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Search Results: 1 - 10 of 199512 matches for " Kathleen N. Deering "
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Condom use within non-commercial partnerships of female sex workers in southern India
Deering Kathleen N,Bhattacharjee Paranita,Bradley Janet,Moses Stephen S
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-s6-s11
Abstract: Background Although female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners. There is limited understanding regarding the factors that influence condom use with FSWs’ non-commercial partners, and of how programs can be designed to increase condom use with these partners. The main objectives of this study were therefore to describe FSWs’ self-reported non-commercial partners, along with interpersonal factors characterizing their non-commercial partnerships, and to examine the factors associated with consistent condom use (CCU) within non-commercial partnerships. Methods This study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006-07. We used bivariate and multivariable logistic regression analysis to examine the relationship between CCU (i.e., ‘always’ compared to ‘never’, ‘sometimes’ or ‘frequently’) with non-commercial partners of FSWs (including the respondents’ husband or main cohabiting partner [if not married] and their most recent non-paying partner [who is neither a husband nor the main cohabiting partner, and with whom the FSW had sex within the previous year]) and interpersonal factors describing these partnerships, as well as social and environmental factors. Weighting and survey methods were used to account for the cluster sampling design. Results Overall, 511 (51.8%) FSWs reported having a husband or cohabiting partner and 247 (23.7%) reported having a non-paying partner. CCU with these partners was low (22.6% and 40.3% respectively). In multivariable analysis, the odds of CCU with FSWs’ husband or cohabiting partner were 1.8-fold higher for FSWs whose partner knew she was a sex worker (adjusted odds ratio [AOR]: 1.84, 95% confidence intervals[CI]: 1.02-3.32) and almost 6-fold higher if the FSW was unmarried (AOR: 5.73, 95%CI: 2.79-11.76]. CCU with FSWs’ non-paying partner decreased by 18% for each one-year increase in the duration of the relationship (AOR: 0.82, 95%CI: 0.68-0.97). Conclusions This study revealed important patterns and interpersonal determinants of condom use within non-commercial partnerships of FSWs. Integrated structural and community-driven HIV/STI prevention programs that focus on gender and reduce sex work stigma should be investigated to increase condom use in non-commercial partnerships.
Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users
Souradet Y Shaw, Kathleen N Deering, Ann M Jolly, John L Wylie
Harm Reduction Journal , 2010, DOI: 10.1186/1477-7517-7-16
Abstract: Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression.A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepatitis C (AOR: 3.5; 95%CI: 1.3,14.7), to have shared needles in the last six months (AOR: 2.6; 95%CI:1.0,6.8), and to have injected talwin & Ritalin (AOR: 10.0; 95%CI: 3.8,26.3).High hepatitis C prevalence, even after controlling for risky injection practices, suggests that solvent users may form closed networks of higher risk even amongst an already high-risk IDU population. Understanding the social-epidemiological context of initiation and maintenance of solvent use is necessary to address the inherent inequalities encountered by this subpopulation of substance users, and may inform prevention strategies for other marginalized populations.In developed countries, sexually transmitted infections (STI) and bloodborne pathogens (BBP) disproportionately affect marginalized populations. In the United States, Australia, and Canada the combined impact of poverty, lack of access, and historical and systemic oppression have resulted in overrepresentation of indigenous populations in national HIV/AIDS and STI statistics, especially amongst females and youth[1-6]. Within Canada, injection drug users (IDU) account for a significant proportion of prevalent HIV and other BBP (such as hepatitis C [HCV]) infections, and are an especially important risk group sustaining endemicity of these pathogens within Aboriginal populations[4,7-9]. However, despite progress in, and substantial efforts towards both understanding, and addressing BBP epidemics in Canadian Aboriginal populations[7], the transmissio
A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India
Deering Kathleen N,Boily Marie-Claude,Lowndes Catherine M,Shoveller Jean
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-s6-s8
