Publications

Abstract

Recent advances in telecommunications technology have created opportunities to enhance the quality of health care services through telehealth, the use of telecommunications and information technologies to deliver health care. However, the diverse technologies and applications encompassed by telehealth have tended to confuse discussions of the effectiveness of these programs. An interactive voice response system (IVRS) is a simple, yet effective telehealth application that improves access to health care by continuing care beyond the hospital setting, with specially tailored programs that are easily accessible to patients around the clock. Often described as a telephone connected to a "talking computer," an IVRS allows patient interaction for data collection or to deliver recorded telephone messages related to medication compliance or behavior modification. Despite easy access to touchtone telephone services and growing familiarity with IVRS, many health care providers are unaware of these programs. This paper reviews the infrastructure of IVRS technology and its uses in health care.

Abstract

A review of the literature reveals few studies that focus on the challenge of language barriers in primary care settings. Recognizing the need for a national consensus on cultural and linguistic standards for health care in the United States, the Office of Minority Health recently released a set of standards for culturally and linguistically appropriate services (CLAS). These standards were utilized to examine the linguistic services available at eight ambulatory care centers in a small New England state in an effort to determine compliance with recommended national standards. Although myriad studies have focused on provision of linguistically appropriate care in emergency rooms (ERs), few studies have specifically examined ambulatory care settings. Numerous strategies have been adopted by individual clinics in an attempt to deal effectively with linguistic barriers. Yet without clear national regulations and dedicated funding for interpreter services, a large spectrum of services exists. Survey data were obtained from on-site visits at select community health clinics to ascertain availability, need, and utilization of linguistic services for patients with limited English proficiency. The majority of patients served by the clinics surveyed were predominantly Spanish-speaking. Results reveal that although most of the clinics provided informal mechanisms of interpreter services, few directly addressed linguistic services as a component of culturally competent care.

Abstract

ISSUES AND PURPOSE: The purpose of this paper is to synthesize the current qualitative literature on homeless women with children living in shelters. METHODS: Eighteen qualitative studies on homeless women with children living in shelters were included in the synthesis. The meta-synthesis was conducted using the meta-ethnographic approach of Noblit and Hare (1988). RESULTS: Six reciprocal translations (themes) of homeless mothers caring for their children in shelters emerged: On becoming homeless, protective mothering, loss, stressed and depressed, survival strategies, and strategies for resolution. PRACTICE IMPLICATIONS: The results may be used by healthcare workers as a framework for developing intervention strategies directed toward helping mothers find new solutions to dealing with shelter living and innovative ways to resolve their homelessness.

Abstract

Objective. Residential drug treatment units are uniquely situated to provide HIV testing and counseling to their patients. This article examines the extent to which residential drug treatment units in the United States provide HIV testing on-site, and identifies organizational and institutional characteristics that differentiate units in which on-site HIV testing is available from those in which it is not. Methods. The analyses use data collected in telephone interviews with unit managers from a random nationwide sample (N=138) of residential drug treatment units in 2001. Results. About half (48.6%) of the residential drug treatment units made HIV testing available to their patients on-site. Residential units were significantly more likely to make on-site testing available if they were larger (i.e., had a greater number of patients treated each month or had a greater number of staff that provided direct patient services) and if they were publicly rather than privately owned. Provision of on-site HIV testing was significantly correlated with having a medical orientation, i.e., with being operated by a hospital, with the unit viewing itself as patients' primary medical provider, or with providing medical care to the patients either on-site or at another part of the same treatment agency. Conclusion. In view of the critical importance of HIV testing for individuals who use illicit drugs and the existence of a simplified testing protocol involving saliva samples (eliminating the need for phlebotomy), units that do not have a medical orientation should be encouraged to make HIV testing available on-site.

Abstract

Objective: To determine strategies to overcome barriers to HIV testing among persons at risk. Methods: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Results: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home selftesting (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. Conclusions: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.

