RESUMEN

HIV-positive patients may present lungs with multiple infections, which may hinder differential diagnoses and the choice of treatment in the course of COVID-19, especially in countries with limited access to high-standard healthcare. Here, we aim to investigate the association between radiological changes and poor COVID-19 outcomes among HIV-positive patients from Central and Eastern Europe. Between November 2020 and May 2021, the Euroguidelines in Central and Eastern Europe Network Group started collecting observational data on HIV and COVID-19 co-infections. In total, 16 countries from Central and Eastern European submitted data (eCRF) on 557 HIV-positive patients. The current analyses included patients who had a radiological examination performed. Logistic regression models were used to identify the factors associated with death, ICU admission, and partial recovery (poor COVID-19 outcomes). Factors that were significant in the univariate models (p < 0.1) were included in the multivariate model. Radiological data were available for 224 (40.2%) patients, 108 (48.2%) had computed tomography, and 116 (51.8%) had a chest X-ray. Of these, 211 (94.2%) were diagnosed using RT-PCR tests, 212 (94.6%) were symptomatic, 123 (55.6%) were hospitalized, 37 (16.6%) required oxygen therapy, and 28 (13.1%) either died, were admitted to ICU, or only partially recovered. From the radiologist's description, 138 (61.6%) patients had typical radiological changes, 18 (8.0%) atypical changes, and 68 (30.4%) no changes. In the univariate models, CD4 count (OR = 0.86 [95% CI: 0.76−0.98]), having a comorbidity (2.33 [1.43−3.80]), HCV and/or HBV co-infection (3.17 [1.32−7.60]), being currently employed (0.31 [0.13−0.70]), being on antiretroviral therapy (0.22 [0.08−0.63]), and having typical (3.90 [1.12−13.65]) or atypical (10.8 [2.23−52.5]) radiological changes were all significantly associated with poor COVID-19 outcomes. In the multivariate model, being on antiretroviral therapy (OR = 0.20 [95% CI:0.05−0.80]) decreased the odds of poor COVID-19 outcomes, while having a comorbidity (2.12 [1.20−3.72]) or either typical (4.23 [1.05−17.0]) or atypical (6.39 [1.03−39.7]) radiological changes (vs. no changes) increased the odds of poor COVID-19 outcomes. Among HIV patients diagnosed with symptomatic SARS-CoV-2 infection, the presence of either typical or atypical radiological COVID-19 changes independently predicted poorer outcomes.

Asunto(s)

RESUMEN

This paper contains reflections on the use of the imagination in technologically-mediated therapy and analysis. As part of the individuation process the psyche is seen as needing to adapt to new technological ways of communicating. The notion of a technologically-mediated self is posited describing a self which can only be apprehended through, and by, the use of telecommunications. This self is seen as identical to the in-person self, a subset, or superset of it. There is a revisioning of our notions of the container and the field in this work performed through technological-mediation. The need to engage the imagination in approaching this kind of work is emphasized in order to create an imaginal play-space in which the body will be deeply affected. Some thoughts on how the process of individuation might look through such analytic work is presented.

Cet article contient des réflexions sur l'utilisation de l'imagination dans la thérapie et l'analyse pratiquées par la médiation de la technologie. En tant que partie intégrante du processus d'individuation, la psyché est considérée comme devant s'adapter à de nouvelles façons de communiquer, basées sur la technologie. La notion d'un soi atteint par la médiation de la technologie est postulée, un soi qui ne peut être appréhendé que par le biais de l'utilisation des télécommunications. Ce soi est considéré comme étant identique au soi dans la personne; un sous-ensemble, ou un sur-ensemble. L'article présente une révision de nos notions de contenant et de champ quand on travaille avec la médiation de la technologie. Il souligne le besoin de mobiliser l'imagination quand on aborde ce genre de travail afin de créer un espace imaginal de jeu dans lequel le corps sera profondément affecté. Il propose quelques pensées sur comment le processus d'individuation pourrait se présenter au travers d'un tel travail analytique.

El presente trabajo contiene reflexiones sobre el uso de la imaginación en terapia y análisis mediado por la tecnología. Como parte del proceso de individuación, la psique necesita adaptarse a nuevos modos tecnológicos de comunicación. Se propone la noción de un self mediado-tecnológicamente, al describir a un self que solamente puede ser aprehendido a través y por el uso de las telecomunicaciones. Este self es considerado como idéntico al self presencial, una parte o una versión mayor del mismo. Se presenta una revisión de nuestras nociones acerca del campo y del espacio de contención en este trabajo realizado a través de la mediación tecnológica. Se enfatiza la necesidad de comprometer a la imaginación al abordar esta forma de trabajo, para crear un espacio de juego-imaginal, en el cual el cuerpo estará profundamente afectado. Se presentan algunas reflexiones acerca de cómo podría mirarse el proceso de individuación a través de dicho trabajo.

Asunto(s)

RESUMEN

OBJECTIVES: Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). RESULTS: About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). CONCLUSIONS: Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.

Asunto(s)

RESUMEN

Social science is becoming increasingly important in conservation, with more studies involving methodologies that collect data from and about people. Conservation science is a normative and applied discipline designed to support and inform management and practice. Poor research practice risks harming participants and, researchers, and can leave negative legacies. Often, those at the forefront of field-based research are early-career researchers, many of whom enter their first research experience ill-prepared for the ethical conundrums they may face. We draw on our own experiences as early-career researchers to illuminate how ethical challenges arise during conservation research that involves human participants. Specifically, we considered ethical review procedures, conflicts of values, and power relations, and devised broad recommendations on how to navigate ethical challenges when they arise during research. In particular, we recommend researchers apply reflexivity (i.e., thinking that allows researchers to recognize the effect researchers have on the research) to help navigate ethical challenges and encourage greater engagement with ethical review processes and the development of ethical guidelines for conservation research that involves human participants. Such guidelines must be accompanied by the integration of rigorous ethical training into conservation education. We believe our experiences are not uncommon and can be avoided and hope to spark discussion to contribute to a more socially just conservation.