Abstract: Background The Avahan Initiative, a large-scale HIV preventive intervention targeted to high-risk populations including female sex workers (FSWs), was initiated in 2003 in six high-prevalence states in India, including Karnataka. This study assessed if intervention exposure was associated with condom use with FSWs’ sexual partners, including a dose-response relationship. Methods Data were from a cross-sectional study (2006-07) of 775 FSWs in three districts in Karnataka. Survey methods accounted for the complex cluster sampling design. Bivariate and multivariable logistic regression was used to separately model the relationships between each of five intervention exposure variables and five outcomes for consistent condom use (CCU= always versus frequently/sometimes/never) with different sex partners, including with: all clients; occasional clients; most recent repeat client; most recent non-paying partner; and the husband or cohabiting partner. Linear tests for trends were conducted for three continuous intervention exposure variables. Results FSWs reported highest CCU with all clients (81.7%); CCU was lowest with FSWs’ husband or cohabiting partner (9.6%). In multivariable analysis, the odds of CCU with all clients and with occasional clients were 6.3-fold [95% confidence intervals, CIs: 2.8-14.5] and 2.3-fold [95% CIs: 1.4-4.1] higher among FSWs contacted by intervention staff and 4.9-fold [95% CIs: 2.6-9.3] and 2.3-fold [95% CIs: 1.3-4.1] higher among those who ever observed a condom demonstration by staff, respectively, compared to those who had not. A significant dose-response relationship existed between each of these CCU outcomes and increased duration since first contacted by staff (P=0.001; P=0.006) and numbers of condom demonstrations witnessed (P=0.004; P=0.026); a dose-response relationship was also observed between condom use with all clients and number of times contacted by staff (P=0.047). Intervention exposure was not associated with higher odds of CCU with the most recent repeat client, most recent non-paying partner or with the husband or cohabiting partner. Conclusion Study findings suggest that exposure to a large-scale HIV intervention for FSWs was associated with increased CCU with commercial clients. Moreover, there were dose-response relationships between CCU with clients and increased duration since first contacted by staff, times contacted by staff and number of condom demonstrations. Additional program effort is required to increase condom use with non-commercial partners.
Prevalence of HIV and sexually transmitted infections among clients of female sex workers in Karnataka, India: a cross-sectional study
Shaw Souradet Y,Deering Kathleen N,Reza-Paul Sushena,Isac Shajy
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-s6-s4
Abstract: Background Studies have demonstrated the significance of commercial sex work in the ongoing transmission of HIV and other sexually transmitted infections (STIs) in India. Clients of female sex workers (FSWs) are thought to be an important bridging population for HIV/STIs. However, there is a lack of information on basic characteristics of sex work clients. This study sought to describe the prevalence of HIV and other STIs, as well as examine the determinants of these pathogens among a sample of clients in south India. Methods Data were from a cross-sectional biological and behavioural survey of FSW clients from six districts in Karnataka State, India. The prevalence of HIV, syphilis, herpes simplex virus type 2 (HSV-2), chlamydia (CT) and gonorrhoea (NG) among clients was examined. Multivariable logistic regression models were used to analyse the socio-demographic, sexual behaviour and sex-work related characteristics related to the prevalence of each pathogen. Sampling weights and appropriate survey methods were utilized in regression models to account for complex sampling design. Results The total sample size was 2,745. The average age of clients was 30.4 (SE:0.3). Across the total sample, the prevalence of HIV, HSV-2, syphilis and CT/NG was 5.6%, 28.4%, 3.6% and 2.2%, respectively. The prevalence of HIV/STIs varied substantially across districts, reaching statistical significance for HIV (p<.0001) and CT/NG (p=.005). In multivariable models, duration of paying for commercial sex was associated with increased risk for HIV and HSV-2 (AOR: 1.1; 95%CI: 1.0-1.1, p<.0001). Clients with brothels as a main FSW solicitation site were associated with increased risk of HIV (AOR: 2.4; 95%CI: 1.2-4.7, p=.001), while those frequenting lodges were at increased risk for CT/NG (AOR: 6.3; 95%CI: 1.9-20.6, p=.03). Examining co-infections, clients with HSV-2 infections were at substantially higher risk of being HIV-positive (AOR: 10.4; 95%CI: 6.1-17.7, p<.0001). Conclusions This study fills in important gaps in knowledge regarding clients in southern India. The strong association between HIV and HSV-2 infections highlights the complications in designing effective prevention, intervention and management programs of this well-hidden population.
