Publications

Abstract

BACKGROUND: Heart transplantation is the procedure of choice for a selected group of patients with end stage heart disease. Gender related differences have been observed in the heart transplant field: less women than men are recipients of heart transplants, more risk of rejection in female recipients, and a perception toward reduced survival in women. We report our experience of heart transplantation in females in Puerto Rico. METHODS: We studied the data bank of 69 heart transplant recipients in the Puerto Rico Heart Transplant Program from June 1999 to June 2005. Gender related differences in the number of recipients: males or females, incidence of rejection, survival, and other outcomes were analyzed. RESULTS: 69 patients received an orthotopic heart transplant from June 1999 to June 2005, in a single center in Puerto Rico. The mean age of the patients was 47 (11-62) years. Fifty patients (72%) were men, and 19 patients (28%), were women. Survival in the female group at 3 months, 1, 2, 3, 4, and 5 years was 100%, 100%, 100%, 100%, 90%, and 90% respectively. The survival in the male group at 3 months, 1, 2, 3, 4 and 5 years was 97%, 97%, 97%, 94%, 86 and 79% respectively. There was an early, higher incidence of rejection in women during the first three months post transplant; 1.5 vs. 0.75, (P=0.04) episodes per patient in the female, and male group respectively. After the third month post transplant there was no significant difference in rejection incidence. The incidence of infectious episodes was significantly more frequent in female than in male recipients, 2.8 vs. 1 (P=0.02) per patient respectively. CONCLUSIONS: There were more male than female heart transplant recipients at a ratio of 3:1, without a significant gender difference in survival. The risk of rejection was higher in females in the early period post transplantation, but thereafter this risk showed no signinificant statistical difference. The incidence of infection was more frequent in female than in male recipients.

Abstract

To detect the rate of hepatitis B virus (HBV) infection among Asian American Pacific Islanders (AAPIs), data on hepatitis B antigens and antibodies were collected as part of a community health fair. Two hundred seventy adults received free hepatitis B screening. The serological results of 82 Whites showed that 1.2% were positive for serum hepatitis B surface antigen (HBsAg) and 21% were positive for serum hepatitis B antibody (HBAb). Of 161 AAPIs, 4.3% were positive for serum HBsAg and 60% were positive for HBAb. Despite the limitation of design, these data provide some insight on the rate of HBV infection in AAPIs because there are no data on prevalence of HBV infection of AAPIs in the Rocky Mountain Area.

Abstract

Inmates in U.S. correctional facilities are approximately 9 times more likely to have hepatitis C virus (HCV) infection than the nonincarcerated population. Some correctional facilities provide HCV services, yet little is known about inmate and staff satisfaction with them. Using qualitative data collected in a prison-based drug treatment program in California, this paper describes inmate and staff perceptions of the benefits and barriers to delivering HCV services. Participants commented primarily on their peer education program and on perceived budgetary constraints as a barrier to ongoing HCV service delivery. Participants' recommendations for the future included increasing HCV education and staff training, and expanding the peer educators program.

Abstract

African Americans are at the intersection of the AIDS epidemic and burgeoning prison and offender populations, yet little is known about offenders' HIV knowledge and risk behaviors or ability to access effective services. We present findings from an exploratory study based on 300 interviews with New York City offenders conducted in 2001-2002. The data indicate relatively high rates of HIV infection and HIV risk behaviors among African American and other offenders. There were no clear patterns of risk behaviors by race/ethnicity. Although overall HIV knowledge level is high, important gaps in HIV knowledge remain and there is widespread skepticism among offenders about government information about HIV/ AIDS. In the corrections setting, there is inconsistent access to HIV prevention and education services, and an emphasis on more passive learning materials. To reduce HIV infection rates, there is a need to expand peer-led and culturally- and gender-specific interventions, and to improve access to correctional facilities for community-based HIV service providers. HIV interventions must also be expanded for offenders on probation and parole. Mandatory HIV education and harm reduction approaches should be considered.