Abstract

PURPOSE: To present the theoretical background for lifestyle change interventions in the prevention and management of type 2 diabetes and to provide pragmatic strategies for advanced practice nurses (APNs) to incorporate such interventions into their practices. DATA SOURCES: Selected scientific literature and the Internet. CONCLUSIONS: There is an epidemic of obesity and type 2 diabetes among adults in the United States. Preventing or managing these health conditions requires significant lifestyle changes by individuals. IMPLICATIONS FOR PRACTICE: APNs are in a key role to deliver lifestyle change interventions, particularly in the primary care setting. Strategies to assist APNs with lifestyle change counseling include (a) assessment, (b) mutual decision making, (c) referral to education programs, (d) individualized treatment goals, (e) strategies to assist with problem solving, (f) continuing support and encouragement, (g) relapse prevention, and (h) ongoing follow-up.

Abstract

Hepatitis C virus (HCV) has reached epidemic proportions among drug users, and drug programs are in a unique position to provide each of their patients with HCV education. Using a nationwide sample (N= 434) of drug treatment programs, we report the results of a logistic regression analysis that differentiates programs providing HCV education to all of their patients versus programs that do not. Fifty-four percent of the programs provide HCV education to all of their patients. Programs are about four and a half times as likely to provide HCV education to all patients if they dispense methadone; almost four times as likely to provide this service if they educate most of their staff about HCV; twice as likely if they are residential; and almost twice as likely if they conduct HIV testing on-site. Our findings indicate that there is a need to increase HCV educational services in drug treatment programs.

Abstract

Psychosocial issues are a major part of palliative treatment, yet, due to inadequate training, physicians are often ill-prepared to address them. Twenty physicians were interviewed about the importance they placed on psychosocial issues and the perceptions they had of their role in addressing them. Several respondents felt psychosocial issues were important because they affect physical issues, enable holistic care, enhance relationships, impact care decisions, and can reduce patient and family stress. Other respondents did not feel psychosocial issues were their responsibility due to time constraints, their focus on physical care, their lack of expertise in this area, the patients' preferences for attending physicians, and a sense on the part of house staff physicians of not yet being "real" doctors. Collaboration with other hospital staff helped overcome some of these obstacles. Since physicians must often provide psychosocial care, improved training in addressing psychosocial issues is indicated.

Abstract

The authors’ research group published a major article in October 2002 showing a strong effect of nurse staffing on both patient outcomes and factors related to nurse turnover in 168 Pennsylvania hospitals. This article reviews major design elements and findings of the study and discusses policy implications of this research. Even though evidence is mounting that hospital staffing is a public health issue, regulation of staffing levels remains controversial. Higher quality staffing data that incorporate information about patients’ needs for nursing care are required for better administrative decision-making and research purposes. That the current nurse shortage is occurring in an era of renewed concerns about safety in hospitals offers unique opportunities for developing public policy to remedy problems with staffing and other long-standing workplace environment issues in hospital nursing.

Abstract

Background: A paucity of epidemiologic research exists concerning the co-occurrence of birth defects and mental retardation (MR). Study of this co-occurrence may yield important clues about the causes of both. Objective: To examine the co-occurrence of birth defects and MR, taking into consideration the type of birth defect, level of MR, co-occurrence of MR with other developmental disabilities, and individual and maternal factors. Design: A retrospective cohort study of infants born in the California Central Valley with and without a structural birth defect by 1 year of age, and with or without MR by 7 to 9 years of age. Setting and Participants: One-year survivors (N = 119556) born in nonmilitary hospitals in 8 California counties between January 1, 1992, and December 31, 1993, for whom information about birth defects was recorded within the first year of life. Main Outcome Measure: Diagnosis of MR by age 7 years considered as being mild or severe and as occurring without other developmental disabilities (isolated MR) or as occurring with other developmental disabilities, including cerebral palsy, epilepsy, or a pervasive developmental disorder. Results: Children with birth defects were nearly 27 times more likely to have MR by 7 years of age compared with children without a diagnosed birth defect regardless of type of defect (prevalence ratio, 26.8; 95% confidence interval, 22.7-31.7). Among those with birth defects, children with Down syndrome (prevalence ratio, 211.7; 95% confidence interval, 171.3-261.5) and children with sex chromosomal defects (prevalence ratio, 57.4; 95% confidence interval, 23.7-138.6) were at the highest risk for MR. Children with nonchromosomal defects, including central nervous system defects and all types of organ and system defects, were at substantially increased risk for all levels of MR. Risks of MR among children with Down syndrome and nonchromosomal defects were not substantially altered when adjusted for individual and maternal factors. Conclusions: Children with chromosomal and other structural birth defects are at a substantially increased risk for having MR by 7 years of age compared with children born without a birth defect. Children with birth defects are at an especially increased risk for having severe MR and MR occurring independently of other developmental disabilities.

