Characteristics of Women Enrolled in a Patient Portal Intervention for Menopause.

Background: We developed a 6-month educational intervention addressing menopause and management of menopausal symptoms called "My HealtheVet to Enable And Negotiate for Shared decision-making" or MEANS. MEANS is offered through secure messaging via the My HealtheVet patient portal system. Materials and Methods: Women veterans aged 45-60 years registered at the Miami, West Palm Beach, and Orlando Veterans Affairs Healthcare Systems (VAHS). Intervention group: women in the Miami VAHS enrolled in My HealtheVet who were sent an invitation, agreed to participate, and completed the baseline survey. Comparison group: women from the Miami, West Palm Beach, and Orlando VAHS who responded to the baseline survey. Results: The intervention group enrolled 269 women at Miami VAHS: average age 53.2 years; 42.4% white, 43.1% black, and 24.2% Hispanic; 95.9% already used My Healthe Vet. The Comparison group had 590 women: average age 53.8 years; 70.8% white, 20.7% black, and 10.2% Hispanic; 57.6% already used My Healthe Vet. Conclusions: The differences between the intervention and comparison groups likely represent the regional demographic variations and the disparate recruitment techniques adopted for the two groups. Using within- and between-group comparisons at the end of the 6-month intervention, this novel project will evaluate the feasibility of a patient portal intervention on knowledge and shared decision-making regarding menopause among racially and ethnically diverse women. The study highlights the scalable and enormous potential for patient portals in nonurgent chronic disease management and shared decision-making, important in the existing health care climate, wherein "meaningful use" of electronic health records is mandated. Because of the COVID-19 pandemic, medical care has abruptly changed to telehealth and this approach to patient education is more relevant now than ever before. This quality improvement project's registration number is ClinicalTrials.gov ID: NCT03109145.

A Patient Portal Intervention for Menopause Knowledge and Shared Decision-Making.

Background: Menopause is a time often fraught with changes and symptoms, which may require difficult choices and decision-making. During this period, women would benefit from a better understanding and in-depth discussions with providers regarding menopause, associated conditions, and appropriate therapy. Patient portals offer a potential means to improve knowledge and shared decision-making (SDM) about menopause. Materials and Methods: This protocol article explores the feasibility of using the secure messaging (SM) function of the Veterans Affairs (VA) Patient Portal, "My HealtheVet" to implement an educational intervention and measure its impact on knowledge and SDM in the management of menopause. Results: This is a quality improvement pilot study in which women veterans of menopausal age in the Miami VA are offered an educational intervention via a patient portal, while women veterans in two neighboring VA facilities are not. Intervention participants receive weekly SMs with information on menopause symptoms, and treatment. After 6-months, all participants are surveyed on menopause knowledge, SDM, and satisfaction with the program. Conclusion: This study is among the first to assess the impact of an innovative patient portal intervention to improve knowledge and SDM between patients and providers regarding menopause. If successful, our program will add to the "meaningful use" of patient portals and offer a scalable and timely resource for SDM about menopause.

Evaluating an Electronic Health Record Intervention for Management of Heart Failure Among Veterans.

Background:We studied the feasibility of using the Veteran Health Administration's electronic health record (EHR), My HealtheVet, as an educational and monitoring tool for veterans with heart failure (HF).Methods:We enrolled 120 HF patients with a mean age (±standard deviation): 64.8 ± 9.6, range: 41-91 years. There were 105 (87.5%) non-Hispanics, 15 (12.5%) Hispanics, 91 (75.8%) whites, and 20 (16.5%) blacks, and 62 (51.7%) were married. Study participants received educational material on managing their HF and were monitored on their weight and HF symptoms weekly. Surveys on My HealtheVet use and secondary outcomes including knowledge of their illness, quality of life (QoL), and self-efficacy were conducted at baseline and 26 weeks after enrollment.Results:Among the participants, 55 (45.8%) had used My HealtheVet. The number of weeks each user responded to the weekly messages by the care coordinator ranged from 1 (4%) to 26 (100%) with a median of 8. Secondary outcome data were available for 54 patients (24 users and 30 nonusers) who participated in both baseline and 26-week surveys. There was a significant improvement in QoL (p < 0.01) among users of My HealtheVet compared with nonusers. There were no significant differences with respect to self-efficacy or HF knowledge. Use of My HealtheVet and ease in using the HealtheVet portal increased from baseline to follow-up.Conclusions:EHR-based interventions have potential for HF monitoring and case management, and may be feasible in improving QoL for patients.

