Publications

Abstract

Background: Although many men who have sex with men (MSM) in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing. Methods: We conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were 'intention to get tested' and 'HIV testing at the clinic.' Findings: In the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR): 2.77, 95% Confidence Interval (CI): 1.42-5.39). After a mean of 125.5 days of observation (range 42-209 days), 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001). In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the textbased intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74-3.20). At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40-2.85). Conclusion: This study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations.

Abstract

Objective: To describe prenatal weight gain and postpartum loss patterns among Hispanic women receiving prenatal care at an urban community health center by language preference. Methods: Data were abstracted from medical records of prenatal patients seen from 2000-2008. Included were self-identified Hispanic women, English- or Spanish-speaking, aged 16-40 years, with weight measured at ≤13 and at >37 weeks gestation. Women with preexisting diabetes, hypertension, gestational diabetes, pre-eclampsia, multiple gestation, or pretermdelivery were excluded. Bivariate (t-test, chi-square) and multivariate regression (linear, polychotomous logistic) statistics were used in the analysis. Results: Of 259 women who met eligibility criteria, 52 (20.1%) were primarily Spanish speakers. Overall, 43.6% exceeded prenatal weight gain recommendations; 30.8% of Spanish speakers vs 46.9% of English speakers (P=.07). Among normal-weight women, Spanish speakers gained below and English speakers gained above that recommended (P=.03). At late postpartum, 22.9% overall returned to their baseline body mass index (BMI ±0.5 kg/m2); Spanish speakers retained 1.21 vs 1.53 kg/m2 among English speakers, which was not statistically significant. Adjusting for baseline BMI, age, and smoking status, language preference was not associated with prenatal weight gain or postpartum weight retention. In adjusted models, being overweight at baseline was predictive of excessive prenatal weight gain (OR 2.12, 95%CI .99, 4.53; P=.05); older age was protective for postpartum weight retention (OR .90; 95% CI .82, .98; P=.02). Conclusions: Adherence to prenatal weight gain guidelines was poor and few women returned to their baseline weight at late postpartum, regardless of language preference.

Abstract

Background. Despite recent advances in breast cancer treatment, breast cancer related lymphedema (BCRL) continues to be a significant problem for many survivors. Some BCRL risk factors may be largely unavoidable, such as mastectomy, axillary lymph node dissection (ALND), or radiation therapy. Potentially avoidable risk factors unrelated to breast cancer treatment include minor upper extremity infections, injury or trauma to the arm, overuse of the limb, and air travel. This study investigates how providing information about BCRL affects the cognitive and symptomatic outcome of breast cancer survivors. Methods. Data were collected from 136 breast cancer survivors using a Demographic and Medical Information interview instrument, a Lymphedema Education Status interview instrument, a Knowledge Test for cognitive outcome, and the Lymphedema and Breast Cancer Questionnaire for symptom outcome. Data analysis included descriptive statistics, t tests, chi-square (χ2) tests, and regression. Results. BCRL information was given to 57% of subjects during treatment. The mean number of lymphedema-related symptoms was 3 symptoms. Patients who received information reported significantly fewer symptoms and scored significantly higher in the knowledge test. After controlling for confounding factors, patient education remains an additional predictor of BCRL outcome. Significantly fewer women who received information about BCRL reported swelling, heaviness, impaired shoulder mobility, seroma formation, and breast swelling. Conclusions. Breast cancer survivors who received information about BCRL had significantly reduced symptoms and increased knowledge about BCRL. In clinical practice, breast cancer survivors should be engaged in supportive dialogues so they can be educated about ways to reduce their risk of developing BCRL.