High Prevalence and Partner Correlates of Physical and Sexual Violence by Intimate Partners among Street and Off-Street Sex Workers
Elena Argento, Katherine A. Muldoon, Putu Duff, Annick Simo, Kathleen N. Deering, Kate Shannon
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0102129
Abstract: Objectives Intimate partner violence (IPV) is associated with increased risk of HIV among women globally. There is limited evidence and understanding about IPV and potential HIV risk pathways among sex workers (SWs). This study aims to longitudinally evaluate prevalence and correlates of IPV among street and off-street SWs over two-years follow-up. Methods Longitudinal data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010–2012). Prevalence of physical and sexual IPV was measured using the WHO standardized IPV scale (version 9.9). Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine interpersonal and structural correlates of IPV over two years. Results At baseline, 387 SWs had a male, intimate sexual partner and were eligible for this analysis. One-fifth (n = 83, 21.5%) experienced recent physical/sexual IPV at baseline and 26.2% over two-years follow-up. In multivariable GEE analysis, factors independently correlated with physical/sexual IPV in the last six months include: childhood (<18 years) sexual/physical abuse (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI]: 1.14–3.69), inconsistent condom use for vaginal and/or anal sex with intimate partner (AOR = 1.84, 95% CI: 1.07–3.16),
Factors Associated with Sexual Violence against Men Who Have Sex with Men and Transgendered Individuals in Karnataka, India
Souradet Y. Shaw, Robert R. Lorway, Kathleen N. Deering, Lisa Avery, H. L. Mohan, Parinita Bhattacharjee, Sushena Reza-Paul, Shajy Isac, Banadakoppa M. Ramesh, Reynold Washington, Stephen Moses, James F. Blanchard
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0031705
Abstract: Objectives There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T. Design Data were from cross-sectional surveys from four districts in Karnataka, India. Methods Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV. Results A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2–14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1–2.7, p = .012). Conclusions These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services.
Homelessness among a cohort of women in street-based sex work: the need for safer environment interventions
Putu Duff, Kathleen Deering, Kate Gibson, Mark Tyndall, Kate Shannon
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-643
Abstract: Bivariate and multivariate logistic regression using generalized estimating equations (GEE) was used to examine the individual, interpersonal and work environment factors that were associated with homelessness among street-based sex workers.Among 252 women, 43.3% reported homelessness over an 18-month follow-up period. In the multivariable GEE logistic regression analysis, younger age (adjusted odds ratio [aOR] = 0.93; 95%confidence interval [95%CI] 0.93-0.98), sexual violence by non-commercial partners (aOR = 2.14; 95%CI 1.06-4.34), servicing a higher number of clients (10+ per week vs < 10) (aOR = 1.68; 95%CI 1.05-2.69), intensive, daily crack use (aOR = 1.65; 95%CI 1.11-2.45), and servicing clients in public spaces (aOR = 1.52; CI 1.00-2.31) were independently associated with sleeping on the street.These findings indicate a critical need for safer environment interventions that mitigate the social and physical risks faced by homeless FSWs and increase access to safe, secure housing for women.Emerging research suggests substantial health inequities exist among individuals without adequate, safe, and affordable shelter. Homelessness represents a unique social and physical environment that has been shown to substantially influence distribution of health inequities, risk taking and adverse health outcomes among marginalized populations [1,2]. "Absolute homelessness" is defined as "individuals living in the streets with no physical shelter of their own, including those who spend their nights in emergency shelters"[3]. Homelessness is a growing concern worldwide: according to a 2005 count, one billion people lack adequate housing, and approximately 100 million do not have housing at all [4]. In North America, homelessness is on the rise in many urban centres [5]. A 2005 homelessness count in the US estimated that 744,313 people experienced homelessness nationwide, with homelessness heavily concentrated in the country's major cities [5,6]. In the greater region of Vanco
Sufficient conditions for a flexible manufacturing system to be deadlocked
Paul E. Deering
International Journal of Industrial Engineering Computations , 2012,
Abstract: In recent years, researchers have been interested in scheduling algorithms to avoid deadlock in Flexible Manufacturing Systems (FMS). FMS are discrete event systems characterized by the availability of resources to produce a set of products. Raw parts, which belong to various product types, enter the system at discrete times and are processed concurrently while sharing a limited number of resources. In such systems, a situation may occur in which parts become permanently block. This is called deadlock. This paper presents the sufficient conditions for deadlock to exist in a FMS; it models a FMS using digraphs to calculate slack, knot, order and space; it identifies three types of circuits that are fundamental in determining if a FMS is in deadlock.
