Comparison of health status, socioeconomic characteristics, and knowledge and use of HIV-related resources between HIV-infected women and men

OBJECTIVES: The authors compared socioeconomic characteristics, and knowledge and use of human immunodeficiency virus (HIV)-related resources and health status measures between HIV-infected women and men registered within the Denver Health and Hospitals health care system. METHODS: Data collected through two Centers for Disease Control-funded surveillance initiatives (Adult Spectrum of Disease and Supplement to HIV/AIDS Surveillance) were linked. Health status measures were obtained using the Medical Outcomes Study (MOS-20) questionnaire. To compare health status measures between genders, men were matched to women based on disease stage, intravenous drug use, race, years of education, employment status, and age. RESULTS: Among all patients interviewed (n = 419), women (n = 52) were more likely to be minority, uneducated, intravenous drug users, and at earlier stages of HIV-disease than men (n = 367). Employment status was not significantly different. Knowledge of available services was generally good among both genders. Women received public assistance and had health insurance (Medicaid) more often than men. Women used support services, social work, and shelter assistance less often than men. The matched pairs analysis (n = 46 pairs) showed no significant differences between genders in physical and social function, mental health, pain, or general health perceptions; however, role function was better in women than in men (P<0.02). CONCLUSIONS: When controlling for factors that may influence health and access to health care, HIV disease generally impacts the health status of both genders similarly. Women scored higher in role function which may reflect family caretakers' responsibilities. Although knowledge of HIV-related resources was similar by gender, men made contact more often suggesting areas for enhanced outreach toward women.     

The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults

BACKGROUND: The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults. METHODS: The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample of enrollees in a health maintenance organization. The intervention was supervised exercise (1-h sessions, three per week, for 24-26 weeks), followed by self-supervised exercise. Exercise groups included strength training using weight machines (n = 25), endurance training using bicycles (n = 25), and strength and endurance training (n = 25). Study outcomes included gait tests, balance tests, physical health status measures, self-reported falls (up to 25 months of follow-up), and inpatient and outpatient use and costs. RESULTS: There were no effects of exercise on gait, balance, or physical health status. Exercise had a protective effect on risk of falling (relative hazard = .53, 95% CI = .30-.91). Between 7 and 18 months after randomization, control subjects had more outpatient clinic visits (p < .06) and were more likely to sustain hospital costs over $5000 (p < .05). CONCLUSIONS: Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults. In community-living adults with mainly mild impairments in gait, balance, and physical health status, short-term exercise may not have a restorative effect on these impairments.     

Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Employment status, social support, and life satisfaction among the elderly.

Relations among employment status, social support, and life satisfaction were examined in a sample of 292 community-living elderly (aged 65–97 yrs) as part of a larger investigation of the role of stressful life experiences and social support in the health of the elderly. Results of a path analysis suggested that the number of hours worked at a paying job, lower levels of depression, and greater perceived social support were directly related to higher levels of life satisfaction. Furthermore, social support mediated the effects of volunteer positions on life satisfaction. These findings are discussed in relation to previous research on vocational issues among the elderly. Limitations of this study are mentioned, and suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward professional counseling among Asian-American college students: Acculturation, conceptions of mental illness, and loss of face.

The present study attempted to examine the influence of culture-bound barriers such as acculturation status, loss of face, and conception of mental health on the attitudes of Asian American college students (n = 134) toward seeking professional psychological help. An adapted Acculturation Attitude Scale (AAS; U. Kim, 1988), Zane's (1991) Loss of Face Scale (LOFS), a 10-factor Conception of Mental Health Scale (CMHS; Nunnally, 1961), and a modified version of the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS) with four subscales (Fischer & Turner, 1970) were used in this study. Results support the hypothesis that acculturation and conceptions of mental health were significantly correlated with attitudes toward mental health services. Loss of face was also significantly correlated with attitudes of being open to professional counseling. Implications for mental health professionals working with Asian Americans are highlighted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Serological responses in Lyme disease: the influence of sex, age, and environment

Social workers in a rehabilitation hospital established an outreach service through which volunteers with previous amputations visited patients with recent amputations, acting as role models and offering emotional support and information. Volunteers received in-depth training and continued with their own system of support. Patients who were visited had strong positive responses to the program. Critical components of the program were developing a collaborative partnership between volunteers and social workers; demonstrating credibility to health care professionals; linking emotional support, information, and affirmation; providing benefits to both patient and volunteer; and strengthening linkages among patient, community, and institution.     

Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments

OBJECTIVE: To evaluate an experimental heroin maintenance programme. Design: Randomised trial. SETTING: Outpatient clinic in Geneva, Switzerland. SUBJECTS: Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments. INTERVENTION: Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance). Main outcome measures: Self reported drug use, health status (SF-36), and social functioning. RESULTS: 25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up. CONCLUSIONS: A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.     

When It Is Better to Give Than to Receive: Long-Term Health Effects of Perceived Reciprocity in Support Exchange.

The authors examined esteem enhancement theory and equity theory in explaining the long-term health status of men (n = 178) and women (n = 575). Baseline characteristics were measured in 1990-1993, intimate reciprocity in 1993, and recorded sickness absences for a 9-year period during 1993-2001. Among women, giving more support than receiving in intimate relationships positively affected subsequent health status, as indicated by fewer sickness absences. Among men, receiving more support than giving predicted fewer absences. These effects remained even after significant covariates were included in the model. Thus, women seem to benefit from giving support in intimate relationships, and men seem to benefit from receiving support in intimate relationships. The findings on women are in line with the esteem enhancement theory. No support was obtained for the equity theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transvenous cold mapping and cryoablation of the AV node in dogs: observations of chronic lesions and comparison to those obtained using radiofrequency ablation

Lymphocyte transfusion from the marrow donor (DLT) is well established as an effective therapy for relapse of CML post allogeneic BMT. Reports thus far have been mostly limited to patients who received DLT from a matched sibling donor. We compared the efficacy and toxicity of DLT in 30 patients who were treated with cells from their HLA-identical sibling (n = 18) or from their phenotypically HLA-matched unrelated marrow donor (n = 12). The overall probability of obtaining a cytogenetic remission was 69% (95%CI: 51-83%) and was not significantly different between the two groups. The disease stage at the time of DLT was the only factor associated with cytogenetic remission by multivariate analysis; patients treated in cytogenetic or molecular relapse (n = 11) were seven times more likely (RR = 7.4, 95%CI: 2.4-22.4, P = 0.0005) to respond compared to patients treated for hematologic relapse (n = 19). There was a trend towards more acute GVHD II-IV in the unrelated donor group (58 vs 39%, P = 0.09), but the probability of developing extensive chronic GVHD was not significantly different (56 vs 39%, P = 0.4). We conclude that transfusion of donor cells from HLA-matched volunteer donors does not appreciably increase the risk of GVHD compared with transfusion of cells from HLA-identical siblings in patients with CML who relapse following allogeneic BMT. Conversely, there is no evidence for an increased graft-versus-leukemia effect after DLT from volunteer donors.     

The origin, content, and workload of e-mail consultations

CONTEXT: Despite the common use of e-mail, little beyond anecdote or impressions has been published on patient-clinician e-mail consultation. OBJECTIVE: To report our experiences with free-of-charge e-mail consultations. DESIGN: Retrospective review of all e-mail consultation requests received between November 1, 1995, and June 31, 1998. SETTING AND PARTICIPANTS: Consecutive e-mail consultation requests sent to the Division of Pediatric Gastroenterology at the Children's Medical Center of the University of Virginia in Charlottesville. MAIN OUTCOME MEASURES: Number of consultation requests per month, time required to respond, who initiated the request and their geographic origin, and the kind of information requested in the consultation. RESULTS: During the 33-month period studied, we received 1239 requests, an average (SD) of 37.6 (15.9) each month. A total of 1001 consultation requests (81%) were initiated by parents, relatives, or guardians, 126 (10%) by physicians, and 112 (9%) by other health care professionals. Consultation requests were received from 39 states and 37 other countries. In 855 requests (69%), there was a specific question about the cause of a particular child's symptoms, diagnostic tests, and/or therapeutic interventions. In 112 (9%), the requester sought a second opinion about diagnosis or treatment for a particular child, and 272 consultations (22%) requested general information concerning a disorder, treatment, or medication without reference to a particular child. A total of 1078 requests (87%) were answered within 48 hours of the initial request. On average, reading and responding to each e-mail took slightly less than 4 minutes. CONCLUSION: E-mail provides a means for parents, guardians, and health care professionals to obtain patient and disease-specific information from selected medical consultants in a timely manner.     

