A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV.

Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.

Housing Instability Associated with Return to Stimulant Use among Previously Abstaining Women.

Stimulant use among unstably housed individuals is associated with increased risks of psychiatric co-morbidity, violence, HIV transmission, and overdose. Due to a lack of highly effective treatments, evidence-based policies targeting the prevention of stimulant use disorder are of critical importance. However, little empirical evidence exists on risks associated with initiating or returning to stimulant use among at-risk populations. In a longitudinal cohort of unstably housed women in San Francisco (2016-2019), self-reported data on stimulant use, housing status, and mental health were collected monthly for up to 6 months, and factors associated with initiating stimulants after a period of non-use were identified through logistic regression. Among 245 participants, 42 (17.1%) started using cocaine and 46 (18.8%) started using methamphetamine. In analyses adjusting for demographics and socio-structural exposures over the preceding month, experiencing street homelessness was associated with initiating cocaine use (AOR: 2.10; 95% CI: 1.04, 4.25) and sheltered homelessness with initiating methamphetamine use (AOR: 2.57; 95% CI: 1.37, 4.79). Other factors-including race, income, unmet subsistence needs, mental health, and treatment adherence-did not reach levels of significance, suggesting the paramount importance of policies directed toward improving access to permanent supportive housing to prevent stimulant use among unstably housed women.

Chronic Respiratory Disease and Health-Related Quality of Life of African American Older Adults in an Economically Disadvantaged Area of Los Angeles.

Background. Most of the attention of policy makers, program planners, clinicians, and researchers in the area of physical health disparities among African American older adults has been traditionally focused on cardiometabolic disease and cancer. Among a long list of chronic medical conditions, chronic respiratory conditions (CRCs), such as asthma, chronic bronchitis, and emphysema, have received less attention. Purpose. This study investigated whether CRCs contribute to physical and mental health-related quality of life (HRQoL) of African American older adults who live in economically disadvantaged urban areas, and whether these effects are due to demographic factors, socioeconomic status (SES), health behaviors, and comorbid medical and mental conditions. Methods. This community-based study recruited 617 African American older adults (age ≥ 65 years) from Service Planning Areas (SPA) 6, an economically disadvantaged area in South Los Angeles. Structured face-to-face interviews were used to collect data on demographic factors (age and gender), SES (educational attainment and financial difficulty), living arrangements, marital status, health behaviors (cigarette smoking and alcohol drinking), health (CRC, number of comorbid medical conditions, depressive symptoms, and pain intensity), and physical and mental HRQoL (Physical and Mental Component Summary Scores; PCS and MCS; SF-12). Linear regressions were used to analyze the data. Results. The presence of CRCs was associated with lower PCS and MCS in bivariate analysis. The association between CRCs and PCS remained significant above and beyond all confounders. However, the association between CRCs and MCS disappeared after controlling for confounders. Conclusion. For African American older adults living in economically disadvantaged urban areas, CRCs contribute to poor physical HRQoL. Evaluation and treatment of CRCs in African American older adults may be a strategy for reduction of disparities in HRQoL in this population. As smoking is the major modifiable risk factor for CRCs, there is a need to increase accessibility of smoking cessation programs in economically disadvantaged urban areas. More research is needed on the types, management, and prognosis of CRCs such as asthma, chronic bronchitis, and emphysema in African American older adults who reside in low-income and resource limited urban areas.

Blunt Trauma Abdominal and Pelvic Computed Tomography Has Low Yield for Injuries in More Than One Anatomic Region.

INTRODUCTION: Most trauma centers order abdominal and pelvic computed tomography (CT) as an automatically paired CT for adult blunt trauma evaluation. However, excessive CT utilization adds risks of excessive exposure to ionizing radiation, the need to work up incidental findings (leading to unnecessary and invasive tests), and greater costs. Examining a cohort of adult blunt trauma patients that received paired abdominal and pelvic (A/P) CT, we sought to determine the diagnostic yield of clinically significant injuries (CSI) in the following: 1) the abdomen alone; 2) the pelvis alone; 3) the lumbosacral spine alone; and 4) more than one of these anatomic regions concomitantly. METHODS: In this retrospective study, we reviewed the imaging and hospital course of a consecutive sample of blunt trauma activation patients older than 14 years of age who received paired A/P CT during their blunt trauma assessments at an urban Level I trauma center from April through October 2014. Categorization of CSI was determined according to an a priori, expert panel-derived classification scheme. RESULTS: The median age of the 689 patients who had A/P CT was 48 years old; 68.1% were male; 64.0% were admitted, and hospital mortality was 3.6%. CSI yields were as follows: abdomen 2.2% (95% confidence interval [CI] [1.3-3.6%]); pelvis 2.9% (95% CI [1.9-4.4%]); lumbosacral spine 0.6% (95% CI [0.2-1.5%]); both abdomen and pelvis 0.3% (95% CI [0.1-1.1%]); both the abdomen and lumbosacral spine 0.6% (0.2-1.5%); both the pelvis and lumbosacral spine 0.1% (0.0-0.8%); all three regions - abdomen, pelvis and lumbosacral spine - 0.1% (0.0-0.8%). CONCLUSION: Automatic pairing of A/P CT has very low diagnostic yield for CSI in both the abdomen and pelvis. These data suggest a role for selective CT imaging protocols that image these regions individually instead of automatically as a pair.

Is Nottingham Health Profile a reliable tool to measure quality of life of Filipinos with chronic kidney diseases undergoing hemodialysis.

The quality of life (QOL) of hemodialysis patients is often compromised and many tools have been developed to assess the health-related QOL of chronic kidney disease (CKD) patients undergoing hemodialysis. However, no such tool is currently in use in the Philippines. The objective of this study is to determine if Nottingham Health Profile (NHP) can be a useful tool in the Philippines. Eighty patients undergoing hemodialysis in the dialysis unit of our hospital were enrolled for this study. Sixty-nine patients completed the study. Comparative analysis revealed significant difference in social isolation with favorable result for the Filipino patients. Other measures correlate well although with differences that were not statistically significant. NHP can be successfully applied as a standard QOL tool in the Philippines. However, it should be translated into Filipino to avoid language difficulty. NHP may be recommended for QOL determination in other developing countries.