Serving Asians and Pacific Islanders with HIV/AIDS: challenges and lessons learned.

This paper reports on findings from an evaluation of the Bridges Project, a community-based intervention implemented at the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), to reduce disparities in care for Asians and Pacific Islanders (APIs) living with HIV/AIDS in New York. Comparisons of participants by primary language (Asian language vs. English) and immigration status (undocumented vs. documented/citizen) show that Asian-primary-language and undocumented participants at baseline had a significantly lower rate of receipt of primary care services and experienced significantly more barriers per service than English-primary-language and documented participants. At follow-up, however, differences by primary language and immigration status disappeared, indicating that the Bridges Project was effective in improving service utilization and reducing barriers for the Asian-primary-language and undocumented participants. Barriers to services reported most frequently by participants were language and cost barriers, not knowing where to go for services, and confidentiality concerns. Study findings indicate that the capacity to address multiple API languages and cultures is essential in providing culturally competent care to APIs living with HIV.

Effect of neonatal circumcision on penile neurologic sensation.

OBJECTIVES: To evaluate penile sensory thresholds in neonatally circumcised and uncircumcised men. METHODS: We evaluated 125 patients, 62 uncircumcised men and 63 neonatally circumcised men. All patients completed the Erectile Function domain of the International Index of Erectile Function questionnaire. Of the 125 patients, 29 (International Index of Erectile Function score of between 25 and 30) were placed in the functional group, and 96 in the dysfunctional group. The patients were tested on the dorsal midline glans of the penis (foreskin retracted). Quantitative somatosensory testing was performed and included vibration, pressure, spatial perception, and warm and cold thermal thresholds. RESULTS: In the functional group, t-test analysis demonstrated a significant (P <0.001) difference, with worse vibration and better pressure sensation for uncircumcised men. When controlling for age, hypertension, and diabetes, all t-test significance was lost. In the dysfunctional group, circumcised men (49 +/- 16 years) were significantly younger (P <0.01) than uncircumcised men (56 +/- 13 years). For the dysfunctional group, t-test analysis also demonstrated worse vibration sensation for uncircumcised men (P <0.01). Again, when controlling for age, hypertension, and diabetes, all t-test significance was lost. CONCLUSIONS: We present a comparative analysis of uncircumcised and circumcised men using a battery of quantitative somatosensory tests that evaluate the spectrum of small to large axon nerve fiber function. Our study controlled for factors, including age, erectile function status, diabetes, and hypertension, that have been shown to alter neurologic testing. In our study of neonatally circumcised men, we demonstrated that circumcision status does not significantly alter the quantitative somatosensory testing results at the glans penis.

Timing and laminar profile of eye-position effects on auditory responses in primate auditory cortex.

We examined effects of eye position on auditory cortical responses in macaques. Laminar current-source density (CSD) and multiunit activity (MUA) profiles were sampled with linear array multielectrodes. Eye position significantly modulated auditory-evoked CSD amplitude in 24/29 penetrations (83%), across A1 and belt regions; 4/24 cases also showed significant MUA AM. Eye-position effects occurred mainly in the supragranular laminae and lagged the co-located auditory response by, on average, 38 ms. Effects in A1 and belt regions were indistinguishable in amplitude, laminar profile, and latency. The timing and laminar profile of the eye-position effects suggest that they are not combined with auditory signals at a subcortical stage of the lemniscal auditory pathways and simply "fed-forward" into cortex. Rather, these effects may be conveyed to auditory cortex by feedback projections from parietal or frontal cortices, or alternatively, they may be conveyed by nonclassical feedforward projections through auditory koniocellular (calbindin positive) neurons.

Postpartum relapse to cigarette smoking in inner city women.

Past studies suggest that African American women who quit smoking during pregnancy are more likely to relapse during the postpartum period than white women, although it is not intuitively clear why this should be the case. To shed further light on this issue, two studies were carried out to determine factors that influence smoking cessation during pregnancy and postpartum relapse to smoking in a predominantly low-income African American population. In Study 1, the women were asked to fill out a written survey, and in Study 2, women participated in a structured interview. The same variables that influence smoking cessation and postpartum relapse in the general population, such as nicotine addiction levels, smoking by other members of the household, lack of social support, stress, weight gain, behavioral intentions to quit temporarily, and quitting for others, as opposed to one's self, influenced the behavior of low-income inner city residents. These findings suggest that the difference in rates of postpartum relapse to smoking in African American women and the general population is a matter of degree, rather than kind. The implications of these findings for understanding postpartum relapse in general and assisting low-income women in particular were discussed.

Quantitative somatosensory testing of the penis: optimizing the clinical neurological examination.

PURPOSE: Quantitative somatosensory testing, including vibration, pressure, spatial perception and thermal thresholds of the penis, has demonstrated neuropathy in patients with a history of erectile dysfunction of all etiologies. We evaluated which measurement of neurological function of the penis was best at predicting erectile dysfunction and examined the impact of location on the penis for quantitative somatosensory testing measurements. MATERIALS AND METHODS: A total of 107 patients were evaluated. All patients were required to complete the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, of whom 24 had no complaints of erectile dysfunction and scored within the "normal" range on the IIEF. Patients were subsequently tested on ventral middle penile shaft, proximal dorsal midline penile shaft and glans penis (with foreskin retracted) for vibration, pressure, spatial perception, and warm and cold thermal thresholds. RESULTS: Mixed models repeated measures analysis of variance controlling for age, diabetes and hypertension revealed that method of measurement (quantitative somatosensory testing) was predictive of IIEF score (F = 209, df = 4,1315, p <0.001), while site of measurement on the penis was not. To determine the best method of measurement, we used hierarchical regression, which revealed that warm temperature was the best predictor of erectile dysfunction with pseudo R(2) = 0.19, p <0.0007. There was no significant improvement in predicting erectile dysfunction when another test was added. Using 37C and greater as the warm thermal threshold yielded a sensitivity of 88.5%, specificity 70.0% and positive predictive value 85.5%. CONCLUSIONS: Quantitative somatosensory testing using warm thermal threshold measurements taken at the glans penis can be used alone to assess the neurological status of the penis. Warm thermal thresholds alone offer a quick, noninvasive accurate method of evaluating penile neuropathy in an office setting.

Immunity in adolescents with major depression.

OBJECTIVE: The association between major depression (MD) and altered immunity appears to be age-related, with differing immune changes found in prepubertal children, young adults, and older adults. There is limited information concerning immunity in adolescents with MD. METHOD: Thirty-six otherwise healthy medication-free adolescents (aged 14-20; 23 female) from a community sample, meeting Diagnostic Interview Schedule for Children DSM-III-R criteria for unipolar MD, were compared with 36 nondepressed adolescents matched by gender, age, and racial background. A battery of quantitative and functional immune measures was obtained. RESULTS: MD adolescents had increased (p < .05) circulating lymphocytes and lymphocyte subsets; however, altered distribution of lymphocyte subsets was found only for activated T (HLA-DR+) cells (p < .004) and, possibly, natural killer (NK) (CD56+) cells (p < .06), each showing lower percentages in the MD adolescents. Concanavalin A (but not phytohemagglutinin or pokeweed mitogen) mitogen response was lower in the MD adolescents (p < .02). NK cell activity was elevated at higher effector-target ratios (p < .001), an effect not associated with the number of circulating CD56+ (NK) cells. CONCLUSIONS: Depressed adolescents showed changes in immune measures that have been found to be altered in other MD groups, although the pattern of effects differs.