Thursday, January 10, 2013

seeking comments on supporting the sexual orientation and gender identity data collection in Stage 3 Meaningful Use Guidelines


Hello Everyone,

Long story short we are all pushing for and/or understand the importance of comprehensive inclusion of LGBT communities in all surveillance instruments through sexual orientation and gender identity measures. Currently the Health Information Technology Policy Committee is seeking comments on supporting the sexual orientation and gender identity data collection in Stage 3 Meaningful Use Guidelines.


By the Close of Business day we are hoping to get as many CEO’s and Directors of Organizations, Foundations etc. to sign on to a letter developed by the Fenway Institute and the Center for American Progress. 

 

 

 
Gustavo Torrez | Program Manager, The Network for LGBT Health Equity. The Fenway Institute | Fenway Health, Ansin Building, 8th Floor, 1340 Boylston Street | Boston, MA 02215  voice: 617.927.6451 | fax: 617.267.0764 www.lgbthealthequity.org www.thefenwayinstitute.org

Mortality attributable to smoking among HIV-1-infected individuals

Reposted at http://www.keystotheclosetblogspot.com

Anyone else read the recent publication "Mortality attributable to smoking among HIV-1-infected individuals" in Clinical Infectious Disease? 

A summary from AIDSmap.com  is included at the bottom for those without academic journal access.

The main figure: Number of Life-Years Lost:

HIV among never smokers: 5.1 

(never smoking HIV patients vs never smoking controls)

Smoking among controls: 3.6 

(comparing smoking HIV-neg to never smoking HIV-neg) 

Smoking among HIV patients: 12.3

(comparing  smoking HIV+ to non-smoking HIV+)

Though this number is pretty shocking, I find some of the methodology suspect (though I'm no biostatistician - correct me if I'm wrong).
 
I don't exactly know how the number of life years lost due to smoking could be so different for HIV+ and HIV- groups (12.3 YLLs vs 3.6 YLLs) without an interaction between smoking and HIV (or, alternatively, a very important confounding variable). But they write: "One might speculate that smoking could have a synergistic rather than additive effect on inflammation in HIV-infected individuals, but we found no interaction between HIV and smoking in the associated risk of death."

 
Also, look at table 2 -  there's such drastic differences in AIDS related mortality for smokers and nonsmokers (considerably more than the disparities in cardiovascular disease), and previous smokers are similar to current smokers rather than non-smokers. To me, this suggests that there are SES or demographic differences between smokers (past or present) and non-smokers that this study is not controlling for that impact access to and retention in care, health behaviors more broadly, etc.

 
Just wanted to through my 2 cents out there. Interesting work, and I'm glad its being read and forwarded.

 - Sam Bakkila

----------------------------------------------------------
Michael Carter
Published: 31 December 2012

Much of the increased mortality seen in patients with HIV can be attributed to smoking, Danish investigators report in the online edition of Clinical Infectious Diseases. “The loss of life-years associated with smoking was larger than that associated with HIV,” write the investigators. The authors believe their findings have important implications for HIV care, showing the importance of smoking cessation counselling and support.

Thanks to antiretroviral therapy, the prognosis of many HIV-positive patients is now excellent. Rates of HIV-related illnesses and deaths have fallen dramatically since the mid 1990s, meaning that lifestyle-related factors are now a major cause of morbidity and mortality in HIV-infected individuals.

A number of studies have shown that HIV-positive individuals are more likely to smoke than their HIV-negative peers. Illnesses that are potentially related to smoking, such as cardiovascular disease and cancers, are being seen with increased frequency in HIV-positive patients. The role of smoking and other potentially modifiable risk factors is currently unclear.

Investigators from Denmark therefore designed a study to evaluate the effect of smoking on mortality among patients with HIV. They also compared the risk of death and loss of life-years associated with smoking with the risk associated with HIV-related factors.

The study population involved 2921 adults who received HIV care between 1995 and 2010. Injecting drug users were excluded from participation. The HIV-infected patients were matched with 10,642 controls.

Both the patients and the controls were followed for a median of four years.

Among HIV-positive patients, 47% were current smokers, 18% were former smokers and 35% had never smoked. The corresponding rates for the controls were 21%, 33% and 47%.

The excess mortality rate for HIV-positive current smokers (compared to HIV-positive patients who had never smoked) was 18 per 1000 patient years. The corresponding rate for the HIV-negative controls was 5 per 1000 patient years.

The risk of non-HIV-related death was five-fold higher for current smokers compared to HIV-infected patients who had never smoked. HIV-positive patients who were current smokers also had a four-fold increase in their risk of all-cause mortality.

The risk of death due to cardiovascular disease was approximately two times higher for HIV-positive current smokers compared to HIV-positive non-smokers. Current smokers were also three times more likely to die of cancer.

Smoking had a significant impact on the life expectancy of HIV-positive patients.

The authors calculated that 35-year-old non-smokers had a life expectancy of 78 years. This compared to a life expectancy of 69 years for former smokers, and a life expectancy of just 63 years for current smokers.

“Our finding of lower mortality among previous compared to current smokers emphasizes the importance of counseling HIV patients onsmoking cessation,” comment the researchers.

They calculated that the HIV-positive patients lost five years of life expectancy due to their HIV infection and that twelve life years were lost because of smoking.

“The loss of life-years associated with smoking was larger than that associated with HIV,” write the investigators. “HIV-infected smokerswith long-term engagement in care lose more life-years to smoking than HIV.”

Reference

Helleberg M et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide population-based cohort study. Clin Infect Dis, online edition. DOI: 10.1093/cid/cis933, 2012.


