Long-term follow-up of smokers living with HIV after an intensive behavioral tobacco treatment intervention.
吸烟伴 HIV 感染者在强化行为烟草治疗干预后的长期随访。
- 作者列表："Shuter J","Kim RS","Durant S","Stanton CA
INTRODUCTION:Cigarette smoking is extremely common among persons living with HIV (PLWH) in the United States, and it has emerged as a leading killer in this group. No tobacco treatment studied to date has demonstrated long-term efficacy. METHODS:This was a follow-up study of PLWH adult smokers who completed a randomized controlled trial of Positively Smoke Free (PSF) group therapy from 2014 to 2017. Participants from two of the three trial sites were recalled to complete a long-term follow-up assessment, at least one year after initial enrollment. RESULTS:Of the 342 candidates for this follow-up study, 11 had died prior to our attempts to contact them, and 194 of the remaining 331 (58.6%) completed the late follow-up assessment. Most (91.2%) of the remaining candidates could not be contacted despite numerous attempts. At a mean of 38.1 months after initial study enrollment, employing an intention-to-treat, lost to follow-up=still smoking (worst case scenario) strategy, 12.7% of group therapy vs. 6.6% of control participants had biochemically-verified 7-day point-prevalence abstinence, OR=2.06 (95% CI:0.96-4.41), P=0.06, and 10.3% of group therapy vs. 4.2% of control participants had biochemically-verified 12-month point-prevalence abstinence, OR=2.61 (95% CI: 1.05-6.47, P=0.03). Improvements in abstinence self-efficacy in the PSF group observed in the original study were sustained through late follow-up. CONCLUSIONS:Targeted group therapy for PLWH smokers was associated with increased cessation and sustained improvements in abstinence self-efficacy at a mean of more than three years of follow-up. This is the first trial to show long-term efficacy of tobacco treatment for PLWH.
引言: 在美国，吸烟在 HIV 感染者 (PLWH) 中极为常见，它已成为这一群体的主要杀手。到目前为止，还没有研究过烟草治疗表现出长期疗效。 方法: 这是一项针对 PLWH 成年吸烟者的随访研究，他们于 2014年 (2017年) 完成了积极无烟 (PSF) 组治疗的随机对照试验。来自三个试验地点中的两个的参与者被召回，以完成长期随访评估，至少在首次入组后一年。 结果: 在这项后续研究的 342 名候选人中，有 11 人在我们试图联系他们之前死亡，其余 194 人中的 331 人 (58.6%) 完成后期随访评估。尽管多次尝试，仍无法联系到其余候选人中的大多数 (91.2%)。在初始研究入组后平均 38.1 个月，采用意向治疗，失访 = 仍吸烟 (最坏情况) 策略，12.7% 的群体治疗 vs. 6.6% 的对照参与者进行了生化验证的 7 天点患病率戒断，OR = 2.06 (95% CI: 0.96-4.41)，P = 0.06,10.3% 的群体治疗 vs.4.2% 的对照参与者进行了生物化学验证的 12 个月点患病率戒断，OR = 2.61 (95% CI: 1.05-6.47，P = 0.03)。原始研究中观察到的 PSF 组戒断自我效能的改善通过后期随访得以持续。 结论: 在平均 3 年以上的随访中，PLWH 吸烟者的靶向团体治疗与戒烟增加和戒断自我效能持续改善相关。这是首次显示烟草治疗对 PLWH 长期疗效的试验。
METHODS:BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.
METHODS::Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.
METHODS:STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.