Nancy L Van Devanter

Abstract

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

Abstract

The need for oral health services among patients with HIV, especially those in advanced stages of disease and those who smoke, has been well documented. Patients receiving HIV-related home care services provide an opportunity for assessment of oral health and smoking cessation needs; however, the majority of home care providers lack formal training to provide these services, thus interprofessional collaborations may be of value. This study assessed the oral health and smoking cessation practices of a random sample of 81 HIV home care providers. Results showed very favorable attitudes toward providing these services with some differences across disciplines. More than 70% of nurses would like to receive additional training in comprehensive oral health assessment by dental professionals. The study provides evidence for the potential of expanding these services for patients with HIV through interprofessional collaboration, in particular with nurses and dentists.

Abstract

A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Twenty-six percent of the cohort experienced a pregnancy during the study period, with a rate of 125 per 1,000 person years in 2006. The age of first pregnancy ranged from 15-25; 24% were younger than 18. Fourteen pregnancies (42%) were terminated. Nineteen pregnancies resulted in live births, and all infants tested negative for HIV. The success of preventing vertical HIV transmission is attributed to interdisciplinary family-centered services, including reproductive health education, family planning, obstetric-gynecologic services and psychosocial support. Such approach is most likely to be effective at promoting healthy reproductive decisions and reducing morbidity in perinatally infected mothers and their children.

Abstract

The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic "bedsides" where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.

Abstract

Process evaluation of community-academic partnership function and fidelity to principles of community-based participatory research (CBPR) is essential to achievement of intermediate and long term partnership goals. This article describes the evaluation of B Free CEED, a community-academic partnership created to address hepatitis health disparities in Asian American and Pacific Islander (API) communities. A mixed methods approach with an online survey and qualitative key informant interviews was conducted with all partnership members at baseline and follow-up, 18 months later. Survey findings showed stability over time, with some consistent differences in community and academic perspectives. Academic members were somewhat more satisfied with the partnership functioning. Key informant interviews provided contextual data key to further defining partnership functioning. Conducting ongoing partnership evaluations is necessary to reassess and align processes and protocols to enhance partnership functioning and strengthen group cohesion.

Abstract

Understanding the sexual risk behaviors of youths living with HIV/AIDS is critical to secondary prevention of HIV. As part of a larger qualitative study of youths living with HIV, in-depth interviews were conducted with 27 African American and Latino, HIV-infected young men who have sex with men, aged 16-24 years, living in New York City. The study explored the role of substance use, the social-sexual-environmental, and psychological contexts in which sexual risk behaviors occurred. Since learning of their HIV infection, the majority of participants had reduced their risky sexual behaviors; however, a subset (26%) of participants continued to have unprotected sex, in most cases with multiple partners. Substance use, the social environmental context of the sexual encounter, the psychological impact of HIV on sexual behavior, and partner characteristics were associated with high-risk sexual behaviors in this group. Among high-risk participants, factors associated with risky sexual behaviors clustered, with 57% reporting two or more factors. More intensive interventions are needed for this subset of youths living with HIV, including assessment and treatment for substance use and mental health issues, strategies for stress reduction, and partner interventions.

Abstract

Since 9/11, federal funds directed toward public health departments for training in disaster preparedness have dramatically increased, resulting in changing expectations of public health workers' roles in emergency response. This article explores the public health emergency responder role through data collected as part of an oral history conducted with the 3 health departments that responded to Hurricane Katrina in Mississippi and Louisiana. The data reveals a significant change in public health emergency response capacity as a result of federal funding. The role is still evolving, and many challenges remain, in particular, a clear articulation of the public health role in emergency response, the integration of the public health and emergency responder cultures, identification of the scope of training needs and strategies to maintain new public health emergency response skills, and closer collaboration with emergency response agencies.