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Original Page: http://www.aidsmap.com/Smoking-has-a-bigger-impact-on-the-prognosis-of-HIV-positive-patients-than-HIV-related-factors/page/2561382/



GLMA Health Digest Jan. 9, 2013

January 9, 2013 Reposted at http://www.keystothecloset.blogspot.com,

Table of Contents

Mexico Removes Ban on Blood Donations by Gay and Bisexual Men

Federal Judge Ordered Alabama to Stop Segregating Prisoners Living with HIV

Call for Abstracts: GLMA’s 31st Annual Conference

Call for Papers: Journal of Environmental and Public Health

Call for Manuscripts for Literature Review

Event: Save-the-Date for GLMA in Los Angeles

Event: LGBT Inaugural Celebration of Barack Obama & Joe Biden

Survey of LGBT Student Experiences at Academic Medical Centers



Mexico Removes Ban on Blood Donations by Gay and Bisexual Men
According to the Advocate on December 28, 2012, a procedural change in Mexico went into effect on December 25th, which lifts the country’s two-decade old ban on blood donations by gay and bisexual men. The new policy instead bans donations from people with HIV or hepatitis and their partners—regardless of sexual orientation—who engage in “risky” sexual practices.

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Federal Judge Ordered Alabama to Stop Segregating Prisoners Living with HIV
According to Fox News on December 21, 2012, a federal judge issued a permanent injunction ordering Alabama to stop segregating prisoners living with HIV, a practice that violates the Americans with Disabilities Act (ADA). The injunction ordered the Alabama Department of Corrections to end its discriminatory practices against prisoners living with HIV, including housing them separately from all other prisoners, excluding them from work-release jobs in the food industry, and a number of other rehabilitative, educational, trade skills and vocational programs. "Today's decision is historic. It spells an end to a segregation policy that has inflicted needless misery on Alabama prisoners with HIV and their families," said Margaret Winter, associate director of the American Civil Liberties Union National Prison Project and lead counsel for the plaintiffs.

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Call for Abstracts: GLMA’s 31st Annual Conference
GLMA invites you to be a part of the premier LGBT health conference by submitting an abstract for this year’s Annual Conference in Denver, CO (Sept 18-21, 2013). GLMA’s Annual Conference educates health professionals and health profession students about the unique health needs of LGBT patients. The conference is a forum for discussion and exploration of how best to address these needs as well as the needs of LGBT health professionals and health profession students.

This year’s conference will place a special emphasis on the role of health professionals in promoting positive, healthy LGBT communities. GLMA encourages the submission of abstracts that explore avenues for optimizing health through effective social supports and wellness, maintaining and improving function and reducing disparities in LGBT communities.

For more on GLMA’s 31st Annual Conference and how to submit an abstract, please click here. Abstracts are due by March 11, 2013.

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Call for Papers: Journal of Environmental and Public Health
We have a need to publish data relevant to the sexual and gender minority population and the Journal of Environmental and Public Health has issued a special issue on sexual and gender minority health. Manuscripts for this Special Section are due January 25, 2013. Contact Dr. McElroy, lead guest editor, with any questions. For more information on the Call for Papers, please click here.

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Call for Manuscripts for Literature Review
Seeking unpublished manuscripts, in press articles and data reports about weight-related issues among lesbian and bisexual women for a comprehensive review of the literature funded by the Office on Women's Health. We are a collective of five projects nation-wide developing and testing interventions to improve health among lesbian and bisexual women who are at risk for weight-related health problems and would like to be in touch with anyone doing this type of research. Please contact Mickey Eliason if you are interested.

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Event: Save-the-Date for GLMA in Los Angeles
Join GLMA members in Southern California for a reception to support LGBT health equality! The reception will take place the evening of Saturday, February 2, 2013, in Los Angeles, CA. Click here for more information!

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Event: LGBT Inaugural Celebration of Barack Obama & Joe Biden
Building on the tradition begun in 1993, the LGBT community celebrates the Inauguration. Join the HRC and many community sponsors for this historic evening celebrating the Inauguration and the successes around the nation. The event will include live musical performances, celebrity guests, dancing, cocktail buffet and premium open bar.

Monday, January 21, 2013
8:00pm - 1:00am
The Mayflower Renaissance Hotel
Washington, DC 20036

Tickets: $375
To purchase tickets, click here or call Box office Tickets at (800) 494-8497.

GLMA is proud to be a community sponsor of this event.

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Survey of LGBT Student Experiences at Academic Medical Centers
The Vanderbilt Program for LGBTI Health is conducting an anonymous survey of lesbian, gay, bisexual, and transgender (LGBT) experiences of students at academic medical centers. Specifically, we are interested in the experience of bias, discrimination and/or harassment due to sexual orientation and gender identity. Survey participation is completely voluntary and anonymous, and survey participation will imply informed consent.

The survey includes questions assessing instances of discrimination/harassment of LGBT individuals at your medical center and the level of support available for LGBT students and employees. The survey should take about 15 minutes to complete and participation in the survey is voluntary. The survey is confidential and responses will be stored in a secure database with access restricted to Dr. Jesse Ehrenfeld, Kristen Eckstrand and Minoo Sarkarati. Click here to complete the survey. If you have any questions or concerns, please contact the study PI Minoo Sarkarati.

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GLMA’s LGBT Health Digest is an electronic newsletter with information and resources for health professionals concerned about the health of lesbian, gay, bisexual and transgender (LGBT) populations.

The Digest highlights issues, events, publications and other newsworthy items pertinent to LGBT health. Please feel free to circulate the Digest to your colleagues.

To sign up, send your request to
digest@glma.org. Also, to submit an item to be considered for publication in the Digest, please send your request to Emily Kane-Lee at ekanelee@glma.org