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Development and acceptability of ViviendoPositivos: A culturally tailored telenovela (soap opera) intervention to improve self-management among Latinos with HIV
Get PDFBecause people with HIV are living longer, there is a growing need for effective health self-management interventions. An urgent gap in care for Latino people with HIV (LWH) is the lack of culturally adapted interventions to support their health information needs. To respond to this need, we developed ViviendoPositivos, a culturally tailored telenovela (soap opera) intervention to promote HIV self-management among LWH. We used a mixed methods approach to gather data for the development of the intervention from 24 Spanish or English-speaking LWHs aged ≥ 18 years. Telenovela vignettes were co-created in collaboration with a community advisory board (CAB), our research team, and a telenovela director. Through focus groups, individual interviews, and a survey, we explored the acceptability of the telenovela vignettes (n = 24 LWH). Participants were mostly male (88%, n = 21), with an average age of 49 years (SD = 12) and living with HIV for 16 years (SD = 12). During the development of ViviendoPositivos, CAB members identified five priority content areas: mental health and social support, HIV knowledge, adherence to antiretroviral treatment, partner communication and negotiation, and healthy aging. Contextual and cultural aspects were also incorporated into the telenovela vignettes. Participants reported high satisfaction with the information and stories presented (92%, n = 22) and mentioned that the topics were relatable. All participants expressed willingness to watch the telenovela with a preference for online streaming via a website. The final product was an HIV self-management telenovela series of five 10-minute filmed episodes that incorporated the ideas and feedback of LWH
Improving PrEP access for adolescent girls and young women: a descriptive analysis of community‐based PrEP delivery in the DREAMS programme in Zambia
Get PDFINTRODUCTION: Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation. METHODS: We collected individual-level PrEP data for AGYW aged 15-24 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024. We used Pearson's Chi-squared test to examine differences in beneficiary characteristics between clients with a PrEP initiation visit and ≥ 2 PrEP visits (i.e. an initiation plus ≥ 1 return visit), and mixed effects Poisson regression modelling to estimate the association between DREAMS enrolment criteria and PrEP continuation (defined as ≥ 1 PrEP visit within 180 days of initiation). We also estimated the marginal probability of PrEP continuation by number of DREAMS enrolment criteria and used Kaplan-Meier methods to estimate the time to the first PrEP return visit by client age band. RESULTS: Between 11 August 2022 and 23 August 2024, 15,502 AGYW aged 15-24 years were screened for PrEP eligibility, of whom 15,072 (97.2%) initiated PrEP per national guidelines. Of those initiating PrEP, 9807 (65.1%) had sufficient follow-up time to allow for observation of a PrEP return visit. The proportion of AGYW who had ≥ 1 PrEP return visit within 180 days of initiation was 59.0% (n/N = 5706/9675). Across age bands, the percent probability of having a PrEP return visit within 180 days of initiation was highest among clients who reported ≥ 4 DREAMS enrolment criteria at 91.7% (95% CI: 70.7, 112.7%) for clients aged 15-19 years and 83.6% (95% CI: 61.1, 106.2%) for clients aged 20-24 years. Overall, 41.5% of clients had a first PrEP return visit between 21 and 42 days of PrEP initiation. CONCLUSIONS: The high number and proportion of AGYW initiated on PrEP suggests that decentralising PrEP services to DREAMS community centres has the potential to improve PrEP access among AGYW. Increasing HIV risk perception among AGYW may improve PrEP continuation
Use of the Ichthyosis Scoring System for Equitable Care in Individuals With Skin of Color.
