Hasil untuk "Men"

R. Siegel, K. Miller, A. Jemal

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3‐fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the “epidemic of diagnosis.” Over the past decade of available data, the overall cancer incidence rate (2004‐2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005‐2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7–30. © 2017 American Cancer Society.

R. Siegel, Jiemin Ma, Zhaohui Zou et al.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data were collected by the National Center for Health Statistics. A total of 1,665,540 new cancer cases and 585,720 cancer deaths are projected to occur in the United States in 2014. During the most recent 5 years for which there are data (2006‐2010), delay‐adjusted cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.4% per year in women. The combined cancer death rate (deaths per 100,000 population) has been continuously declining for 2 decades, from a peak of 215.1 in 1991 to 171.8 in 2010. This 20% decline translates to the avoidance of approximately 1,340,400 cancer deaths (952,700 among men and 387,700 among women) during this time period. The magnitude of the decline in cancer death rates from 1991 to 2010 varies substantially by age, race, and sex, ranging from no decline among white women aged 80 years and older to a 55% decline among black men aged 40 years to 49 years. Notably, black men experienced the largest drop within every 10‐year age group. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population. CA Cancer J Clin 2014;64:9–29. © 2014 American Cancer Society, Inc.

R. Siegel, D. Naishadham, A. Jemal

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. A total of 1,660,290 new cancer cases and 580,350 cancer deaths are projected to occur in the United States in 2013. During the most recent 5 years for which there are data (2005‐2009), delay‐adjusted cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.5% per year in women. Overall, cancer death rates have declined 20% from their peak in 1991 (215.1 per 100,000 population) to 2009 (173.1 per 100,000 population). Death rates continue to decline for all 4 major cancer sites (lung, colorectum, breast, and prostate). Over the past 10 years of data (2000‐2009), the largest annual declines in death rates were for chronic myeloid leukemia (8.4%), cancers of the stomach (3.1%) and colorectum (3.0%), and non‐Hodgkin lymphoma (3.0%). The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of approximately 1.18 million deaths from cancer, with 152,900 of these deaths averted in 2009 alone. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket and other underserved populations. CA Cancer J Clin 2013;. © 2013 American Cancer Society.

K. Flegal, M. Carroll, Brian K. Kit et al.

C. McLean, Anu Asnaani, B. Litz et al.

P. Phillips, B. Rolls, J. Ledingham et al.

Bill Wang

In the Gale-Shapley model of two-sided matching, it is well known that for generic preferences, the outcomes for each side can vary dramatically in the male-optimal vs. female-optimal stable matchings. In this paper, we show that under a widely used characterization of similarity in rankings, even a weak correlation in preferences guarantees assortative matching with high probability as the market size tends to infinity. It follows that the men's average ranking of women and the women's average ranking of men are asymptotically equivalent in all stable matchings with high probability, as long as the market imbalance is not too extreme.

Rob Horne, Caroline Sabin, Trudie Chalder et al.