Abstract

Introduction: We studied the relationship between registered nurses' extended work duration with adverse events and errors, including needlestick injuries, work-related injuries, patient falls with injury, nosocomial infections, and medication errors. Method: Using bivariate and multivariate logistic regression, this secondary analysis of 11,516 registered nurses examined nurse characteristics, work hours, and adverse events and errors. Results: All of the adverse event and error variables were significantly related to working more than 40 hours in the average week. Medication errors and needlestick injuries had the strongest and most consistent relationships with the work hour and voluntary overtime variables. Discussion: This study confirms prior findings that increased work hours raise the likelihood of adverse events and errors in healthcare, and further found the same relationship with voluntary overtime. Impact on Industry: Legislation has focused on mandatory overtime; however, this study demonstrated that voluntary overtime could also negatively impact nurse and patient safety.

Abstract

Overview: Inpatient palliative care teams' (PCT) contribution to improved quality of life and patient satisfaction as well as decreased utilization and costs has been well established. Yet few studies have examined the specific effect of an inpatient PCT on discharge disposition, despite evidence of an association between hospice enrollment, decreased rehospitalization, and improved resource utilization. Methods: Patients admitted to a large nonprofit multisite hospital between June 2004 and December 2007 and seen by the PCT were matched to usual care (UC) patients on age, mortality risk, prior year hospitalized days, and disease severity. Discharge disposition and demographic factors were abstracted from hospital administrative claims; mortality data was collected from the social security death index. Analyses were performed using Wilcoxon's test, χ2 analysis, and multinomial logit regression. Results: Three hundred sixty-one matched pairs were available for analysis. Compared to UC, patients who received a PCT consultation were 3.24 times more likely to be discharged to hospice (p< 0.0001), 1.52 times more likely to be discharged to a nursing facility, and 1.59 times more likely to be discharged home with services (p< 0.001), controlling for patient demographics and disease severity. PCT patients were also referred to hospice earlier in their disease trajectory, rather than in the last few weeks of life. Conclusion: Patients receiving an inpatient PCT consultation are more likely to receive follow-up services upon discharge from the hospital. These services likely contribute to better quality of care and financial benefits, and warrants further study, especially considering the current focus on health care efficiency and quality.

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.

Abstract

This article presents a new model, Evidence-Based Practice Improvement, for improving patient care. The model merges 2 extant paradigms currently used for quality improvement initiatives-evidence-based practice and practice or performance improvement. The literature expounds on the virtues of each of these approaches, yet no authors have moved beyond parallel play between them. The merged model, Evidence-Based Practice Improvement, may provide a more effective and practical approach to reach our quality goals.

Abstract

Consequences of the use of tobacco products claim the lives of 443,000 Americans and 5.4 million persons worldwide every year. Persons with diagnosed psychiatric illnesses, including addiction, have the highest prevalence of smoking of any population, and smoke more intensely and heavily than others. In preparation for developing a step-wide protocol for a nursing intervention, recent literature on smoking cessation with smokers and those with psychiatric diagnoses was searched. A total of 16 related or specific studies and reviews were identified and critiqued, seeking support for interventions specific to the needs and attributes of this population. Few studies either included or focused on the smoking cessation with those having diagnoses of addiction and/or other psychiatric disorders, although study populations may have included such individuals. The results of research critiques suggest that standard approaches to smoking cessation have comparable success with the general population and persons with psychiatric disorders. The need to tailor interventions to achieve continued smoking cessation, however, remains an important need. The protocol steps are supported by the evidence drawn from the research literature and best practice guidelines.

Abstract

Using qualitative data, this article explored the circumstances leading to HIV testing among 59 HIV-infected adolescents recruited from New York City HIV clinics. Results showed differences between the heterosexual women and the gay and bisexual men. Most of the young women were tested during routine health care or self-initiated tests, and most were asymptomatic when they tested positive. Their testing decisions were sometimes based on assessments of their boyfriends' risk behaviors rather than their own. Many young men were experiencing symptoms of illness when they tested positive, and about half of them recognized their symptoms as related to HIV and sought tests. Some young men expressed fear of learning about positive test results, which delayed their testing, and some providers did not initially recommend HIV testing for young men who presented with symptoms. The article concludes that consideration of these gender and sexual orientation-related concerns can facilitate HIV testing among adolescents.