Personal contact from friends to increase mammography usage

To increase the use of mammography among women 40 years of age and older, the American Cancer Society (ACS) designed a telephone intervention strategy (the "Tell A Friend" program) that relied on ACS volunteers. During a half-day training session, each volunteer provided a list of 10 women she was willing to contact over a 6-month period and encourage to have a mammogram. Each list was randomized, and five names were returned to each volunteer for inclusion in the intervention. The other women served as controls and were not contacted by the volunteers. All women were subsequently interviewed at the end of the intervention period. Forty-nine percent of the women in the intervention group (n = 289) had received their most recent mammogram since the start of the intervention period, whereas 34% of control women (n = 305) received mammograms during the same time period (p < or = .001, rate ratio = 1.4, 95% confidence interval = 1.2, 1.7). The effectiveness of the intervention remained after controlling for demographic characteristics. The strategy was effective for both black and white women of all ages, but principally among women with annual household incomes of less than $40,000. We conclude that a telephone intervention strategy of personal contacts between acquainted women can significantly increase mammography use, particularly among women with low-to-moderate income.     

Addressing the barriers to mental health services for inner city children and their caretakers

This paper will outline a series of three research studies meant to identify factors related to child mental health service usage and barriers to help seeking for urban minority children and their caretakers. In addition, this paper will describe the systematic development and evaluation of a telephone intervention strategy aimed towards increasing overall attendance at initial intake appointments at an urban child serving agency. The first study explores differences in demographic variables, for two groups of children (n = 450), those that came to an initial intake interview and those that requested child mental health services, but failed to come to any scheduled appointments. The second study evaluates a telephone engagement intervention meant to increase initial attendance (n = 54). Finally, the third study, more rigorously evaluates the impact of an intensive telephone intervention on initial attendance rates by randomly assigning families to the more focused telephone intervention or a "business as usual" telephone screening (n = 108).     

Motivation to volunteer by older adults: a test of competing measurement models

Four measurement models of the structure of motivation to volunteer were evaluated in 2 samples of older (minimum age = 50 years), active volunteers. Motivation to volunteer was assessed with the Volunteer Functions Inventory. Whereas no support was found for either unidimensional or bipartite models, qualified support was observed for both 6-factor and 2nd-order factor models. The best fit of the data was obtained with the 6-factor model of motivation to volunteer (career, enhancement, protective, social, understanding, and values). Contrary to the prediction derived from the 2nd-order factor model, the 6 volunteer motives were differentially related to demographic variables and number of hours spent volunteering for the organization during the past year. Implications for assessing motivation to volunteer among older adults and recruiting older adults as volunteers are discussed.     

The delivery of preventive services in primary care practices according to chronic disease status

OBJECTIVES: The current study examined the relationship between chronic disease status and the receipt of cancer preventive services over a 3-year period. METHODS: Adults (n = 4320) cared for by 167 nonacademic physicians in 42 primary care group practices were studied. Medical records were audited for each patient, as were patient responses to two questionnaires assessing health and sociodemographic characteristics. RESULTS: While the odds of having received counseling to obtain regular checkups were increased for men (1.56) and women (1.46) with hypertension, the odds were reduced (range = 0.32 to 0.81) for having received a sigmoidoscopy (women with diabetes or hypertension, men with hypertension or heart disease), fecal occult blood test (men with diabetes or heart disease, women with heart disease), mammogram or counseling about smoking (women with diabetes), clinical breast exam (women with heart disease), and Pap test (women with diabetes or heart disease). CONCLUSIONS: The presence of common chronic health problems in older adults is associated with lower levels of cancer screening services.     

Stress, social support, and distress in a statewide population of persons with AIDS in New Jersey

This study examined the effects of stress, social support, and health status on distress in a sample of 79 persons with AIDS in New Jersey. The study used New Jersey's AIDS Registry as a geographically based list sampling frame, with data gathered through in-person interviews. The study examined the effects of health status (operationalized as symptom burden), stress (operationalized with a stressful-life-events scale), social support from friends, and social support from family on depression as measured by the Center for Epidemiological Studies-Depression (CES-D) scale. We examined the differential effects of friend support and of family support at differing levels of stressful life events. Results indicate that health status and stressful life events both have substantial impact on distress. Friend support reduced distress under lower-stress conditions, while family support reduced distress under high-stress conditions. These results suggest that social support from peers is critical for emotional well-being of persons with HIV in many circumstances, but that in periods of crisis family support becomes a more important determinant of emotional well-being.     

