS: Very low food security was associated with more frequent frailty and pre-frailty among women with and without for HIV. HIV serostatus was not associated with frailty.


Assuntos
Fragilidade , Infecções por HIV , Idoso , Estudos Transversais , Feminino , Insegurança Alimentar , Abastecimento de Alimentos , Fragilidade/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Estados Unidos/epidemiologia
6.
Am J Epidemiol ; 190(8): 1457-1475, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33675224

RESUMO

In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018-September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48-63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research.


Assuntos
Envelhecimento/fisiologia , Infecções por HIV/epidemiologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Coortes , Comorbidade , Grupos de Populações Continentais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos , Carga Viral
7.
AIDS Patient Care STDS ; 35(3): 75-83, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33689457

RESUMO

The goal of HIV treatment is viral suppression as it is linked with improved health outcomes and decreased risk of viral transmission. We assessed the sociodemographic, behavioral, and patient-provider interaction associations with viral suppression with an administered survey to HIV-seropositive women in the metropolitan Washington, DC, site of the Women's Interagency HIV Study (WIHS) between 2017 and 2018. Logistic and mixed models were used to explore related factors between HIV viral suppression groups and HIV treatment self-efficacy, respectively. Higher HIV treatment self-efficacy and disclosure concerns were positively associated with viral suppression, while illicit drug use had a negative association. In mixed models, more health care provider trust was associated with higher HIV treatment self-efficacy, while depressive symptoms were associated with lower HIV treatment self-efficacy. Depression, illicit substance use, and HIV treatment self-efficacy are potentially modifiable factors that can influence viral suppression. Implementation studies are needed to determine whether interventions to manage depression or self-efficacy and improve trust in health care providers will influence treatment outcomes.


Assuntos
Infecções por HIV , Autoeficácia , Estudos de Coortes , District of Columbia/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Resultado do Tratamento , Carga Viral
8.
Clin Infect Dis ; 72(5): e112-e119, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33247896

RESUMO

BACKGROUND: Food insecurity is associated with increased morbidity and mortality in people with human immunodeficiency virus (HIV) on antiretroviral therapy, but its relationship with immune dysregulation, a hallmark of HIV infection and comorbidity, is unknown. METHODS: In 241 women participating in the Women's Interagency HIV Study, peripheral blood mononuclear cells were characterized by flow cytometry to identify cell subsets, comprising surface markers of activation (%CD38+HLADR+), senescence (%CD57+CD28-), exhaustion (%PD-1+), and co-stimulation (%CD57- CD28+) on CD4+ and CD8+ T cells. Mixed-effects linear regression models were used to assess the relationships of food insecurity with immune outcomes, accounting for repeated measures at ≤3 study visits and adjusting for sociodemographic and clinical factors. RESULTS: At the baseline study visit, 71% of participants identified as non-Hispanic Black, 75% were virally suppressed, and 43% experienced food insecurity. Food insecurity was associated with increased activation of CD4+ and CD8+ T cells, increased senescence of CD8+ T cells, and decreased co-stimulation of CD4+ and CD8+ T cells (all P < .05), adjusting for age, race/ethnicity, income, education, substance use, smoking, HIV viral load, and CD4 count. In stratified analyses, the association of food insecurity with CD4+ T-cell activation was more pronounced in women with uncontrolled HIV (viral load >40 copies/mL and CD4 <500 cells/mm3) but remained statistically significant in those with controlled HIV. CONCLUSIONS: Food insecurity may contribute to the persistent immune activation and senescence in women with HIV on antiretroviral therapy, independently of HIV control. Reducing food insecurity may be important for decreasing non-AIDS-related disease risk in this population.


Assuntos
Infecções por HIV , Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Feminino , Insegurança Alimentar , HIV , Infecções por HIV/tratamento farmacológico , Humanos , Leucócitos Mononucleares , Ativação Linfocitária , Carga Viral
9.
J Public Health Dent ; 81(1): 65-76, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33049081

RESUMO

OBJECTIVES: Research has shown inconsistent patterns of patients' HIV serostatus disclosure to their dentists. Common barriers to disclosure have included confidentiality concerns, fear of treatment refusal, and discrimination. This study evaluated the prevalence of HIV serostatus disclosure to the dentist, whether the frequency of dental care utilization is associated with disclosure, and reasons for nondisclosure among women living with HIV. METHODS: We administered a cross-sectional oral health survey to 1,526 women living with HIV in the Women's Interagency HIV Study including questions regarding HIV serostatus disclosure to dentists. Logistic regression models were used to analyze the association between dental care utilization (at least annually versus less than annually) and HIV serostatus disclosure to dentists. RESULTS: Overall, 83 percent of women reported that they disclosed their HIV serostatus to their dentist. The most common reasons for nondisclosure were: a) the dentist did not ask, b) believing that the dentist did not need to know, and c) not having a consistent dentist. In the multivariable logistic regression model, at least annual dental care utilization, compared to less than annual, led to a 59 percent reduction in the odds of HIV nondisclosure to the dentist. DISCUSSION: Study findings highlight that dentists who see their patients infrequently should consider methods for overcoming barriers to HIV nondisclosure and the possibility that their patient's HIV serostatus is undisclosed. Educating women living with HIV about how disclosure to dentists is a critical component of their dental assessment and treatment, and how preventive dental treatment can improve overall health outcomes, is important.