Background Antiretroviral therapy has transformed human immunodeficiency virus infection intoa chronic condition associated with normal life expectancy. In the United Kingdom, the uptake of antiretroviral therapy is generally high, but a delay in starting antiretroviral therapy and non-adherence compromise the health and well-being of people living with human immunodeficiency virus, increase the risk of transmission of human immunodeficiency virus and increase National Health Service costs. Objectives The overall aim was to improve antiretroviral therapy uptake and adherence by addressing perceptual and practical barriers. The objectives were to (1) identify culturally specific beliefs and other factors influencing uptake of and adherence to antiretroviral therapy that have not emerged in previous research; (2) refine existing methods for assessing perceptual and practical barriers to antiretroviral therapy uptake and adherence; (3) develop an intervention to increase antiretroviral therapy uptakeand adherence; (4) determine intervention feasibility and acceptability; (5) evaluate intervention efficacy;(6) assess the short- and long-term costs and cost-effectiveness of the interventions and (7) prepare for implementation within the National Health Service. Design Objective 1 – in-depth interviews with Black African and Black Caribbean people living with human immunodeficiency virus (n = 52); objective 2 – adaptation of the Beliefs about Medicines Questionnaire; objective 3 – development of the Supporting UPtake and Adherence to antiretroviral therapy service intervention; objective 4 – feasibility study (n = 213) and acceptability/process interviews (n = 24); objective 5 – observational study (n = 484) and randomised controlled trial (n = 143); objective 6 – systematic review, cost-effectiveness analysis (n = 210) and economic modelling; and objective 7 – preparatory implementation work with people living with human immunodeficiency virus and human immunodeficiency virus clinic staff. Setting National Health Service human immunodeficiency virus clinics in England with a high proportion of ethnic minority populations. Participants People living with human immunodeficiency virus. Interventions Adherence support – cognitive–behavioural therapy plus care as usual. Main outcome measures Workstream 1 – adapted Beliefs about Medicines Questionnaire–antiretroviral therapy. Workstream 2 – feasibility study: participant recruitment and withdrawal rates. Workstream 3 – randomised controlled trial – primary outcome: medication event monitoring system adherence. Workstream 4 – incremental cost-effectiveness ratio. Results Workstream 1 – qualitative studies were used to refine the Beliefs about Medicines Questionnaire – antiretroviral therapy and, together with our preparatory research, to inform the cognitive–behavioural therapy-based intervention. Workstream 2 – recruitment to the randomised controlled trial and observational study was deemed feasible. Thematic analysis of exit interviews with recipients of the SUPA intervention demonstrated that the intervention was acceptable and addressed perceptual and practical barriers to antiretroviral therapy. In Workstream 3, we did not meet the recruitment targets and our trial was underpowered for the primary outcome: 143 participants met the inclusion criteria and were randomised (care as usual, n = 72; care as usual plus cognitive–behavioural therapy, n = 71). There was no significant effect of cognitive–behavioural therapy on the primary end point. Of the 112 participants (care as usual, n = 55; cognitive–behavioural therapy, n = 57) for whom sufficient data for primary end-point analysis were available, 17 (15.2%) met the primary end point (> 80% of months with an average monthly adherence of ≥ 90%) [9 (16.4%) in the care-as-usual group and 8 (14.0%) in the cognitive–behavioural therapy group (p = 0.94)]. Secondary end points: median Medication Event Monitoring System adherence at 12 months was 61.9% in the care-as-usual group and 66.5% in the cognitive–behavioural therapy group (p = 0.40), representing a 7.5% uplift in adherence. Participants who were randomised to receive the intervention, based on perceptions of antiretroviral therapy at baseline (low antiretroviral therapy necessity beliefs, and/or high antiretroviral therapy concerns), experienced a greater decrease in antiretroviral therapy concerns [care as usual −0.9 (95% confidence interval −1.4 to −0.5) vs. cognitive–behavioural therapy −0.6 (95% confidence interval −0.8 to −0.3); p = 0.03], treatment intrusiveness [median change in highly active antiretroviral treatment (antiretroviral therapy) Intrusiveness Scale scores: care as usual −0.5 (95% confidence interval −5.6 to 18.0) vs. cognitive–behavioural therapy −5.6 (95% confidence interval −20.4 to 1.2); p = 0.03] and depression scores [median change in depression score: care as usual 0 (95% confidence interval −1.5 to 2.0) vs. cognitive–behavioural therapy −1 (95% confidence interval −3 to 0); p = 0.02] between baseline and 12 months. Workstream 4 – cognitive–behavioural therapy resulted in 0.056 more quality-adjusted life-years than care as usual (95% confidence interval 0.0029 to 0.083). The incremental cost-effectiveness ratio was £11,189 per quality-adjusted life-year. At a threshold of £20,000 per quality-adjusted life-year, there was > 90% likelihood that the intervention would be more cost-effective than care as usual. There was a 13% likelihood that the intervention would produce more quality-adjusted life-years and result in lower health and social care costs than care as usual. A Markov model showed that, over the longer term, cognitive–behavioural therapy results in fewer quality-adjusted life-years and higher costs and, therefore, care as usual would be the more cost-effective option. Limitations Our primary outcome of full Medication Event Monitoring System adherence was problematic, our randomised controlled trial was underpowered and we were unable to demonstrate a significant difference in our primary outcome. Conclusions Patients who received the Supporting UPtake and Adherence to antiretroviral therapy service intervention benefited from a reduction in antiretroviral therapy concerns, a reduction in antiretroviral therapy intrusiveness and reduced depressive symptoms, and from improved quality of life. The intervention was likely to be cost-effective for the National Health Service within 12 months. Future work Given the difficulty in recruiting people at a high risk of non-engagement with human immunodeficiency virus care, future work assessing the effectiveness of adherence interventions may require alternative, non-standard randomised controlled trial designs. Further studies are necessary to recalibrate our understanding of the levels of antiretroviral therapy adherence necessary to achieve viral load suppression. Study registration The trial is registered as ISRCTN35514212 and the study is registered as CRD42019072431. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-0109-10047) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary Human immunodeficiency virus treatment (known as antiretroviral therapy) is very effective, but some patients do not get the full benefit because they delay treatment or miss doses. This increases the chances of getting ill and the risk of passing human immunodeficiency virus on to others. There are many reasons why people delay treatment or take less than has been prescribed, including beliefs and concerns about treatment and practical difficulties. People from United Kingdom Black African and Caribbean communities often experience difficulties with human immunodeficiency virus treatment, but few studies have focused on this group. We interviewed 52 people from Black African and Caribbean communities about their views and experiences of human immunodeficiency virus and its treatment, and designed questionnaires to measure these. After consulting with people living with human immunodeficiency virus, we developed a new service to help people get the best from human immunodeficiency virus treatment (i.e. Supporting UPtake and Adherence to antiretroviral therapy). The Supporting UPtake and Adherence to antiretroviral therapy service included a video and booklet about human immunodeficiency virus and antiretroviral therapy and up to four meetings or telephone calls with a nurse to address questions and concerns. We compared the Supporting UPtake and Adherence to antiretroviral therapy service with usual National Health Service care to test whether or not patients who received the Supporting UPtake and Adherence to antiretroviral therapy intervention were more likely to take antiretroviral therapy as prescribed by their doctor (known as adherence). We also tested whether or not the Supporting UPtake and Adherence to antiretroviral therapy programme benefited patients by reducing antiretroviral therapy concerns and practical difficulties, and if it improved depression and provided value for money for the National Health Service. It was more difficult than we expected to recruit people to the trial. Because of this, and difficulties in measuring the amount of antiretroviral therapy taken, we did not show that people who received the Supporting UPtake and Adherence to antiretroviral therapy intervention took more antiretroviral therapy over 12 months than those who received normal care. People who received the Supporting UPtake and Adherence to antiretroviral therapy intervention benefited from reduced concerns about antiretroviral therapy and antiretroviral therapy interfered less in their lives. People who received the Supporting UPtake and Adherence to antiretroviral therapy intervention were also less depressed and used fewer extra National Health Service services. The Supporting UPtake and Adherence to antiretroviral therapy service represented value for money in the short term. Scientific summary Background Antiretroviral therapy (ART) is highly effective and the majority of people living with human immunodeficiency virus (PLWH) in the UK now have an undetectable viral load and a near-normal life expectancy and pose a low risk of onward human immunodeficiency virus (HIV) transmission. However, adherence to ART is necessary to suppress and maintain an undetectable HIV viral load. Substantial numbers of PLWH in the UK are not prescribed ART or have a detectable viral load when prescribed ART. This is a problem because both delays to start ART and non-adherence compromise the health and well-being of PLWH, increase the risk of HIV transmission and increase NHS costs. There is a need for a pragmatic, evidence-based approach to increase uptake and adherence to ART. Interventions to increase adherence across long-term conditions have had limited success, and it is not yet clear which strategies are most effective. To optimise engagement with ART, there is a need to understand why people with HIV may not want to, or be unable to, initiate and take ART. Our preparatory research was conducted across multiple chronic illnesses, including HIV infection, and in different cultural contexts and showed that adherence was consistently related to both perceptions of their treatment [i.e. how patients judged their personal necessity for treatment (necessity beliefs) relative to their concerns about potential adverse effects] and practical difficulties with taking treatment, such as limitations in capability and opportunity. This work influenced the National Institute for Health and Care Excellence (NICE) guidelines for adherence that recommend tailoring adherence support to address the specific perceptual and practical barriers that are salient for the individual. Aim The aim of this programme was to improve engagement with ART (uptake and adherence) by addressing perceptual and practical barriers, providing the evidence base for HIV care and informing the implementation of NHS policy. Figure a shows an overview of the programme and highlights the various components of each workstream (WS). FIGURE aProgramme overview. AC, ancillary study; BMQ, Beliefs about Medicines Questionnaire; CAU, care as usual; CBT, cognitive–behavioural therapy; IPA, interpretative phenomenological analysis; RCT, randomised controlled trial; SUPA, Supporting UPtake and Adherence to ART. Objectives Identify culturally specific beliefs and other factors influencing uptake of and adherence to ART that have not emerged in previous research. Refine our existing methods for eliciting and measuring the salient perceptual and practical factors influencing uptake of and adherence to ART. Develop an intervention (including intervention manuals, materials and therapeutic intervention) to increase uptake of and adherence to ART. Determine the feasibility and acceptability of the intervention. Evaluate the efficacy of the intervention for increasing ART uptake and adherence. Assess the costs and cost-effectiveness of providing the intervention in the short and long term. Prepare for implementation within the NHS. Methods and results Workstream 1: intervention development Workstream 1 addressed objectives 1–3 in three studies from discussions with our patient and public involvement group, clinical advisors and our analysis of gaps in the published literature on adherence to antiretrovirals, it became apparent that people from UK Black African and Caribbean communities often experience difficulties with HIV treatment, but few studies have focused on this group. We therefore paid particular attention to this group in our intervention development studies. Study 1 identified culturally specific beliefs and other factors influencing the uptake of and adherence to ART in Black African and Caribbean communities that have not emerged in previous research. We interviewed 52 men and women from Black African and Caribbean