Outcomes of a Mobile Phone Intervention for Heart Failure in a Minority County Hospital Population.

BACKGROUND: Chronic heart failure (HF) causes significant morbidity, mortality, and cost. Managing HF requires considerable self-management skills and self-efficacy. Little information exists about feasibility and potential impact of a mobile monitoring intervention to improve self-efficacy and quality of life (QoL) among minority patients with HF. MATERIALS AND METHODS: We developed a mobile phone-assisted case management program and tested its impact on outcomes in minority patients with HF in a 2:1 randomized controlled trial. We evaluated self-care efficacy, knowledge, behavior, and QoL at baseline and 3 months. RESULTS: We enrolled 61 participants: intervention 42, usual care 19; mean age ± SD: 55 ± 10 years; 64% male; 75% white Hispanic, 25% African American; and 56% high school education or less. Comparison of the two groups with respect to changes from baseline to 3 months showed significant differences for Self-Efficacy for Managing Chronic Disease (2.09 ± 2.32, p-value = 0.005); health distress scale (-1.1 ± 1.5, p-value = 0.017); and QoL (Role Physical, 23.6 ± 44.5, p-value = 0.042, and General Health, 11.1 ± 14.2, p-value = 0.012). CONCLUSIONS: A mobile phone-based disease management program may help improve self-care efficacy and QoL in a minority population and offers a modality to help reduce ethnic disparity.

Mobile Phone Intervention for Heart Failure in a Minority Urban County Hospital Population: Usability and Patient Perspectives.

BACKGROUND: Chronic heart failure (HF) is a complex and costly disease. Daily weight and symptom monitoring is the cornerstone of HF management. Little information exists about feasibility of a mobile monitoring intervention among minority patients with HF. METHODS: We developed and tested usability of a mobile-monitoring system in minority patients with HF in a 2:1 randomized controlled trial. We tracked usage and obtained feedback on usability and the system overall at 1, 2, and 3 months. RESULTS: Forty-two participants aged 53.0 ± 9.4 years (mean ± standard deviation) were randomized to the mobile-monitoring intervention group. They included the following: 67% males, 76% White Hispanics, 21% African Americans, and 52% with high school education or less. Over the 3-month intervention period, 26 (62%) participants used the system over 50% of the time. Overall, on a 1.0-7.0 scale for both, program satisfaction scores were excellent (mean 6.84 ± 0.46), and the usability ratings were all above 6.0. Comparing 1- to 3-month responses, there was a substantial increase in the percentage of participants who felt the system was easy to use after they had gotten used to it (84% vs. 94%) and that navigating the system was not complicated (78% vs. 84%). Almost all participants said that the program made them feel more secure about their health and that they would stay enrolled in a program like this. None of them had used a similar system before. CONCLUSIONS: A mobile phone-based disease management program is feasible in a minority county hospital population and offers a modality to help reduce ethnic disparity.

Vitamin D and Physical Function in Sedentary Older Men.

OBJECTIVES: To determine the effectiveness of vitamin D supplementation in preventing decline in physical function in older men. DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: Single-center study conducted at a Veterans Affairs Healthcare System. PARTICIPANTS: Sedentary men aged 65 to 90 (mean 72.4 ± 6.8) with baseline 25-hydroxyvitamin D (25(OH)D levels of less than 30 ng/mL and Short Physical Performance Battery (SPPB) test scores of 9 or less (N = 130). INTERVENTION: Daily capsule containing cholecalciferol 4,000 IU daily or placebo for 9 months. MEASUREMENTS: Main outcomes were SPPB score and gait speed. RESULTS: After the intervention, serum 25(OH)D increased from 23.1 ± 5.0 ng/mL to 46.2 ± 12.7 ng/mL in the cholecalciferol group and from 22.5 ± 5.3 ng/mL to 24.0 ± 7.2 ng/mL in the placebo group. At study end, improvements in SPPB score and gait speed were not significantly greater in men receiving cholecalciferol than in those receiving placebo. No differences were found in adverse events or numbers of falls. CONCLUSION: Daily cholecalciferol 4,000 IU for 9 months resulted in significant increases in 25(OH)D concentrations, but achieving these higher levels did not result in improvements in SPPB score or gait speed. These data do not support prescribing vitamin D supplements to older sedentary men to prevent physical function decline.