Assuntos
Revelação , Infecções por HIV , Confidencialidade , Estudos Transversais , Odontólogos , Feminino , Humanos , Autorrevelação
10.
J Nutr ; 150(12): 3061-3067, 2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33269394

RESUMO

The collective findings from human microbiome research, randomized controlled trials on specific microbes (i.e., probiotics), and associative studies of fermented dairy consumption provide evidence for the beneficial effects of the regular consumption of safe live microbes. To test the hypothesis that the inclusion of safe, live microbes in the diet supports and improves health, we propose assessment of the types and evidentiary quality of the data available on microbe intake, including the assembly and evaluation of evidence available from dietary databases. Such an analysis would help to identify gaps in the evidence needed to test this hypothesis, which can then be used to formulate and direct initiatives focused on prospective and randomized controlled trials on live microbe consumption. Outcomes will establish whether or not the evidence exists, or can be generated, to support the establishment of dietary recommendations for live microbes.


Assuntos
Dieta , Suplementos Nutricionais , Microbiologia de Alimentos , Microbiota , Recomendações Nutricionais , Humanos , Política Nutricional , Necessidades Nutricionais , Prebióticos , Probióticos
11.
Am J Clin Nutr ; 112(5): 1280-1286, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-32844175

RESUMO

BACKGROUND: Neurocognitive impairment (NCI) persists among women living with HIV. Food insecurity is also common among women and may be an important modifiable contributor of NCI. OBJECTIVE: The goal of this study was to determine the association of food insecurity with neurocognitive function among women living with or without HIV. METHODS: From 2013 to 2015, we analyzed data from a cross-sectional sample from the Women's Interagency HIV Study (WIHS). Measures included food insecurity and a comprehensive neuropsychological test battery assessing executive function, processing speed, attention/working memory, learning, memory, fluency, and motor function. We conducted multivariable linear regressions to examine associations between food insecurity and domain-specific neurocognitive performance, adjusting for relevant sociodemographic, behavioral, and clinical factors. RESULTS: Participants (n = 1,324) were predominantly HIV seropositive (68%), Black/African-American (68%) or Hispanic (16%), and low income (48% reported <$12,000/y), with a median age of 49.6 y (IQR = 43.1, 55.5). Approximately one-third (36%, n = 479) were food insecure. Food insecurity was associated with poorer executive function (b = -1.45, SE = 0.58, P ≤ 0.01) and processing speed (b = -1.30, SE = 0.59, P ≤ 0.05). HIV serostatus modified the association between food insecurity and learning, memory, and motor function (P values <0.05). Food insecurity was positively associated with learning among women living with HIV (b = 1.58, SE = 0.77, P ≤ 0.05) and negatively associated with motor function among HIV-negative women (b = -3.57, SE = 1.08, P ≤ 0.001). CONCLUSIONS: Food insecurity was associated with domain-specific neurocognitive function in women, and HIV serostatus modified associations. Food security may be an important point of intervention for ethnically diverse women with low socioeconomic status. Longitudinal studies are warranted to determine potential pathways by which food insecurity is associated with neurocognitive function among women living with or at risk for HIV.


Assuntos
Insegurança Alimentar , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Transtornos Neurocognitivos/etiologia , Adulto , Estudos Transversais , Infecções por HIV/complicações , HIV-1 , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia
12.
AIDS ; 34(13): 1959-1963, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32694420