communities in London who had been identified as having previous or current problems adhering to their medication. Two separate analyses were conducted. The first used interpretative phenomenological analysis to understand the lived experiences of taking ART among a group of women from West Africa (n = 10), which was a previously under-represented community in HIV adherence research. The analysis identified issues and challenges that the women experienced with adherence to ART. The following three overarching themes were identified: (1) negative experiences of medication, (2) temporal improvement and (3) spurs to adherence. The second analysis used framework analysis to identify perceptual and practical barriers to adherence (n = 52). This analysis of in-depth interviews with people with demonstrated suboptimal adherence showed that perceptual barriers to ART could be grouped into two overarching themes: doubts about the need for ART and concerns about potential harm and stigma. The findings of our preparative research were discussed with patient representatives and practising clinicians from centres with a large proportion of men who have sex with men (MSM). The consistent view was that our preparative research findings remained relevant for MSM and that further research in this group to inform our measures of perceptual and practical barriers to ART was unnecessary. Study 2 refined existing methods to measure patients’ perceptions of ART. The study 1 findings were used to refine our measures of perceptual and practical barriers to ART uptake and adherence with four items added to the Beliefs about Medicines Questionnaire (BMQ)-ART. Study 3 developed an intervention to address barriers and facilitate ART uptake and adherence. Medical Research Council guidance was applied to develop a cognitive–behavioural therapy (CBT)-based intervention to support uptake and adherence to ART. The intervention, intervention manual and animations were developed by an Intervention Development Group, including experts in adherence, behaviour change theory, CBT, HIV medicine, nursing, pharmacy and HIV patient advocacy. It was informed by our preparatory research and the findings of study 1, incorporating: standardised information about HIV and its treatment, designed to address common, adherence-related misconceptions and concerns and signpost patients to further support to help overcome practical difficulties with taking ART and reduce the degree to which ART interfered with daily living (ART intrusiveness), delivered through an animated video and a booklet personalised discussion with a HIV nurse to introduce the Supporting UPtake and Adherence to ART (SUPA) video and booklet and address barriers to adherence, applying CBT techniques in up to four sessions – the first was face to face, with further sessions in clinic or by telephone follow-up, determined by patient preference. The intervention manual and animation were reviewed by the SUPA management group and members of the target population. User testing and further development of materials were conducted with PLWH, who were recruited through the Africa Advocacy Foundation (AAF). Workstream 2: feasibility and acceptability of the Supporting UPtake and Adherence to antiretroviral therapy (cognitive–behavioural therapy) intervention Study 4 determined the feasibility and acceptability of the SUPA (CBT) intervention. Study 4 included the following two components. Quantitative feasibility study nested within the randomised controlled trial to determine the feasibility of the Supporting UPtake and Adherence to antiretroviral therapy intervention Over an initial period of 14 months, 213 PLWH were recruited to an observational study, of whom 86 were eligible for the randomised controlled trial (RCT) and 46 were successfully randomised [23 to the care as usual (CAU) group and 23 to the CBT group]. Rates of attrition were low: of the 213 patients enrolled in the observational study, only 5 were not reached for follow-up appointments. Of the 46 patients randomised, 2 withdrew. Qualitative feasibility study The qualitative feasibility study was a thematic analysis of qualitative interviews conducted with people randomised to receive the SUPA intervention. This analysis determined the acceptability of the SUPA intervention and explored the process of change. Twenty-four people from the PLWH community in the UK were interviewed about their experiences of taking part in the trial and receiving the SUPA intervention. Participants reported various reasons for enrolling in the trial, including the desire to learn about HIV and its treatment, play an active role in their health care, and give something back to other PLWH. Intervention sessions gave participants the opportunity to discuss their concerns about ART and to receive confidential advice and support. Participants indicated that the intervention materials were relevant and accessible. The findings indicated that the intervention addressed misconceptions about HIV, provided a rationale for taking ART, reduced concerns about ART and provided practical strategies for adherence and emotional support. Workstream 3: randomised controlled trial efficacy of the Supporting UPtake and Adherence to antiretroviral therapy cognitive–behavioural therapy-based intervention to support antiretroviral therapy uptake and adherence The efficacy of the SUPA intervention was examined in a RCT. A two-step consent process was followed. ART-naive PLWH who had received a treatment offer were recruited from eight HIV clinics in England to take part in an observational study. Participants completed the BMQ-ART, and those who had perceptual barriers to ART (doubts about personal need for ART and/or concerns about ART), and were therefore deemed at risk of non-adherence, were invited to take part in the RCT. Those who consented to take part in the RCT were randomised to receive CAU or CBT (Figure b). Those who were not eligible for the RCT or who declined to take part remained in the observational study and completed the BMQ-ART at the 3-, 6- and 12-month follow-ups. FIGURE bThe SUPA study trial design. The primary end point was designed to capture both a delay to initiate treatment and non-adherence, and was developed in discussion with NIHR. In the months prior to ART initiation, adherence was set to 0%. After starting ART, the proportion of days within the month with full adherence was assessed using Medication Event Monitoring System (MEMS®) (AARDEX Group, Seraing, Belgium). Adherence within each patient-month was then classified as being good (≥ 90%) or poor (< 90%), and the prespecified primary outcome was met if individuals achieved good adherence in > 80% of the months during which they were under follow-up. The secondary outcomes were percentage MEMS adherence, self-reported adherence, changes in beliefs about ART, ART intrusiveness and practical difficulties with