Primary Pulmonary Synovial Sarcoma in Pregnancy
K. Bunch,S. H. Deering
Case Reports in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/326031
Abstract: Background. Primary pulmonary synovial sarcoma is a rare malignancy with a poor prognosis. Surgical resection and postoperative management of these tumors has not been previously described in pregnancy. Case. A 38-year-old pregnant woman was admitted for evaluation of a right thoracic mass found on chest radiography at 26 weeks of gestation. A computed tomography-guided biopsy was subsequently completed and demonstrated a high-grade neoplasm. A right pneumonectomy was performed at 28 weeks of gestation due to pulmonary decompensation, and pathological examination revealed a pulmonary synovial sarcoma. The patient developed a postpartum pulmonary embolism and expired 6 weeks after delivery. Conclusion. Aggressive intervention for pulmonary malignancies during pregnancy may be necessary. Complete tumor resection is the most important prognostic factor in primary pulmonary synovial sarcoma.
Primary Pulmonary Synovial Sarcoma in Pregnancy
K. Bunch,S. H. Deering
Case Reports in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/326031
Abstract: Background. Primary pulmonary synovial sarcoma is a rare malignancy with a poor prognosis. Surgical resection and postoperative management of these tumors has not been previously described in pregnancy. Case. A 38-year-old pregnant woman was admitted for evaluation of a right thoracic mass found on chest radiography at 26 weeks of gestation. A computed tomography-guided biopsy was subsequently completed and demonstrated a high-grade neoplasm. A right pneumonectomy was performed at 28 weeks of gestation due to pulmonary decompensation, and pathological examination revealed a pulmonary synovial sarcoma. The patient developed a postpartum pulmonary embolism and expired 6 weeks after delivery. Conclusion. Aggressive intervention for pulmonary malignancies during pregnancy may be necessary. Complete tumor resection is the most important prognostic factor in primary pulmonary synovial sarcoma. 1. Introduction Soft-tissue synovial sarcomas commonly arise in paraarticular locations of the extremities but are rarely found in the lungs. Primary pulmonary synovial sarcoma is an aggressive tumor accounting for approximately 0.05% of all primary lung malignancies [1, 2]. The most common presenting symptoms include chest pain, cough, dyspnea, and hemoptysis. Diagnosis is made by a combination of radiologic imaging, histologic analysis, and cytogenetic testing. The recent identification of a chromosomal translocation specific to pleuropulmonary synovial sarcoma has increased the recognition of this particular sarcoma subtype. The chromosomal translocation t(x;18) is present in more than 80% of cases of primary pulmonary synovial sarcoma [3]. The mainstays of treatment are surgical resection followed by radiation or chemotherapy. 2. Case Presentation A 38-year-old African American woman at 26 weeks' gestation presented with a 3-week history of dyspnea, upper right back pain, and orthopnea. Her pregnancy was complicated by the finding of a small fetal ventricular septal defect on ultrasound. The remainder of her medical history was noncontributory. Physical examination revealed a patient in moderate distress with a heart rate of 126, blood pressure 140/68, and respiratory rate of 25. Auscultation was notable for crackles in the base of the right lung. Chest roentgenography demonstrated complete opacification of the right lower lobe with an adjacent effusion. A computed tomography (CT) angiogram was performed revealing a large, 12?cm partially calcified mass in the right chest with broad-based apposition to the mediastinum. This was followed by a CT-guided needle biopsy
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