Abstract

The objective of this paper is to profile the role of homelessness in drug and sexual risk in a population of young men who have sex with men (YMSM). Data are from a cross-sectional survey collected between 2000 and 2001 in New York City (N = 569). With the goal of examining the import of homelessness in increased risk for the onset of drug and sexual risk, we compare and contrast three subgroups: (1) YMSM with no history of homelessness, (2) YMSM with a past history of homelessness but who were not homeless at the time of the interview, and (3) YMSM who were currently homeless. For each group, we describe the prevalence of a broad range of stressful life events (including foster care and runaway episodes, involvement in the criminal justice system, etc.), as well as selected mental health problems (including past suicide attempts, current depression, and selected help-seeking variables). Additionally, we examine the prevalence of selected drug and sexual risk, including exposure to a broad range of illegal substances, current use of illegal drugs, and prevalence of lifetime exposure to sex work. Finally, we use an event history analysis approach (time-event displays and paired t-test analysis) to examine the timing of negative life experiences and homelessness relative to the onset of drug and sexual risk. High levels of background negative life experiences and manifest mental health distress are seen in all three groups. Both a prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk. Onset of these risks occur earlier in both groups that have had an experience of housing instability (e.g., runaway, foster care, etc.) but are delayed or not present among YMSM with no history of housing instability. Few YMSM had used drug prior to becoming homeless. While causal inferences are subject to the limitations of a cross-sectional design, the findings pose an empirical challenge to the prevailing assumption that prior drug use is a dominant causal factor in YMSM becoming homeless. More broadly, the data illustrate the complexity of factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of homelessness and its relationship to the onset of drug and sexual risk among high risk youth populations.

Abstract

Family history is a major risk factor for myocardial infarction (MI). However, known gene variants associated with MI cannot fully explain the genetic component of MI risk. We hypothesized that a gene-centric association study that was not limited to candidate genes could identify novel genetic associations with MI. We studied 11,053 single-nucleotide polymorphisms (SNPs) in 6,891 genes, focusing on SNPs that could influence gene function to increase the likelihood of identifying disease-causing gene variants. To minimize false-positive associations generated by multiple testing, two studies were used to identify a limited number of nominally associated SNPs; a third study tested the hypotheses that these SNPs are associated with MI. In the initial study (of 340 cases and 346 controls), 637 SNPs were associated with MI (P < .05); these were evaluated in a second study (of 445 cases and 606 controls), and 31 of the 637 SNPs were associated with MI (P < .05) and had the same risk allele as in the first study. For each of these 31 SNPs, we tested the hypothesis that it is associated with MI, using a third study (of 560 cases and 891 controls). We found that four of these gene variants were associated with MI (P < .05; false-discovery rate <10%) and had the same risk allele as in the first two studies. These gene variants encode the cytoskeletal protein palladin (KIAA0992 [odds ratio (OR) 1.40]), a tyrosine kinase (ROS1 [OR 1.75]), and two G protein-coupled receptors (TAS2R50 [OR 1.58] and OR13G1 [OR 1.40]); all ORs are for carriers of two versus zero risk alleles. These findings could lead to a better understanding of MI pathophysiology and improved patient risk assessment.

Abstract

The Child Care and Development Block Grant (CCDBG) is the largest source of state and federal child care assistance. Between 1996-2004, the number of reports on state implementation of the CCDBG soared. Using the matrix method, this article synthesizes 39 reports from public and private entities on how states differed in the use of CCDBG funds. We found considerable variation among states with regard to populations served, financing of child care through CCDBG and TANF (Temporary Assistance to Needy Families), administration of the CCDBG, and use of its quality set-asides. This issue is of prime importance to nurses who work with low-income families with children, especially because quality, accessibility and affordability of child care affects a child's emotional, social, cognitive, and physical development. The CCDBG reauthorization and annual appropriations are currently on the congressional agenda and warrant nurse's input for ongoing sustainability and support. Recommendations for policy and future research are included.

Abstract

The dramatic increase in our understanding of the brain's development throughout childhood has increased our knowledge of the significance of micronutrients, such as iron and vitamin B-12, for this development. Deficiencies of these micronutrients have been shown to have an impact on students' cognitive development. Regardless of this knowledge, students continue to make unhealthy food choices and develop poor dietary habits. School environments are places where there is an opportunity to practice healthy eating habits. Yet many school policies fail to address the sale of foods of minimal nutritional value in the school setting. School nurses can play a vital role in planning policies at the local and national level that support and encourage healthy food environments, performing assessments of the nutritional status of students, and spearheading the implementation of evidence-based health promotion programs. It is time for school nurses to take the lead in efforts aimed at improving the quality of students' dietary intake in the school setting.