ART, perceptions of HIV, depression and anxiety, viral load suppression, regimen switches, treatment failure, and disengagement from care. Between March 2014 and July 2017, 1575 patients were assessed for eligibility, of whom 143 were randomised (CAU, n = 72; CBT, n = 71). Recruitment was challenging, and our target of 372 was not reached. The observational study included 484 individuals who were not eligible or chose not to take part in the RCT (RCT-eligible decliners at high non-adherence risk, n = 27; not eligible for RCT at low non-adherence risk, n = 457). Owing to the challenges in using MEMS, the number of participants with sufficient data for primary end-point analysis was 112 (CAU, n = 55; CBT, n = 57). Of those, 17 participants (15.2%) met the primary end point (> 80% of months, with an average monthly adherence of ≥ 90%) [9 (16.4%) in the CAU group and 8 (14.0%) in the CBT group (p = 0.94)]. There was no significant difference in the primary outcome (i.e. MEMS adherence) between the CBT and CAU groups at 12 months. There was a 7% improvement in median percentage adherence by MEMS in the CBT group relative to the CAU group (61.9% CAU and 66.5% CBT; p = 0.40). There was a significant increase in the proportion of people with high adherence (by self-reported Medication Adherence Report Scale) at 3 months’ follow-up (75% CAU and 81% CBT; p = 0.02). Participants randomised to receive CAU plus CBT benefited from a significantly greater reduction in ART concerns, ART intrusiveness and depression between baseline and 12 months than those randomised to receive CAU. There were no significant differences between the randomised groups in ART necessity beliefs (which were high in both groups), anxiety, illness perceptions, viral load, cluster of differentiation 4 (CD4) T-cell count, rates of treatment failure or treatment switches. Workstream 4: economic studies Workstream 4, study 6, addressed objective 6: assessing the costs and cost-effectiveness of the SUPA intervention in the short and long term. It comprised three substudies, as follows. Systematic review of economic evaluations of antiretroviral therapy adherence interventions A systematic literature search identified 20 studies reporting costs or cost-effectiveness of interventions to increase adherence to ART in PLWH. The quality of the economic evaluations was assessed. There was evidence of improved adherence and favourable cost-effectiveness ratios in people receiving adherence interventions compared with the control conditions. However, these effects tended to be short term. Trial-based cost-effectiveness analysis of the Supporting UPtake and Adherence to antiretroviral therapy intervention Use of the intervention and other health and social care services and HIV-specific medications were measured in the RCT (i.e. study 5) and costs were calculated. Quality-adjusted life-years (QALYs) were generated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Costs were compared at baseline and each follow-up time point. QALYs were compared, controlling for baseline EQ-5D-5L tariffs. Cost-effectiveness was assessed by combining incremental costs and incremental QALYs using an incremental cost-effectiveness ratio (ICER). The mean costs among the CBT group were £621 more than for the CAU group. This difference was not statistically significant [95% confidence interval (CI) –£569 to £1462]. CBT resulted in 0.056 more QALYs over the follow-up period than CAU, and this was significant (95% CI 0.0029 to 0.083). The ICER was £9143 per QALY. At a threshold of £20,000 per QALY, there was more than a 90% likelihood that CBT would be more cost-effective than CAU. There was a 19% likelihood that CBT would produce more QALYs and result in lower health and social care costs than CAU. A simulation model of the long-term cost-effectiveness of the intervention A Markov model was used to extrapolate for 15 years, in 12-month cycles beyond the trial period. Health states were defined by CD4 T-cell counts and all-cause mortality. The expected costs for those receiving CBT and CAU in the 15 years after the trial follow-up were less for CBT than for CAU, but CBT also resulted in fewer QALYs. Combining the trial period with the 15-year extrapolation period resulted in CBT having costs that were lower by £470 and 0.47 fewer QALYs. Therefore, in the long term, CAU is cost-effective with an ICER of £1187 per QALY. Workstream 5: preparing for implementation within the National Health Service Workstream 5 was intended to address objective 7: prepare for implementation within the NHS. Owing to the extended time needed for recruitment to the RCT, we were unable to carry out a full implementation WS. We have planned implementation strategies informed by NICE guidance on how to change practice. These involve identifying barriers to implementation by conducting study discussion groups in HIV clinics, discussion of our findings with HIV commissioners and conducting focus groups with PLWH at AAF. Workstream 6 (additional workstream): ancillary studies During the programme, we conceived an additional seven ancillary studies (WS6): patients’ perceptions of standard care ART perceptions and treatment outcomes in HIV-positive patients starting ART to protect their partners (treatment as prevention) compared with clinical need the level ART adherence required to achieve virological suppression in treatment-naive patients a systematic review and meta-analysis examining the content of effective adherence interventions beliefs about ART as predictors of side effects (analysis of historical data) associations between self-reported adherence and electronic monitoring of adherence the effect of the SUPA intervention on rates of engagement with HIV services. These ancillary studies were conceived on the assumption of complete and timely recruitment to the SUPA RCT; however, recruitment was lower and slower than expected for this hard-to-reach study population. Consequently, only six ancillary studies were feasible (1–6). Conclusions The SUPA programme fulfilled its objectives to develop and evaluate a pragmatic, theory-based intervention to support ART uptake and adherence among PLWH at risk of non-adherence by addressing perceptual and practical barriers. Recruitment to the SUPA RCT was slower than anticipated and our trial was underpowered with no effect on the primary outcome measure of adherence over 12 months. However, the SUPA intervention benefited recipients by reducing ART concerns, ART intrusiveness and depression and improving quality of life. It was also cost-effective during the follow-up period. Study registration The trial is registered as ISRCTN35514212 and the study is registered as CRD42019072431. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-0109-10047) and is published in full in Programme Grants for Applied Research; Vol. 13, No. 8. See the NIHR Funding and Awards website for further award information.