Presurgical levels of circulating cell-derived microparticles discriminate between patients with and without transfusion in coronary artery bypass graft surgery.

OBJECTIVES: Improved understanding of presurgical risk factors for transfusions will lead to reduction in their number and related complications. The goal of this study is to identify these factors in coronary artery bypass graft (CABG) surgery. METHODS: Presented herein are results of analyses of data from an ongoing study of transfusion in CABG surgery. Of 122 patients, 81 received transfusion (Tx) and 41 did not (NoTx). In addition to routine tests, presurgical levels of microparticles from platelets (PMPs), red cells (RMPs), and other lineages were assayed. RESULTS: The Tx and NoTx groups were similar with respect to most presurgical variables but differed in distribution of gender, blood type, diabetes prevalence, activated partial thromboplastin time (aPTT), hemoglobin (HGB), and microparticle levels. Stepwise multiple logistic regression was used to evaluate presurgical variables and to develop a model to assess risk factors for transfusion. CD41(+) PMP and CD235(+) RMP levels were found to be the main risk factors for transfusion. The Model's discriminating ability was assessed using receiver operating characteristic curve analysis, which showed that the area under the model curve (± standard error) was 0.86 ± 0.04 (95% confidence interval, 0.77-0.94). According to the model, patients with higher presurgical levels of circulating CD41(+) PMP, CD235a(+) RMP, and HGB, as well as a shorter aPTT, are less likely to receive transfusion(s). CONCLUSIONS: Presurgical levels of CD41(+) PMPs and CD235a(+) RMPs are the main risk factors for transfusion in CABG, followed by HGB and aPTT.

Physical activity and quality of life improvements of patients with idiopathic pulmonary fibrosis completing a pulmonary rehabilitation program.

INTRODUCTION: Pulmonary rehabilitation is effective for patients with COPD, but its benefit is less clearly established in idiopathic pulmonary fibrosis (IPF), especially in regard to levels of physical activity and health-related quality of life. The objectives were to determine whether pulmonary rehabilitation increased physical activity as assessed by the International Physical Activity Questionnaire (IPAQ), and improved quality of life and symptoms as assessed by the St George respiratory questionnaire for IPF (SGRQ-I) and the Borg dyspnea index (BDI). METHODS: Subjects who met current criteria for IPF were randomized to a 3-month pulmonary rehabilitation program (n = 11) or to a control group (n = 10). The rehabilitation group participated in twice-weekly, 90-min exercise sessions (24 total sessions). The control group maintained its preceding, normal physical activity. All subjects underwent 6-min walk tests to assess the postexertion BDI. The SGRQ-I and a 5-point self-assessment of health were completed at baseline, after 3 months of intervention or observation, and after 3-month follow-up. All subjects completed the IPAQ weekly. RESULTS: Subjects in the rehabilitation group maintained significantly higher levels of physical activity throughout the 3-month rehabilitation program (rehabilitation: 51,364 ± 57,713 [mean ± SD] metabolic equivalent of task-minutes; control: 20,832 ± 37,155, P = .027 by 2-tailed Mann-Whitney test). SGRQ-I symptom domain scores improved considerably by -9 ± 22 in the rehabilitation group, whereas in the control group they worsened (16 ± 12 rehabilitation compared with control, P = .013 by 2-tailed Mann-Whitney test). During the 3-month follow-up, self-reported physical activity levels in the rehabilitation group were 14,428 ± 8,884 metabolic equivalent of task-minutes and in the control group 16,923 ± 32,620 (P = .17 by 2-tailed Mann-Whitney test), demonstrating substantial reversal of activity in the rehabilitation group. BDI scores after 6-min walk tests did not change significantly. CONCLUSIONS: A 3-month rehabilitation program significantly improved symptoms (SGRQ-I) and physical activity levels (IPAQ) in subjects with IPF while they participated actively in the program. (ClinicalTrials.gov registration NCT01118221.).