RESUMO

INTRODUCTION: Smoking, low education, obesity, and depressive symptoms are all associated with HIV health status, increased blood pressure, and inflammation, and constitute a syndemic burden that may contribute to poor health outcomes. The current study examined syndemic burden and health outcomes among women living with HIV. METHODS: Women were participants enrolled in the Women's Interagency HIV Study. Outcomes included blood pressure, HIV health status (HIV-1 RNA viral load and CD4 T-cell counts), and IL-6. Syndemic burden was defined as a count variable of low education, obesity, cigarette use, and depressive symptoms. RESULTS: Women (N = 131) were an average of 60.54 years of age (SD = 8.86), and 49% were non-Hispanic Black. In multivariable analyses, syndemic burden was not significantly associated with SBP (P = 0.342) or DBP (P = 0.763), IL-6 (P = 0.168), or CD4 cell count (P = 0.846). However, syndemic burden was associated with increased viral load (age adjusted ß = 0.35, P < 0.001). Comparing women with high versus low syndemic burden, also controlling for women's age, women with high syndemic burden had higher DBP and HIV viral load. DISCUSSION: Syndemic burden appeared to play an important role in HIV health status and could potentially increase the risk of HIV transmission. High syndemic burden, defined as at least two syndemic conditions, had the greatest effects of HIV viral load and DBP. Targeted interventions to address syndemic burden may help improve health outcomes in women living with HIV as well as reduce the risk of hypertension and HIV transmission.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hipertensão/epidemiologia , Inflamação/epidemiologia , Sindemia , Carga Viral/efeitos dos fármacos , Adulto , Pressão Sanguínea , Estudos de Coortes , Depressão/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/psicologia , Nível de Saúde , Humanos , Estudos Prospectivos , Qualidade de Vida
13.
J Am Dent Assoc ; 151(7): 527-535, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32593355

RESUMO

BACKGROUND: Oral health-related quality of life (OHRQoL) is a multidimensional, perception-based measure of how oral health affects social and physical functioning and self-image. OHRQoL is important for assessing women living with HIV (WLWH) who may have unmet dental needs and experience disparities that impact dental care accessibility. METHODS: In 2016, the authors conducted an assessment of OHRQoL among a national sample of 1,526 WLWH in the Women's Interagency HIV Study using the Oral Health Impact Profile instrument, which assesses the frequency of 14 oral health impact items. OHRQoL was measured using multivariable linear regression with a negative binomial distribution to assess the association between report of a recent unmet dental need and OHRQoL. RESULTS: "Fair or poor" oral health condition was reported by 37.8% (n = 576) of WLWH. Multivariable linear regression showed that unmet dental needs had the strongest positive association with poor OHRQoL (difference in Oral Health Impact Profile mean, 2.675; P < .001) compared with not having unmet needs. The frequency of dental care utilization was not associated with higher OHRQoL. Older age, fair or poor dental condition, smoking, symptoms of anxiety and loneliness, and poor OHRQoL were also associated with worse OHRQoL. CONCLUSION: Self-perceived impact of oral health on social and physical function and self-image, as measured by OHRQoL, may be an easily assessable but underrecognized aspect of OHRQoL, particularly among women aging with HIV. PRACTICAL IMPLICATIONS: Dentists should implement OHRQoL assessments in their management of the care of patients with HIV to identify those who do have significant oral health impacts.


Assuntos
Infecções por HIV , Saúde Bucal , Idoso , Estudos Transversais , Feminino , Humanos , Qualidade de Vida , Inquéritos e Questionários
14.
J Athl Train ; 55(6): 636-643, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32396472

RESUMO

CONTEXT: Limited information exists about health patterns among female rowers at the collegiate level. Furthermore, the element of weight class (lightweights classified as <130 lb [59 kg]) as a factor in the physical and mental health of female collegiate athletes has not been investigated, despite weight requirements in sport being a risk factor for the female athlete triad. OBJECTIVE: To test the hypotheses that (1) components of the female athlete triad were more prevalent in lightweight than in openweight rowers; (2) perceived stress levels were greater in lightweight than in openweight rowers; and (3) rowers who were unable to row due to injury had greater perceived stress levels than uninjured athletes. DESIGN: Cross-sectional study. SETTING: Twelve collegiate women's rowing programs consisting of 6 National Collegiate Athletic Association Division I openweight and 6 Intercollegiate Rowing Association-level lightweight teams. PATIENTS OR OTHER PARTICIPANTS: A total of 158 female collegiate rowers (78 lightweight, 80 openweight). MAIN OUTCOME MEASURE(S): An electronic survey addressing injury history, diet and eating habits and body image (according to the triad screening questionnaire), stress levels (Perceived Stress Scale), and athlete identity (Athlete Identity Measurement Scale) was administered. RESULTS: Lightweight rowers reported limiting or carefully controlling foods more frequently than openweight rowers (41.9% to 29.9%, P = .013). A history of an eating disorder was more prevalent among lightweight than openweight rowers (25.7% to 13.0%, P = .048). Prevalences of stress fractures and menstrual irregularities did not differ between weight classes. Lightweight and openweight rowers' scores on the Perceived Stress Scale (16.0 ± 9.9 and 17.3 ± 6.4, respectively) were not different. Injured rowers scored higher on the Perceived Stress Scale (19.4 ± 7.2) than did uninjured rowers (16.6 ± 5.72). CONCLUSIONS: Weight class did not contribute to differences in the prevalence of female athlete triad components or perceived stress, although lightweight rowers were more likely to have a history of eating disorder. Injury may be a risk factor for increased stress in this population.