Get PDFIn their Brief Report in this issue of JAMA Dermatology, Luo et al address a critical gap in the equitable provision of dermatology care across skin tone ranges
MALDI imaging mass spectrometry differentiates basal cell carcinoma from trichoblastoma and trichoepithelioma: A proof of principle study
Get PDFBACKGROUND: Basal cell carcinoma (BCC) comprises a large portion of dermatopathology specimens; however, benign mimics such as trichoblastoma/trichoepithelioma (TB/TE) place accurate diagnosis at risk and consequently lead to inappropriate clinical management and overuse of healthcare resources. This study aims to address the challenges of traditional histopathological evaluation by utilizing matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI IMS). METHODS AND FINDINGS: Formalin-fixed paraffin-embedded BCC and TB/TE tissue blocks were taken from archival tissue. A cohort of 69 BCC and TB/TE specimens were identified, each having three concordant diagnoses given by Dermatopathologists after a blinded analysis. H&E stained sections of each specimen were imaged for pathological analysis and uploaded to a digital annotation software with the following classifications: BCC, TB, TE, BCC stroma, TB stroma, and TE stroma. Mass spectra were collected from unstained serial sections guided by the areas annotated by the Dermatopathologists on the H&E stained serial sections. Before informatics, the data from the cohort were divided randomly into a training set (n = 55) and a validation set (n = 14). Prediction models were developed using a support vector machine (SVM) classification model from the training set data. The platform predicted BCC and TB/TE in model 2 (tumor nests alone) with a sensitivity of 98.9% (95% CI 98.3-99.4%) and specificity of 88.4% (95% CI 78.4-94.5%) at the spectral level in the validation set. Model 1 (stroma alone) had a sensitivity of 46.1% (95% CI 43.0-49.1%) and specificity of 99.2% (95% CI 97.1-99.9%). A combined model 3 (tumor nests and stroma) had a sensitivity of 90.26% (95% CI 89.1%-91.3%) and a specificity of 97.1% (95% CI 94.6% to 98.7%). The limitations of this study included a small sample set, which included easily identifiable cases obtained from a single tissue source. CONCLUSIONS: Our study proves that BCC and TB/TE exhibit different proteomic profiles that one can use to enable accurate differential diagnosis. While our findings are not yet validated for clinical use, this merits further research to support IMS as an ancillary diagnostic tool for adequately and efficiently identifying the most common cutaneous malignancy in the United States. We recommend that future studies obtain a more extensive set of histologically challenging cases from multiple institutions and adequate clinical follow-up to confirm diagnostic accuracy
Association of PFAS and Metals with Cardiovascular Disease Risk: Exploring the Mediating Effect of Diet
Get PDFBackground: Cardiovascular disease (CVD) is a major global health burden influenced by genetic, behavioral, and environmental factors. Among these, exposure to per- and poly-fluoroalkyl substances (PFASs) and toxic metals has been increasingly implicated in adverse cardiovascular outcomes. However, the mediating role of dietary inflammation in these associations remains unclear. Objective: This study investigates the relationship between PFAS and metal exposures and CVD risk, focusing on the potential mediating role of diet, operationalized through the Dietary Inflammatory Index (DII). Additionally, this study examines age as an effect modifier in these associations. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle (n = 660), we assessed environmental exposures (lead, cadmium, mercury, perfluorooctanoic acid-PFOA, perfluorooctane sulfonate-PFOS), dietary inflammatory potential (DII), and cardiovascular markers (blood pressure, lipid profile, C-reactive protein). Statistical analyses included linear regression and Bayesian Kernel Machine Regression-Causal Mediation Analysis (BKMR-CMA) to estimate the direct, indirect (through DII), and total effects of exposure on CVD risk biomarkers. Results: Linear regression revealed significant associations between mercury and reduced systolic blood pressure (SBP) (p = 0.017) and cadmium with increased C-reactive protein (CRP) (p = 0.006). Mediation analysis suggested dietary inflammation may play a role, though estimates were imprecise. Conclusions: PFAS and metals may influence CVD risk through inflammatory pathways, with potential age-related differences. Future longitudinal studies are needed to clarify these complex interactions, reduce measurement error, and guide age-specific exposure regulations
Applying the Health Stigma and Discrimination Framework to psychosis stigma in Malawi
Get PDFPsychotic disorders are highly stigmatized across the globe, negatively impacting people with psychosis and their families. However, little is known about stigma faced by people with psychosis in sub-Saharan Africa. We developed semi-structured qualitative guides based in a constructivist epistemology and formative research methodologies and conducted 36 in-depth interviews (IDIs) and two focus-group discussions (FGDs) with 12 people with lived experience (PWLE) with psychosis; 12 caregivers of PWLE; six traditional healers; six medical providers; six community leaders (1 FGD); and six religious leaders (1 FGD) in Blantyre, Malawi. We drew from the Health Stigma and Discrimination Framework to delineate the stigmatization process. Participants described key drivers of stigma as lack of awareness, prejudice, stereotypes, and fear. Manifestations included experienced, anticipated, witnessed, perceived, internalized and secondary stigma in the form of insults, gossip, abuse, physical violence, restraints, social exclusion, and employment-based discrimination from family and community. With respect to negative outcomes and health and social impacts, stigma impacted quality of care, resilience, mental health, morbidity, social inclusion and quality of life. In Malawi, stigma is pervasive challenge for PWLE, with severe implication for their health and social wellbeing. In partnership with PWLE, investment into the integration of evidence-based stigma reduction activities into existing psychosis management programs is warranted
The impact of slip perturbations on minimum toe clearance during walking in younger and older adults