Study design and baseline characteristics of participants in the Vitamin D in Vulnerable Adults at the VA (the VIVA Study).

Hypovitaminosis D has been associated with age-related physical decline and an increased risk for falls. The objective of this study is to test whether supplementation with 4000IU of vitamin D(3) (vitD(3)) for 9 months will improve, or slow down the decline of the ability to perform physical tests which have been associated with the preservation of independence in sedentary older men. We describe the study design and the baseline characteristics of the 314 men screened in the VIVA-VA Study (Vitamin D In Vulnerable Adults in the VA), a 2-year, single-site, double-blind, placebo-controlled, randomized clinical trial that enrolled sedentary male veterans ages 65 to 95. The main inclusion criteria are 25-OH vitamin D (25-OHD) levels between 10 and 30 ng/ml, and a Short Performance Physical Battery (SPPB) score ≤ 9. The primary outcome of the study is the SPPB. Subjects were recruited from the Miami Veterans Medical Center clinics. The study recruited 314 male veterans of multiethnic backgrounds. The baseline characteristics observed from the 314 men screened in the VIVA-VA Study are consistent with what is expected in a cohort of elderly sedentary men: low physical performance scores, and low 25OHD levels despite living in South Florida. The results of this study that uses a high dose of vitamin D in a cohort of sedentary older men could provide an evidence-based indication for vitamin D supplementation to improve physical performance in this population.

Exercise limitation in IPF patients: a randomized trial of pulmonary rehabilitation.

BACKGROUND: Patients with idiopathic pulmonary fibrosis (IPF) have severely limited exercise capacity due to dyspnea, hypoxemia, and abnormal lung mechanics. This pilot study was designed to determine whether pulmonary rehabilitation were efficacious in improving the 6-min walk test (6-MWT) distance, exercise oxygen uptake, respiratory muscle strength [maximum inspiratory pressure (MIP)], and dyspnea in patients with IPF. Underlying physiological mechanisms and effects of the intervention were investigated. METHODS: Subjects were randomly assigned to a 3-month pulmonary rehabilitation program (n = 11) or to a control group (n = 10). All subjects initially underwent the 6-MWT and constant load exercise gas exchange studies. RESULTS: Subjects in the rehabilitation group increased treadmill exercise [metabolic equivalent of task-minutes] over the first 14 sessions. Beneficial effects on physical function resulted in those who completed rehabilitation. Subjects who completed the program increased cycle ergometer time and maintained exercise oxygen consumption (exercise VO(2)) at the baseline level over 3 months, while the control group suffered a significant decrease in exercise VO(2). Rehabilitation subjects also increased their MIP. Plasma lactate doubled and brain natriuretic peptide levels increased significantly after exercise, as did the plasma amino acids glutamic acid, arginine, histidine, and methionine. These changes were associated with significant decreases in arterial oxygen saturation and increases in 15-F(2t)-isoprostanes after exercise. CONCLUSIONS: Pulmonary rehabilitation effectively maintained exercise oxygen uptake over 3 months and lengthened constant load exercise time in patients with moderately severe IPF. Exercise endurance on cycle ergometry testing was limited by dyspnea and severe hypoxemia associated with systemic oxidant stress.

The role of vitamin D in improving physical performance in the elderly.

There is an ongoing debate over the role of serum 25(OH) vitamin D [25(OH)D] levels in maintaining or improving physical performance and muscle strength. Much of the controversy is because of the variability between studies in participants' characteristics, baseline serum 25(OH)D levels, and baseline physical functioning. The aim of this ancillary study conducted within a randomized controlled clinical trial was to investigate whether supplementation with 400 or 2000 IU vitamin D3 daily for 6 months would improve measures of physical performance and muscle strength in a community-dwelling elderly population aged 65 to 95 years. Those with the slowest gait speed improved their ability to do chair-stand tests after vitamin D supplementation. This finding remained significant after controlling for potential confounding variables. There was also an inverse correlation between serum 25(OH)D levels and fat mass index (FMI) among women, suggesting that higher supplementation with vitamin D is needed as weight increases. The results of this study suggest that supplementation with vitamin D may be most beneficial in older populations who have low baseline physical functioning.