Assuntos
Traumatismos em Atletas , Imagem Corporal , Comportamento Alimentar , Síndrome da Tríade da Mulher Atleta , Esportes Aquáticos , Adulto , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/etiologia , Peso Corporal , Estudos Transversais , Feminino , Síndrome da Tríade da Mulher Atleta/epidemiologia , Síndrome da Tríade da Mulher Atleta/etiologia , Síndrome da Tríade da Mulher Atleta/psicologia , Fraturas de Estresse/epidemiologia , Humanos , Prevalência , Fatores de Risco , Estresse Psicológico/fisiopatologia , Inquéritos e Questionários , Universidades , Esportes Aquáticos/lesões , Esportes Aquáticos/fisiologia , Esportes Aquáticos/psicologia , Esportes Aquáticos/estatística & dados numéricos
16.
Epidemiol Psychiatr Sci ; 29: e113, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32248873

RESUMO

AIMS: Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. METHODS: We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). RESULTS: Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). CONCLUSIONS: Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.


Assuntos
Abastecimento de Alimentos/estatística & dados numéricos , Infecções por HIV/psicologia , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Qualidade de Vida , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Estudos de Coortes , Estudos Transversais , Depressão/tratamento farmacológico , Depressão/psicologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Hipnóticos e Sedativos/uso terapêutico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Saúde Mental , Pobreza , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/complicações , Estados Unidos/epidemiologia
18.
Curr Opin Biotechnol ; 61: 226-234, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32087535

RESUMO

Antibiotic-associated diarrhea (AAD) is a common and unintended adverse effect of antibiotic treatment. It is characterized by the disruption of the gut microbiota, decreased intestinal short chain fatty acid (SCFA) concentrations, accumulation of luminal carbohydrates and colonic bile acids, altered water absorption, and ultimately diarrhea. Probiotics were shown to prevent AAD in numerous clinical trials. This review examines what is currently known about how probiotics reduce the risk for AAD via modulating the gut microbiota, altering nutrient and bile acid metabolism, inducing epithelial solute transporter activity, supporting intestinal barrier function, and influencing the immune system. Although probiotics are frequently prescribed with antibiotic use, mechanistic evidence verifying how they confer protection against AAD is extremely limited. This information is urgently needed for improving recommendations for sustaining probiotic development and for implementing probiotics in clinical settings.


Assuntos
Microbioma Gastrointestinal , Probióticos , Antibacterianos/uso terapêutico , Diarreia/tratamento farmacológico , Humanos , Intestinos
19.
Clin Infect Dis ; 71(6): 1517-1523, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-31608363

RESUMO

BACKGROUND: Food insecurity is a well-established determinant of suboptimal, self-reported antiretroviral therapy (ART) adherence, but few studies have investigated this association using objective adherence measures. We examined the association of food insecurity with levels of ART concentrations in hair among women living with human immunodeficiency virus (WLHIV) in the United States. METHODS: We analyzed longitudinal data collected semiannually from 2013 through 2015 from the Women's Interagency HIV Study, a multisite, prospective, cohort study of WLHIV and controls not living with HIV. Our sample comprised 1944 person-visits from 677 WLHIV. Food insecurity was measured using the US Household Food Security Survey Module. ART concentrations in hair, an objective and validated measure of drug adherence and exposure, were measured using high-performance liquid chromatography with mass spectrometry detection for regimens that included darunavir, atazanavir, raltegravir, or dolutegravir. We conducted multiple 3-level linear regressions that accounted for repeated measures and the ART medication(s) taken at each visit, adjusting for sociodemographic and clinical characteristics. RESULTS: At baseline, 67% of participants were virally suppressed and 35% reported food insecurity. In the base multivariable model, each 3-point increase in food insecurity was associated with 0.94-fold lower ART concentration in hair (95% confidence interval, 0.89 to 0.99). This effect remained unchanged after adjusting for self-reported adherence. CONCLUSIONS: Food insecurity was associated with lower ART concentrations in hair, suggesting that food insecurity may be associated with suboptimal ART adherence and/or drug absorption. Interventions seeking to improve ART adherence among WLHIV should consider and address the role of food insecurity.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Preparações Farmacêuticas , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Insegurança Alimentar , Abastecimento de Alimentos , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação , Estudos Prospectivos , Estados Unidos/epidemiologia
20.
Nat Rev Gastroenterol Hepatol ; 16(10): 642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31399728

RESUMO

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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