Get PDFPurpose The purpose of this study was to examine the kinematic differences in minimum toe clearance (MTC), a risk factor for falls, between older and younger adults during habitual walking and treadmill-induced slip perturbations. Materials and methods Data from 28 older adults and 30 younger adults were analyzed for this study. Each subject was fitted with whole-body retroreflective markers for 3D motion capture and walked habitually and while responding to treadmill-induced slip perturbations. Minimum toe clearance and leg joint kinematics were obtained and compared between groups and across conditions. Results There was no difference in MTC between age groups during habitual walking (Older: 5.75±1.08cm, Younger: 5.45±0.93cm, p=0.125). Independent of age, MTC increased significantly in response to treadmill-induced slips (p<0.001). However, significant age×condition interactions revealed that older adults increased MTC significantly less than younger adults in response to treadmill-induced slips. Older adults walked with significantly less knee flexion (31.4±9.9° vs. 41.3±11.9°; p<0.001) and significantly more hip internal rotation (6.5±6.3° vs. 3.8±6.3°; p=0.004) than younger adults during slip perturbations. Conclusions This study builds on prior work to conclude that, compared to younger adults, older adults appear to have a diminished capacity to instinctively increase MTC during walking in response to slip-like balance perturbations, which may allow them lesser time to accommodate instability. © 2025 Gelinne et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Income Inequality Depresses Support for Higher Minimum Wages
Get PDFThe minimum wage can be an effective policy tool for mitigating economic inequality, but public demand for higher minimum wages has not kept up with rising levels of income disparities. In our first study using protest attendance data over a six-and-a-half-year period in the United States (N = 130,562), we find evidence that higher economic inequality was associated with fewer and less well-attended protests targeted at changing economic conditions and raising minimum wages. We corroborate this finding across eight laboratory experiments (N = 7,286)-including a U.S. nationally representative sample-finding causal evidence that higher levels of income inequality decrease support for higher minimum wages. We propose that this decreased support results from a psychological tendency to engage in "is-to-ought" reasoning, where individuals use information about how much people actually earn to determine how much they should earn. We conclude by introducing an intervention to mitigate the effects of this phenomenon and discuss implications for policy communication.
The West African Influence on R/L Liquid Variation in Caribbean and Coastal Spanish Varieties: Observations, Connections and Theories
Get PDFIn this paper, I draw connections between consonantal switching in Igbo and other languages to hypothesize the origins of R/L liquid variation in Caribbean Spanish Dialects. This is a work focused on drawing connections and obeservations between these two langauge families and seeks to gain more insight on the instability of the liquids /r/ and /l/ as a whole.
First, I survey general theories of metathesis and liquid variation with examples that contextualize my research as a whole. I then discuss the historical context of Afro-Hispanic contacts, subsequent linguistic development, and Colonial attitudes and representations of African and bozal communities in the New World. I then provide surveys of Igbo, other West African languages, and Caribbean Spanish Dialects with an emphasis on r/l variation. I conclude by discussing the connections drawn by these two linguistic groups and their implications. Bachelor of Art
Feeding the People and the System: Assessing the Effects of U.S.-Delivered Food Aid on Domestic Food Systems in Uganda
Get PDFABSTRACTBackground: Food aid, particularly from the U.S., plays a crucial role in addressing global food insecurity, meeting both emergency and long-term needs. Uganda is a major food aid recipient due to its vulnerability to drought and status as Africa’s largest refugee-hosting nation. While food aid contributes to food security and humanitarian relief, it also raises concerns about sustainability, dependency, and local market disruption.Objectives: The purpose of this study is to better understand the effects of U.S.-delivered food aid on various dimensions of Uganda’s domestic food system in order to improve practices and minimize negative effects. Particular attention is paid to how food aid programs affect local supply chains and infrastructure, markets, food production, and recipient behaviors.Methods: This study conducted 10 semi-structured KI interviews with scholars and practitioners of food aid programs based in Uganda or Sub-Saharan Africa. Purposive and snowball sampling were utilized to identify the KIs, and interviews conducted over Microsoft Teams lasted 30-60 minutes. An integrated approach to qualitative analysis was used, combining inductive and deductive thematic coding.Results: Food aid programs in Uganda, primarily funded by the U.S., strengthened supply chains both incidentally, through operational investments in local infrastructure, and intentionally, through initiatives like agricultural cooperatives and monetization programs–the latter tend to yield longer-term beneficial effects. Adverse market effects are minimal, and short-term disruptions tend to be localized and rare. Local purchasing and livelihood programs enhance food production and market participation for Ugandan farmers and refugees. Food aid consumption patterns are shaped by factors including recipients’ preferences, time spent receiving aid, and level of food insecurity, with the selling of in-kind rations in local markets often motivated by the need for cash.Discussion: This study highlights how food aid shapes infrastructure, market integration, and agricultural capacity for refugees and Ugandan nationals. It highlights important systemic inconsistencies in program design and raises questions about the long-term sustainability of agricultural development programs that rest on demand generated by humanitarian crises. The study also emphasizes key policy implications and the importance of stakeholder coordination. The findings aim to ensure the implementation of more nuanced and sustainable food aid strategies that minimize harm to domestic food systems and maximize development potential.Bachelor of Science in Public Healt