Older women and hormone replacement therapy: factors influencing late life initiation

OBJECTIVE: To describe factors associated with initiation of hormone replacement therapy (HRT) by older women. DESIGN: A cross-sectional study of 671 randomly selected women aged 65 to 80 who participated in a larger telephone survey on preventive health behaviors. SETTING: A large health maintenance organization (HMO) in Seattle, Washington. PARTICIPANTS: Of the 521 women who responded (78%), 51 had begun taking HRT at age 60 or older and were identified as initiators. Women who had never used HRT or past users who had begun HRT before age 60 were classified as noninitiators (n = 362). Current users who started HRT before age 60 (n = 108) were excluded. MEASUREMENTS: Sources included the telephone survey, automated HMO pharmacy data, and HMO utilization and provider databases. RESULTS: Initiators were similar to noninitiators with respect to age, marital status, education, and health status. Initiators were more likely to have had a hysterectomy at age 60 or later than noninitiators. Sixty-two percent of the non-initiators said they had received no information about the benefits of HRT from their providers compared with 18% of initiators. HRT initiation was associated with belief in prevention benefits of HRT for fractures and cardiovascular disease and with reported encouragement from the physician to use HRT. CONCLUSIONS: Other than hysterectomy status, there were few sociodemographic or health characteristics that markedly distinguished older initiators from noninitiators. Our findings show the importance of physician counseling in an older woman's decision to initiate HRT.     

The actualization balance of ethnic identity.

The authors propose that individuals set limits to the actualization of their social and personal identities. Two studies investigated the notion of actualization balance, according to which identity related decision making is affected by the actualization status of that identity. The first study found that people are more willing to allow nonactualization of Jewish ethnic identity to a person who recently actualized that identity than to an individual who has not done so. In the second study, American Jewish students were requested to volunteer for a Jewish cause. When participants had previously been given the opportunity to actualize their Jewish ethnic identity, fewer of them agreed to volunteer, as compared with participants who had been denied the opportunity to actualize that identity and also as compared with control participants. Previous nonactualizers also showed a stronger motivation to actualize their Jewish identity in a new situation than did participants in the control group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serum concentrations of luteinizing hormone, growth hormone, and cortisol in gilts treated with N-methyl-D,L-aspartate during the estrous cycle or after ovariectomy

The objective of this experiment was to determine the effects of n-methyl-d,l-aspartate (NMA), an agonist of the neurotransmitter glutamate, on circulating concentrations of LH, GH, and cortisol in gilts treated during the luteal (n = 4) or follicular (n = 4) phase of the estrous cycle, or after ovariectomy (n = 4). Blood was sampled every 15 min for 10 h on each of two consecutive days. On the 1st d, two gilts from each group received i.v. injections of NMA (10 mg/kg BW) at h 4 and 6, and the remaining gilts received .9% saline (vehicle). The following day, gilts that had received NMA on the 1st d received vehicle, and gilts that had received vehicle on d 1 received NMA. All gilts received an i.v. challenge of GnRH (.1 microg/kg BW) at h 8 on each day. The NMA treatment increased (P < .01) LH pulse frequency in luteal-phase gilts by 125%. In contrast, NMA decreased (P < .05) mean concentrations of LH by 48% and suppressed (P < .01) LH pulse frequency by 33% in ovariectomized gilts. No characteristics of LH secretion were affected (P > .05) by NMA in follicular phase gilts. Serum LH concentrations for the 2-h period following GnRH were lower (P < .05) in follicular-phase gilts than in ovariectomized gilts and were 1.15 +/- .09 (mean +/- SE), .81 +/- .05, and .51 +/- .17 ng/mL for ovariectomized, luteal-phase, and follicular-phase gilts, respectively. Treatment with NMA increased circulating concentrations of GH by 334% (P < .01) and cortisol by 77% (P < .03) in all gilts. We suggest that the effects of NMA on LH release in gilts depend on the circulating steroidal milieu. In contrast, NMA evokes secretion of GH and cortisol irrespective of the reproductive status of treated gilts.