Publications

Abstract

The development of effective behavioral interventions is critical to controlling the HIV epidemic. Although heterosexual transmission accounts for a growing proportion of new infections in the United States, little is known about factors that influence sexual behavior in HIV-discordant heterosexual couples. The objective of this study was to examine the reproductive behaviors of HIV-discordant heterosexual couples. Data were obtained on 71 discordant couples enrolled in a study of HIV heterosexual transmission. Results showed that women in such couples have pregnancy rates similar to those of women of reproductive age in the general population. One seroconversion occurred as a result of pregnancy attempt. These results suggest the need for educational efforts directed at HIV-discordant heterosexual couples.

Abstract

The purpose of this project was to study the applicability of pen-based computer technology to home health care through the development of a pen-based computer system for a Hospital/Community-Patient Review Instrument (H/C-PRI) used for nursing home placement. The sample included nurses (n = 12) from the four regional Visiting Nurse Service of New York offices, as well as all patients on whom a H/C-PRI was completed during the pre-period (n = 238) and patients on whom a H/C-PRI was completed during the post-period (n = 238). The quality of documentation was higher for patients whose H/C-PRI was performed using the pen-based computer (0% calculation errors) than for those patients whose H/C-PRI was documented in the usual manner (11% calculation errors).

Abstract

With the changing perspectives of the HIV epidemic and the introduction of protease inhibitors to treat human immunodeficiency virus (HIV) disease, the issue of compliance has gained considerable interest among health care providers. The idea that clients with HIV disease should succumb to a patriarchal system of medical care has been challenged by AIDS activists since the beginning of the epidemic. The concept that there is only one explanation for "noncompliance" is outdated. The reasons for noncompliance are multifaceted in nature and include psychosocial factors, complex medication and treatment regimens, ethnocultural concerns, and in many instances substance use. Therefore, the notion that there is one intervention to resolve noncompliance is at best archaic. Interventions to enhance compliance include supervised therapy, improving the nurse-client relationship, and patient education, all of which should be combined with ethnocultural interventions. Plans to enhance compliance must incorporate person-specific variables and should be tailored to individualized needs.

Abstract

Sixty percent of patients with human immunodeficiency virus (HIV) in the United States and 90% throughout the world will have diarrhea at some point in their illness. This article provides an introductory exploration and discussion of Western and Eastern perspectives of chronic diarrhea in patients with HIV. Western etiologies and treatment approaches, as well as Eastern views from traditional Chinese medicine pathogenesis and treatment principles involving acupuncture and moxibustion are presented. Whereas their interpretations of the causes of diarrhea are different, both the East and West have something to offer patients with this distressing symptom. Further exploration and clinical research is needed in this area.

Abstract

Although Hispanics are overrepresented in AIDS cases in the United States, little information is available to help understand differences in drug and sex risk behaviors in Hispanic subgroups, needed to develop appropriate prevention programs. This study reports on HIV-related risk behaviors in three groups of Hispanic prostitutes recruited in the United States: Dominican (77), recruited in Washington Heights, NY; Mexican (151), recruited in El Paso, TX; and Puerto Rican (48), recruited in East Harlem, NY. Ethnographic interviews were conducted with a subsample of subjects to examine cultural meaning of risk behaviors; structured interviews were conducted with subjects to describe demographic characteristics and summarize levels of risk behaviors. Results indicated that the labels Hispanic and prostitute obfuscated important differences related to geographic and cultural factors. To be effective for diverse Hispanic groups, HIV prevention efforts and interventions must be based on knowledge of these differences.

Abstract

Recent availability of VL monitoring and multiple ARVT have ushered in a new era of medical management in patients (pts) with HIV. Studies in adults have demonstrated dramatic reductions in VL following the use of newer ARVT. We analyzed our first experiences in utilizing VL monitoring in a pediatric clinical setting, to examine the effect of changing ARVT on VL in children. VL was measured by the Roche-Amplicor PCR HIV Monitor Test. Of pts 1-13 yrs who had at least one VL between 7/96 - 12/96, 6 pts had a change in ARVT 4 weeks prior to the first VL (C), 23 pts had change 4-12 weeks prior to VL (B), and 35 had ARVT change >12 weeks prior to VL (A). Mean ± SD VL (copies/ml) and CD4 index (CD4 count/ 50% for age) were compared between these 3 groups. Viral Load CD4 Index p values (for VL) A 180,760±229,530 .42±37 A v B: <.07 B 61,573±68,893 .39±.36 B v C: <.05 C 7,322±7,643 .46±.35 A v C: <.07 Fifty pts had 76 follow up VLs during the same period. One drug change (n=5) produced a mean log fall of .84, 2 drugs (n=8) -1.27, and 3 drugs (n=3) change -1.77 log fall in VL. The change to AZT+3TC or DDI (n=3) resulted in 1.09 log drop, a change to 3TC+D4T -1.37 and 2 nucleoside analogs + 1 protease inhibitor -1.43 log fall. Significantly lower VL with no change in CD4 counts were measured in HIV infected children with a recent change in ARVT. Greater troughs in VL response were seen with combination therapy changes and with the use of newer ARV drugs. VL is a useful tool to assess ARVT response in children with HIV infection.

Abstract

This two-part series describes the collaborative summer home care nursing program for Korean nurses conducted by the Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, in cooperation with the College of Nursing of Yonsei University, Seoul, Korea. Part I focuses on the development of the collaboration, and part II focuses on the content of the three-week summer home care program and describes related issues and problems as well as suggests solutions. The series concludes with the findings on the program from the postprogram evaluations of students, preceptors, and patients. The collaborative educational program was developed to give Korean home care nurses an opportunity to gain clinical experience in home care nursing in the United States so that they could learn how to deliver better-quality home care for patients and their informal caregivers. Therefore, the program focused on practice-oriented lectures and clinical experiences.

Abstract

The aims of the study reported here were to describe the socio-demographic characteristics of caregivers of demented elders in Korea and their care recipients and to compare the positive and negative meanings and outcomes of the caregiving experiences of caregivers who had admitted their elderly demented relative to a nursing home (G1: n = 24) and caregivers still caring for their elderly demented relatives at home (G2: n = 30). Most caregivers were female (80%), married (89%), and related to the care receiver as daughter-in-law (39%), daughter (22%), wife (15%), son (13%), or neighbor (6%). Social class differences were found between the home care and nursing home groups: the upper classes were significantly more likely to have placed their demented elder in a nursing home, whereas the low social classes were more likely to keep taking care of their demented elder at home instead of placing them in a nursing home. Caregivers who had admitted their relative to a nursing home (G1) reported significantly more difficulties from disturbed sleep, disrupted children's studies, and limited personal life when they were caring for the elder at home (p < .05). Caregivers in the home care group (G2) had significantly greater satisfaction in serving as a model for their children and practicing religion (p < .05), and they also reported a better relationship with the care receiver than those who have placed their demented elder in a nursing home, although the difference in this case was not significant.

Abstract

Thirty-four of 67 MCOs in New York and Connecticut responded to requests for information on the roles, participation, and listing of nurse practitioners as primary care providers or in other capacities. MCO executives report a high degree of satisfaction with NPs who serve as their primary care providers, especially in women's health and geriatrics, as they spend more time teaching and explaining procedures than physicians. Ongoing lack of up-to-date information and/or confusion about the scope of NP practice exists among both health care professionals and the public. Perceived differences in the scope of care provided by NPs was related to state regulations, physician practice patterns, and availability of primary care physicians. Eighty-five percent of MCO executives thought their organizations should encourage the use of NPs.