Evan S. Manning, MD, MPP, Gautam R. Shroff, MD, David R. Jacobs, Jr., PhD et al.

Background: Inflammation plays a role in cardiovascular disease (CVD). We defined various noncardiovascular and noncancer conditions, both infectious and noninfectious, with a common basis of inflammation, collectively termed chronic inflammatory-related disease (ChrIRD). We describe ChrIRD and its interplay with CVD during follow-up in the Multi-Ethnic Study of Atherosclerosis. Objectives: The aim of the study was to describe ChrIRD, its associations with CVD, and its association with mortality. Methods: Participants were free of overt CVD at baseline with median 17.9 (Q1-Q3: 14.9-18.6) years of follow-up. ChrIRD was determined by review of hospitalization and death records of International Classification of Diseases codes. CVD diagnosis was adjudicated based on medical records. We performed time-dependent proportional hazard regressions to identify risks related to ChrIRD or CVD events. Results: MESA (Multi-Ethnic Study of Atherosclerosis) participants (n = 6,791) had a mean age of 62 ± 10 years, with 47% (3,201/6,791) men, 39% (2,617/6,791) White, 28% (1,882/6,791) Black, 22% (1,489/6,791) Hispanic, and 12% (803/6,791) Chinese race/ethnicity. ChrIRD was observed in 29% (1,965/6,791) and CVD in 21% (1,420/6,791); including 11% (761/6,791) with both conditions. Mortality after ChrIRD only was 47% (567/1,204; 95% CI: 44%-49%); after CVD only was 45% (300/659; 95% CI: 41%-49%); and after both conditions was 67% (510/761; 95% CI: 63%-70%). CVD was associated with increased risk of ChrIRD (HR: 1.48, 1.23-1.77) and ChrIRD was associated with increased risk of CVD (HR: 2.23, 1.97-2.52). Baseline inflammatory markers predicted both conditions. Conclusions: ChrIRD is common, present in all organ systems, and is associated with significant mortality, particularly in combination with CVD. The association between CVD and ChrIRD is bidirectional, and baseline inflammatory markers are associated with ChrIRD and CVD.