Consideraciones Éticas cuando la Investigación para la Conservación Involucra a la Gente Resumen Las ciencias sociales cada vez son más importantes para la conservación pues más estudios involucran metodologías que recolectan datos de y sobre la gente. La ciencia de la conservación es una disciplina normativa y aplicada diseñada para apoyar e informar al manejo y a la práctica. La investigación deficiente corre el riesgo de dañar a los participantes y a los investigadores, además de que puede dejar un legado negativo. Es común que investigadores que recién inician sus carreras estén al frente de investigación basada en el campo, muchos de los cuales comenzaron su experiencia mal preparados para los dilemas éticos que podrían enfrentar. Partimos de nuestras propias experiencias como investigadores de carrera temprana para ilustrar cómo emergen los retos éticos durante la investigación para la conservación que incluye a participantes humanos. Específicamente, consideramos los procedimientos de revisión ética, los conflictos de valores y las relaciones de poder y con ellas diseñamos recomendaciones de comité sobre cómo navegar los retos éticos cuando surjan durante la investigación. Particularmente, recomendamos a los investigadores que apliquen la reflexividad (es decir, el pensamiento que permite a los investigadores reconocer el efecto que ellos tienen sobre la investigación) para ayudar a navegar los retos éticos y para alentar un mayor compromiso con los procesos de revisión ética y con el desarrollo de las directrices éticas para la investigación de la conservación que involucra a participantes humanos. Dichas directrices deben estar acompañadas por la integración de un entrenamiento ético riguroso dentro de la educación para la conservación. Creemos que nuestras experiencias no son poco comunes y pueden evitarse y esperamos iniciar una discusión para contribuir a una conservación más justa socialmente.

Asunto(s)

RESUMEN

BACKGROUND/OBJECTIVES: Inadequate HIV care for hard-to-reach populations may result in failing the UNAIDS 90-90-90 goal. Therefore, we aimed to review the HIV continuum of care and hard-to-reach populations for each step of the continuum in Central, Eastern and South Eastern Europe. METHODS: Euro-guidelines in Central and Eastern Europe (ECEE) Network Group were created in February 2016. The aim of the network was to review the standards of HIV care in the countries of the region. Information about each stage of HIV continuum of care and hard-to-reach populations for each stage was collected through on-line surveys. Respondents were ECEE members chosen based on their expertise and involvement in national HIV care. Data sources (year 2016) used by respondents included HIV Clinics electronic databases, Institutes of Public Health, Centres for AIDS Prevention, and HIV Programme Reviews. RESULTS: The percentage of people living with HIV (PLHIV) linked to HIV care after HIV diagnosis was ranged between 80% and 96% in Central Europe, 51% and 92% in Eastern Europe and 80% and 100% in South-Eastern Europe. The percentage of PLHIV who are on ART was ranged from 80% to 93% in Central Europe, 18% to 92% in Eastern Europe and 80% to 100% in South-Eastern Europe. The percentage of people virologically suppressed while on ART was reported as 70-95%, 12-95% and 62-97% in Central, Eastern, and South Eastern Europe, respectively. All three regions reported people who inject drugs (PWID) as hard-to-reach population across all HIV continuum stages. Migrants were the second most reported hard-to-reach population. The proportion of late presenters among newly diagnosed ranged between 20% and 55%, 40% and 55% and 48% and 60% in Central, Eastern and South Eastern Europe, respectively. Four countries reported ARVs' delivery delays resulting in treatment interruptions in 2016: two (25%) in South-Eastern, one (20%) in Central and 1 (16.7%) in Eastern Europe. CONCLUSION: Irrespective of the diversity in national HIV epidemics, countries from all three regions reported PWIDs as hard-to-reach population across all HIV continuum stages. Some countries are close to the UNAIDS 2020 goals, others need to strive for progress. However, differences in data sources and variations in definitions limit the utility of continuum of care as a comparative tool.

Asunto(s)

RESUMEN

Objective: This meta-analysis examines the predictive validity of client change language subtypes in motivational interviewing (MI) sessions addressing addictive behavior change. Method: A systematic review identified k = 13 primary studies, contributing 16 MI conditions (N = 1556). The pooled correlation coefficient was used to assess the significance, direction, and strength of seven language subtypes (i.e., reason, desire, need, ability, commitment, taking steps, and other) by three valences (i.e., frequency positive or change talk, frequency negative or sustain talk, and proportion change talk) and their relationship to subsequent engagement in addictive behavior. Results: For frequency measures, more sustain talk related to reason, desire, ability, and other were associated with more addictive behavior at follow up. Other change talk was associated with MI outcomes but in an unexpected direction (i.e., more addictive behavior). Proportion measures showed more proportion change talk-reason and -other statements were associated with less addictive behavior at follow up. Sensitivity analyses indicated some heterogeneity and instability of effect sizes, but no evidence of publication bias. Conclusions: This preliminary meta-analysis suggests that aggregate measures of change and sustain talk are comprised of statement subtypes that are not equally meaningful in predicting outcome following MI for addictive behavior change.

Asunto(s)

Asunto(s)