Correlation of CHADS2 and CHA2DS2-VASc scores with transesophageal echocardiography risk factors for thromboembolism in a multiethnic United States population with nonvalvular atrial fibrillation.

BACKGROUND: The aims of this study were to evaluate the relationship of the CHA(2)DS(2)-VASc score and risk categories with transesophageal echocardiographic (TEE) risk factors for thromboembolism and to compare the CHA(2)DS(2)-VASc and CHADS(2) risk stratification schemes with respect to their ability to predict these risk factors in a multiethnic US population with nonvalvular atrial fibrillation. METHODS: Transesophageal echocardiograms of 167 patients (mean age, 66.3 ± 11.6 years; 146 men [87%]; 100 whites [60%]; 40 Hispanics [24%]; 27 blacks [16%]) with nonvalvular atrial fibrillation were retrospectively reviewed for smoke, sludge, thrombus, and left atrial appendage (LAA) emptying velocity ≤20 cm/sec. The patients' CHA(2)DS(2)-VASc and CHADS(2) risk scores and categories were also calculated. RESULTS: Any LAA abnormality, smoke, sludge, thrombus, and abnormal LAA emptying velocity were present in 45%, 38%, 13%, 3%, and 22% of patients, respectively. Heart failure (P < .001), age (P < .001 for age ≥75 vs ≤64 years, P = .013 for age 65-74 vs ≤64 years), and diabetes (P = .019) were independent predictors of LAA abnormalities, while ethnicity was not. The prevalence of TEE risk factors for thromboembolism increased with increasing CHA(2)DS(2)-VASc score and risk category. The CHADS(2) risk categories of 35 patients (21%) were upgraded by the CHA(2)DS(2)-VASc scheme. Using the latter scheme, fewer patients were classified as at intermediate risk compared with the CHADS(2) system (21 [13%] vs 46 [28%]). Patients classified as at low risk by either scheme had almost no TEE risk factors. Of 30 intermediate-risk patients by CHADS(2) score upgraded to high risk using CHA(2)DS(2)-VASc score, eight (27%) had at least one TEE risk factor for thromboembolism. C-statistics, sensitivity, and specificity for predicting any LAA abnormality were 0.607 (95% confidence interval, 0.549-0.665), 92.0%, and 28.9% for CHA(2)DS(2)-VASc score and 0.685 (95% confidence interval, 0.615-0.755), 81.3%, and 54.2% for CHADS(2) score. CONCLUSIONS: CHA(2)DS(2)-VASc score is associated with TEE risk factors for thromboembolism in a multiethnic US population. Compared with CHADS(2) score, it has increased sensitivity, decreased specificity, and lower ability for predicting TEE risk factors in this population.

Differences in vitamin D3 dosing regimens in a geriatric community-dwelling population.

OBJECTIVE: The adequate dose of vitamin D supplementation for community-dwelling elderly people has not been thoroughly investigated. This study aims to determine the efficacy of a low-dose and a higher dose of vitamin D3 in maintaining 25-hydroxyvitamin D [25(OH)D] levels at or above 30 ng/mL. METHODS: This was a single site, double-blind, randomized exploratory clinical trial that enrolled adults 65 years of age and older. Within strata of baseline 25(OH)D levels (<30 versus ≥ 30 ng/mL) subjects were randomized in a 1:2 ratio to receive either 400 or 2,000 IU vitamin D3 daily for 6 months. The main outcome measures were changes in serum 25(OH)D levels according to baseline 25(OH)D levels and dose of vitamin D3. RESULTS: At baseline, 41 of 105 participants (39%) had low 25(OH)D levels (<30 ng/mL). After 6 months of vitamin D3 supplementation, 21 of 32 participants (66%) receiving 400 IU and 14 of 59 participants (24%) receiving 2,000 IU of vitamin D3 still had low 25(OH)D levels. The largest increases in serum 25(OH)D levels were observed in subjects with baseline levels <30 ng/mL who received 2,000 IU of vitamin D daily. CONCLUSION: Regardless of baseline 25(OH)D level, in persons 65 years of age and older, 6-month vitamin D3 supplementation with 400 IU daily resulted in low 25(OH)D in most individuals, while 2,000 IU daily maintained 25(OH)D levels within an acceptable range in most people on this regimen.