Abstract

Apolipoprotein E (APOE) polymorphism plays an important role in lipid metabolism. Preliminary evidence suggests that APOE genotype appears to be a risk factor for not only cardiovascular disease, but also Alzheimer's disease and cancer. We screened the APOE genotype in 290 breast cancer patients and 232 non-cancer controls and determined the relationship between APOE gene polymorphism and breast cancer in Taiwan. We found risk for breast cancer was associated with the APOE genotype (ξ2 = 8.652, p = 0.013). Carriers of the ε4 allele were more common in breast cancer cases than carriers of ε3 allele (p = 0.004, OR = 1.786, 95% CI: 1.197-2.664). In addition, the ε4 allele is also associated with HER2/neu negative status in breast cancer patients (p = 0.006, OR = 0.277, 95% CI: 0.111-0.693). No significant associations between APOE genotype and tumor grade, TN classification, progesterone receptor, estrogen receptor, lymphatic invasion, or recurrence of breast cancer were in evidence. These results suggest that the APOE ε4 allele may be a risk factor for breast cancer and correlates with HER2/neu negative status.

Abstract

Purpose: Research on the initial stage of acculturation of new immigrants is crucial for identifying AIDS prevention policies and priorities for this vulnerable population. Methods: This study employed an exploratory approach and qualitative data collection methods to identify and describe social and behavioral factors influencing risk for HIV infection among recent Hispanic immigrants (<3 years in the United States). Immigrants from Guatemala, El Salvador, Honduras, the Dominican Republic and Mexico were interviewed in urban, suburban and semirural settings in the New York Metropolitan Area. Data were collected through ethnographic fieldwork, in-depth interviews (N=51), focus groups (N-11; total number of participants=86) and individual interviews with health and social service providers (N=26). Results: Initial stages of acculturation for immigrants reflect both retention and change in attitudes and behaviors involving their mental health, gender role norms, social and sexual behavior, and alcohol and other drug use. Current living environments may introduce conditions affecting HIV risk and prevention, while sustained connections to countries of origin may support retention of attitudes and behaviors with positive and negative risk implications. Conclusions: Specific epidemiological, environmental, economic, social and psychosocial factors are identified that provide the context for risk and prevention. The challenges and opportunities faced by these new communities must be distinguished from those of more acculturated immigrant populations if culturally appropriate interventions are to be developed.

Abstract

Hepatitis C virus (HCV) is the most prevalent blood-borne infectious disease in the United States, especially among drug users, and coinfection with HIV is common. Because drug users are often medically underserved, drug treatment units are important sites of opportunity for providing services for these infectious diseases. Given the commonalities in the routes of transmission of HIV and HCV, and the fact that many drug treatment units have established an infrastructure to provide HIV services, some have suggested integrating HCV services into those already established for HIV. Using data collected in a telephone survey with 89 drug treatment units throughout the United States, this paper examines the extent to which drug treatment units have expanded their HIV services to include those for HCV, and the extent to which this expansion was facilitated by having HIV services in place. Overall, a greater proportion of methadone maintenance than drug-free treatment units provided services for HIV and HCV. The majority of units in both modalities that provided HIV- and HCV-related services expanded their HIV service delivery to include similar HCV services, and one third expanded all of their HIV services. A large number of these units, however, indicated that having an HIV service infrastructure did not facilitate this expansion, often because the units wanted to emphasize differences in the two viral infections. Policy makers and individual treatment units need to develop strategies that capitalize on existing infrastructures while maintaining the distinction between HIV and HCV primary and secondary prevention efforts.

Abstract

More than 24,000 women in the United States are diagnosed with ovarian cancer every year, and half of these women die from their disease. Stage 1 ovarian cancer is curable in 95% of cases; however, due to inadequate screening tools and lack of symptoms in early disease, ovarian cancer is generally at Stage 3 or 4 when finally diagnosed. CA125 is a tumor antigen used to monitor the progression and regression of epithelial ovarian cancer. When its levels are elevated postsurgery (hysterectomy/salpingo-oophorectomy with or without peritoneal washings and lymph node biopsy) and postchemotherapy, it is suggestive of recurrent disease. Due to its similarly elevated levels in some nonmalignant conditions, however, it is not specific enough to be used for population screening. The CA125 molecule is considered a very large glycoprotein because of its molecular weight, and it has three domains: the carboxy terminal domain, the extracellular domain, and the amino terminal domain. MUC16 is the gene that encodes the peptide moiety of the CA125 molecule. MUC16 domains provide novel opportunities to develop newassays and refine current tools to improve the sensitivity and specificity of CA125 for population-based screening guidelines.