P. Wood, M. Stefanick, Paul T. Williams et al.

Shelley E. Taylor, M. Kemeny, L. Aspinwall et al.

Hector Galindo-Silva, Paula Herrera-Idárraga

This study investigates the impact of integrating gender equality into the Colombian constitution of 1991 on attitudes towards gender equality, experiences of gender-based discrimination, and labor market participation. Using a difference-in-discontinuities framework, we compare individuals exposed to mandatory high school courses on the Constitution with those who were not exposed. Our findings show a significant increase in labor market participation, primarily driven by women. Exposure to these courses also shapes attitudes towards gender equality, with men demonstrating greater support. Women report experiencing less gender-based discrimination. Importantly, our results suggest that women's increased labor market participation is unlikely due to reduced barriers from male partners. A disparity in opinions regarding traditional gender norms concerning household domains is observed between men and women, highlighting an ongoing power struggle within the home. However, the presence of a younger woman in the household appears to influence men's more positive view of gender equality, potentially indicating a desire to empower younger women in their future lives. These findings highlight the crucial role of cultural shocks and the constitutional inclusion of women's rights in shaping labor market dynamics.

Ts. B. Georgiev, R. K. Zamanov, S. Y. Stefanov

We analyzed TESS photometric data of the flickering-active cataclysmic star AQ Men in 2018--2019. We processed 7 sectors with 14 light curves (LCs) inside them, with a time resolution of 2 min. Aiming to study the "macro-flickering", with quasi periods (QPs) between 10 and 100 hours, we processed LCs after 55 time reduced, with a time resolution of 1.83 hours. The method, developed earlier by us, includes comparing the LCs by their statistical and fractal parameters, as well as revealing QPs by minima of structure functions and relevant maxima of autocorrelation functions. We distinguish the known high state of AQ Men, in the sectors ## 01, 05, 08, 12, 13, as well as the low state, in sectors #19, #20. In the low state the LCs show noticeable eclipses with period 3.4 h, lower average fluxes, higher scatters, and additional QPs. By its statistical and fractal parameters, the macro-flickering of AQ Men in the high state is similar to the ordinary flickering of 3 symbiotic binaries, studied by us earlier (see below). We found 92 QPs in the range of 20--70 h. We reveal 3 QP modes, at 20.9 h, 32.5 h and 54.1 h (1.149, 0.738 and 0.434 c/d; Fig. 7) within a standard error about 10%. The last mode is the most populated one and seems to be a manifestation of the superorbital period. Other 4 QP modes of AQ Men are added from the literature. The regularity of these 7 QP modes follows a power function with a base 1.57 and standard deviation 6.4% (Fig. 8). This power model prognosticates 5 other QP modes: 3 internal and 2 external (Table 2). The bases of the power regularity models for the flickering of the symbiotic binaries RS Oph, T CrB, and MWC 560 (however in the time scale of minutes) are 1.55, 2.0, and 1.34, respectively (Table 1). For unknown reasons in these 4 cases we find (i) regularities with (ii) different bases.

Jingyi Liao, Xiao Fan Liu, Xiao-Ke Xu et al.

Unfolding different gender roles is preceding the efforts to reduce gender inequality. This paper analyzes COVID-19 family clusters outside Hubei Province in mainland China during the 2020 outbreak, revealing significant differences in spreading patterns across gender and family roles. Results show that men are more likely to be the imported cases of a family cluster, and women are more likely to be infected within the family. This finding provides new supportive evidence of the men as breadwinner and women as homemaker (MBWH) gender roles in China. Further analyses reveal that the MBWH pattern is stronger in eastern than in western China, stronger for younger than for elder people. This paper offers not only valuable references for formulating gender-differentiated epidemic prevention policies but also an exemplification for studying group differences in similar scenarios.

Riccardo Leoncini, Mariele Macaluso, Annalivia Polselli

This paper aims to evaluate how changing patterns of sectoral gender segregation play a role in accounting for women's employment contracts and wages in the UK between 2005 and 2020. We then study wage differentials in gender-specific dominated sectors. We found that the propensity of women to be distributed differently across sectors is a major factor contributing to explaining the differences in wages and contract opportunities. Hence, the disproportion of women in female-dominated sectors implies contractual features and lower wages typical of that sector, on average, for all workers. This difference is primarily explained by "persistent discriminatory constraints", while human capital-related characteristics play a minor role. However, wage differentials would shrink if workers had the same potential and residual wages as men in male-dominated sectors. Moreover, this does not happen at the top of the wage distribution, where wage differentials among women working in female-dominated sectors are always more pronounced than those of men.