Abstract

Background: Although approximately half of adults with heart failure (HF) are women, relatively little is known about gender differences and similarities in HF self-care. Aims: The aim of this study was to describe HF self-care in men and women and to identify gender-specific barriers and facilitators influencing HF self-care. Methods: A total of 27 adults (8 women) with chronic HF participated in a cross-sectional, comparative mixed methods study. An analysis of in-depth interviews was used to describe gender-specific barriers and facilitators of self-care. After the interview data were analyzed, the results were confirmed in quantitative data obtained from the same sample and at the same time. Concordance between qualitative and quantitative data was assessed. Results: There were no consistent gender-specific differences in self-care practices but there were distinct gender differences in the decisions made in interpreting and responding to symptoms. The men were better than the women at interpreting their symptoms as being related to HF and in initiating treatment. These differences were associated with differences in self-care confidence, social support, and mood. Conclusion: Gender-specific differences in self-care behaviors are minimal. However, gender-specific barriers and facilitators greatly influence the choice of self-care behaviors.

Abstract

Responses of 2. 369 newly licensed registered nurses from 3 generational cohorts-Baby Boomers, Generation X, and Generation Y-were studied to identify differences in their characteristics, work-related experiences, and attitudes. These responses revealed significant differences among generations in: job satisfaction, organizational commitment, work motivation, work-to-family conflict, family-to-work conflict, distributive justice, promotional opportunities, supervisory support, mentor support, procedural justice, and perceptions of local job opportunities. Health organizations and their leaders need to anticipate intergenerational differences among newly licensed nurses and should provide for supportive working environments that recognize those differences. Orientation and residency programs for newly licensed nurses should be tailored to the varying needs of different generations. Future research should focus on evaluating the effectiveness of orientation and residency programs with regard to different generations so that these programs can be tailored to meet the varying needs of newly licensed nurses at the start of their careers.

Abstract

In conflict or post-conflict situations, health system reconstruction becomes a critical component of ensuring stability. The purpose of this study was to determine the priorities for health system reconstruction among Iraqi physicians residing in the northern region of the country. A convenience sample of practicing male and female physicians residing in the Kurdish region completed a 13-item survey about health system reconstruction. A total of 1001 practitioners completed the survey with gender breakdown of 29% female and 71% male, all working in different specialty areas. Significant differences between the providers based on gender (p=0.001), specialty (p=0.001) and geographic location (p=0.004) were found to affect the responses of the participants. This study demonstrates that input from healthcare professionals is important for health system reconstruction, but that gender, geography and medical specialty make the process complex.

Abstract

Aims: New injection drug users (IDUs) are vulnerable to hepatitis C infection from risky injection practices. This article considers the range of hepatits C virus (HCV) knowledge among participants in a 2-year study examining the behaviours of new IDUs. Methods: Respondents (n 36) were members of a cohort of new IDUs recruited in the New York City metropolitan area whose first injection occurred within the previous 18 months. Respondents were offered human immuno virus (HIV), hepatits B virus (HBV) and HCV testing. Two tested HIV positive and 12 tested HCV positive. During pre-test counselling they completed a qualitative interview focusing on aspects of HCV including: transmission, symptoms, long-term effects, prevention, treatment, concern regarding contracting HCV and how this concern impacted drug use and injection practices. Findings: Substantial gaps were seen in HCV knowledge. While respondents were aware that HCV is a blood-borne virus, the majority had only approximate knowledge regarding transmission, symptoms and effects. Respondents reported little discussion of HCV with peers and minimal concern about contracting HCV, especially compared with HIV. Conclusion: Accurate HCV information is failing to reach new IDUs, and new IDUs may not value the little information they do receive. More effective and innovative efforts are required to disseminate effective HCV prevention information to new IDUs.