Abstract

Puerto Rican drug users both in New York and Puerto Rico have disproportionately high rates of HIV/AIDS. This paper derives findings from the ARIBBA Project--a dual site study of HIV risk behaviour determinants among Puerto Rican injection drug users and crack smokers, conducted in East Harlem, NY and Bayamón, PR. Qualitative data collected in focus groups, interviews and observations revealed significant differences in sexual risk behaviours, perceptions of risks and cultural/behavioural norms between the two locations, which were supported by the results of a survey of 1200 drug users. Recommendations are made for enhancing HIV risk reduction efforts in both communities.

Abstract

Parkinson disease (PD) is the second most common neurodegenerative disorder, surpassed in frequency only by Alzheimer disease. Elsewhere we have reported linkage to chromosome 2q in a sample of sibling pairs with PD. We have now expanded our sample to include 150 families meeting our strictest diagnostic definition of verified PD. To further delineate the chromosome 2q linkage, we have performed analyses using only those pedigrees with the strongest family history of PD. Linkage analyses in this subset of 65 pedigrees generated a LOD score of 5.1, which was obtained using an autosomal dominant model of disease transmission. This result strongly suggests that variation in a gene on chromosome 2q36-37 contributes to PD susceptibility.

Abstract

The social networks of substance-using women consist of people who provide constructive social support, individuals who enable their drug use, and those who do both. Women's success in recovery may be attenuated because some of the people who are most likely to provide them with social support after drug treatment previously enabled their drug use. This article examines the social support systems of women offenders (N=100) who were mandated to four therapeutic communities in New York City. The women had an average of nine supporters (four males and five females). Although most of the women had partners who provided them with constructive social support, many of their partners also enabled their drug use. Some of the women indicated that their partners did not provide constructive support but were among their main enablers, while half of the women said that their partners actually encouraged them to stop using drugs. The majority of the women also received support from their parents, siblings, other kin, and friends. Some of these supporters also enabled their drug use while others encouraged them to stop using drugs and enter drug treatment.

Abstract

Diarrhea affects more than 60% of persons living with HIV/AIDS. Diarrhea can be caused by pathogens, neoplastic diseases, side effects of medications, malabsorption, and/or enteropathy. Activities of daily living and quality of life are often affected by HIV/AIDS-related diarrhea. Traditional Chinese medical interventions such as acupuncture and moxibustion show promise in the area of gastrointestinal symptom management. The purposes of this study were to (a) determine the influence of acupuncture and moxibustion in reducing the frequency of diarrhea and increasing stool consistency in HIV-infected men with chronic diarrhea (defined as three or more episodes of watery, liquid, or loose stools in a 24-hour period for 3 weeks or more), (b) ascertain the feasibility of the methodology for a future prospective randomized controlled trial, and (c) determine sample size estimate for a prospective randomized controlled trial. Using a time-series design, 15 HIV-positive men with chronic diarrhea received the same acupuncture/moxibustion treatment for six sessions over a 3-week period. Each participant maintained a daily stool frequency/consistency and medication diary. All treatments were administered by a licensed acupuncturist trained in traditional Chinese medicine. Based on the intent to treat analysis comparing the change in stool frequency from baseline (Week 1) to Week 3 and Week 4, stool frequency reduced approximately one episode per day (Week 3: p < .001; Week 4: p < .005). Stool consistency also improved, from baseline to Week 3 and Week 4, by more than 1 point on Hansen's stool consistency scale. Acupuncture and moxibustion are promising modalities for the symptom management of chronic diarrhea in HIV/AIDS. The results of this pilot study also establish the feasibility of a larger study and provide the empirical basis to serve as preliminary data from which to estimate statistical power and sample size for a larger efficacy study, inclusive of women as well as men.