E. V. Assche, M. Bonduelle, H. Tournaye et al.

Tsubasa Tsutsumi, Dan Nakano, Machiko Kawaguchi et al.

Abstract Background and aim Metabolic dysfunction and associated systemic inflammation are risk factors for chronic obstructive pulmonary disease (COPD) and COPD is highly prevalent in men. We investigated the impact of metabolic-associated fatty liver disease (MAFLD) and MAFLD-related systemic inflammation on COPD in men. Methods We enrolled 2,041 men with fatty liver. Patients were classified into the COPD (n = 420/2041) and non-COPD (n = 1621/2041) groups. COPD and its high-risk group were diagnosed using the Japanese Respiratory Society Disease statement. Systemic inflammation was evaluated using the C-reactive protein (CRP)/albumin ratio. Independent factors for COPD were investigated by multivariate analysis and decision-tree analysis. Results The prevalence of MAFLD was significantly higher in the COPD group than in the non-COPD group. In multivariable analysis, in addition to heavy smoking and aging, MAFLD was identified as an independent factor for COPD (OR 1.46, 95% CI 1.020–2.101, P = 0.0385). Decision-tree analysis showed that MAFLD, rather than heavy smoking, was the most influential classifier for COPD in non-elderly men (14% in MAFLD vs 6% in non-MAFLD groups). MAFLD was also the second most influential factor in elderly men who were not heavy smokers. In both groups, the CRP/albumin ratio was the first classifier for COPD (16% in the high CRP/albumin ratio group vs 3% in the low CRP/albumin ratio group of non-elderly men). Conclusions MAFLD is an independent predictor of COPD in men. MAFLD had a significant impact on COPD through systemic inflammation in men of all ages who were not heavy smokers. MAFLD may be useful to broadly identify COPD in men.

Nikolina Bogdanić, Josip Begovac, Loris Močibob et al.

The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal–oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.

Antoni Nadbrzeżny

Inspired both by the phenomenological thought of Karol Tarnowski and Józef Tischner and the personalist theology of Czeslaw Bartnik, the article fits into contextual soteriology which deliberately uses the method of correlation. The aim of this article is to present the Christian meaning of salvation in the context of one of the most moving existential experiences, that is the experience of anxiety (Angst). The indelible phenomenon of anxiety raises important soteriological questions: Who or what can bring the fullness of salvation to men and women? In what circumstances is the experience of salva­tion possible to the human being who is called an “anxious existence”? The first part of the article shows the essential difference between anxiety and fear (in contrast to fear, the matter of anxiety is real but indeterminate). The second part presents an ambivalent character of anxiety (anxiety can lead to despair or to salvation) and human attempts to overcome anxiety through falling into an inauthentic existence (a utopia of “salvation by fashion”). The third part characterizes an “eschatological conscience” (a con­science filled with anxiety of tragic finality) and its antithesis in the form of a “soteriological conscience” (a conscience which is open to the possibility of salvation coming from God). The last part of the article argues that the phenomenon of authentic interpersonal encounter is a necessary condition to experi­ence the salvation coming from God in Christ.

Farzan Madadizadeh, Seyed Yaser Ghelmani, Tahare Fallah Tafti

Introduction: Yazd province is the center of Iran and the highway for travelers to other cities. This province is susceptible to disease transmission in Iran. This study aimed to spatial analysis of corona virus prevalence, predicting the spread and determination of hot spot areas in Yazd province, central part of Iran. Methods: This analytical Cross-sectional study was conducted in Yazd province from February 2020 to January 2021. Patients with COVID-19 admitted to hospitals in Yazd province were selected by census. Required information includes the number of patients as well as their place of residence were collected through the hospital information system (HIS) of Shahid Sadoughi Hospital in Yazd, Iran. The inclusion criteria were positive polymerase chain reaction (PCR) test for COVID-19 and registration of patient information in the hospital emergency department. After collecting the data, it was entered into the ArcGIS software is 9.3.1. software. Moran's I measure and chi square test were used to data analysis. Significant level were considered 5 %. Results: Overall disease prevalence in Yazd province was equal to 0.0053. The prevalence of disease was higher in men women (55.7%, 3412 cases). The highest prevalence of the disease occurred in Yazd city (0.0096) and the highest death occurred in Meybod city (20.8%). Bahabad city also had the highest number of transfer (2.7%). Areas one (15.2% and 932 patients) and two (15.9% and 975 patients) of Yazd city were the most infected areas. There was no significant spatial pattern between the prevalence of the disease in the cities (Moran's Index: 0.18, P-value = 0.58). Conclusion: There was no spatial pattern in the prevalence of the disease and only in the city of Yazd, regions one and two need the special attention of policymakers.