Abstract

Over the course of addiction, a substantial proportion of drug users enter drug abuse treatment programs. Data from a cross-sectional survey of drug abuse treatment programs in the United States were analyzed to describe the scope of the medical examination performed at admission to such programs. All of the methadone programs (n = 95) and 50% of drug-free programs (80 of 161) required a medical examination at entry. Most examinations included screening for signs and symptoms of liver disease and liver function testing. Nearly all methadone programs (97%) provided referral to medical care or support for patients with test results positive for antibody to hepatitis C virus (HCV), compared with 75% of drug-free programs (P < .01). Drug-free programs requiring medical examinations provided education about HCV and testing for HCV to a larger proportion of their patients (P < .05). With high dropout rates in the early stages of treatment for drug addiction, these medical visits may be an important opportunity for further monitoring and care for HCV infection and other conditions.

Abstract

Aims. To examine factors associated with metabolic control, self-management (diet and exercise behaviour), and psychosocial adjustment (diabetes-related distress) in women with type 2 diabetes. Design. Cross-sectional design using baseline data of women with type 2 diabetes enrolled to participate in a pilot study of a nurse coaching intervention (n = 53). Ethical issues. Appropriate ethical review and approval was completed. Informed consent from participants was obtained. Outcome measures. Physiological measures included body mass index and glycosylated haemoglobin (HbA1c). Self-management measures included the Dietary Subscale of the Summary of Diabetes Self-Care Activities Questionnaire and a modified Paffenbarger Physical Activity Questionnaire. Psychosocial measures included the Problem Areas in Diabetes Survey (diabetes-related distress), the Diabetes Questionnaire, the Diabetes Self-Management Assessment Tool Support and Confidence Subscale, and the Social Functioning Scale. Descriptive, bivariate, and multivariate analyses were completed. Results. The most consistent predictor of metabolic control, dietary self-management, and diabetes-related distress was support and confidence in living with diabetes. Additionally, women had difficulty meeting optimal goals for exercise, yet reported higher levels of other physical activity. Limitations. This study was an exploratory analysis with a homogeneous sample of women with type 2 diabetes enrolled in an intervention study and measurements included multiple self-report instruments. Conclusions. Interventions to increase women's perceived self-confidence and support may contribute to positive health outcomes in women with type 2 diabetes. Relevance to clinical practice. Assessment of social support and self-confidence in diabetes self-management in women with type 2 diabetes may assist in determining individualized goals and strategies. Enhanced social support and self-confidence in diabetes self-management may subsequently improve metabolic control, self-management and psychosocial adjustment to diabetes.

Abstract

Background: Optimal elements of a sexual history for sexually transmitted infection (STI) and HIV risk assessment remain undefined. Goal: The goal of this study was to describe sexual histories in use at STI clinics across the United States. Study: This study consisted of a cross-sectional survey of facilities in cities with populations > 200,000 (n = 65). Within each city, a public health STI clinic (71% of the sample) or other STI care facility (29%) was randomly selected and sexual history forms were requested. Information was obtained from 48 clinics (74% response). Results: Most forms recorded information on symptoms and prior STI (96%), condom use (88%), other contraception (85%), and numbers and gender (83%) of sex partners. Common HIV risk questions were injecting drug use (IDU; 94%), sex for drugs or money (58%), and sex with an HIV-positive or IDU partner (52%). Ascertainment of time during which risks occurred (contact periods) varied from the past 14 days to the past 12 months, with only 38% of clinics using any 1 time period. Few histories (17%) incorporated questions for men who have sex with men (MSM). Only 2 (4%) had space to record Information about sexual behaviors by the HIV status of the sex partner. Condom use was infrequently assessed specifically for vaginal and anal sex (13%), and condom use problems were rarely explored (10%). Most forms documented STI/HIV counseling, although few (25%) included specific risk reduction plans. Conclusions: Sexual histories are highly variable. Although challenging to accomplish, STI/HIV care, surveillance, and prevention may be improved by developing consensus on core questions to be used in sexual histories.