Medical students' attitudes toward obese patient avatars of different skin color.

Physicians' biases for skin color and obesity may negatively affect health-care outcomes. Identification of these biases is the first step to address the problem. We randomized 128 U.S medical students into one of four animated videos of avatar physician-patient counseling sessions, varying the weight and skin color of an elderly patient avatar: white-thin, black-thin, white-obese and black-obese. Medical students viewed white obese avatars as unattractive, ugly, noncompliant, lazy, and sloppy. Medical students' comments suggested a paternalistic attitude toward avatar patients. Avatar-mediated experiences can elicit medical students' bias potentially enabling medical educators to implement bias reduction interventions.

Postural asymmetries in transfemoral amputees.

BACKGROUND: Postural asymmetries are thought to lead to impairment of body structure and function such as muscle imbalance, gait asymmetry and possible chronic conditions, which result in limitation of mobility and restriction of daily activity for transfemoral amputees (TFAs). Despite the potential clinical impact, postural asymmetries have not been confirmed or quantified in TFAs. OBJECTIVES: To identify the presence of postural asymmetries in TFAs utilizing clinical evaluation measures. STUDY DESIGN: An observational cross-sectional study in which participants were evaluated at a single time point without intervention or follow-up. METHODS: Forty-seven unilateral TFAs were measured for standing limb length, pelvic innominate inclination (PII), lateral trunk flexion and hip extension. RESULTS: Limb length discrepancy was present in 66% of participants and 57% had a short prosthetic limb. PII was greater than has been reported in the literature, and the shorter the prosthetic lower limb, the greater the PII on the amputated side (r = -0.422, p = 0.004). Limb length discrepancy and decreased lateral trunk flexion accounted for 26% of the variance in amputated side PII. CONCLUSION: Three postural measurements, namely leg length, pelvic innominate inclination and hip extension, were found to differ between the intact and amputated limb in this study sample. CLINICAL RELEVANCE: Clinicians should include postural assessment as part of their routine evaluation of TFAs in an effort to achieve postural symmetry and reduce the risk of chronic conditions associated with impairment of body structure and function.

Faculty and resident physicians' attitudes, perceptions, and knowledge about antimicrobial use and resistance.

We surveyed faculty and residents to assess attitudes, perceptions, and knowledge about antimicrobial use and resistance. Most respondents were concerned about resistance when prescribing antibiotics and agreed that antibiotics are overused, that inappropriate use is professionally unethical, and that others, but not themselves, overprescribe antibiotics. Antimicrobial stewardship programs should capitalize on these perceptions.

Microparticles in stored red blood cells as potential mediators of transfusion complications.

This article reviews evidence for the involvement of cell-derived microparticles (MPs) in transfusion-related adverse events. The controversy concerning possible added risk of older versus fresher stored blood is also reviewed and is consistent with the hypothesis that MPs are involved with adverse events. Although all types of circulating MPs are discussed, the emphasis is on red blood cell-derived MPs (RMPs). The evidence is particularly strong for involvement of RMPs in transfusion-related acute lung injury, but also for postoperative thrombosis. However, this evidence is largely circumstantial. Work in progress to directly test the hypothesis is also briefly reviewed.

Description of a pilot anal pap smear screening program among individuals attending a Veteran's Affairs HIV clinic.

Despite the higher risk of anal cancer among HIV-infected individuals currently there are no national or international guidelines for anal dysplasia screening. We assessed acceptance and feasibility of screening for anal intraepithelial neoplasia (AIN), the rate of abnormalities, and relationship between the presence of AIN and a history of receptive anal intercourse. Eighty-two percent of HIV-patients approached during routine clinic visit agreed to participate in the study with anal Pap smear collection; 53% had abnormal cytology results and among those undergoing high-resolution anoscopy with biopsy, 55% had high-grade AIN, including 2 cases of carcinoma in situ. Anal cytology was well accepted and it was feasible to be incorporated into HIV primary care practice. Abnormal cytology was not significantly associated with history of anal intercourse (p = 0.767). The high rate of abnormal results reinforces the need for further evaluation of the role of systematic anal Pap smear screening for HIV patients.

Self-reported versus measured height and weight in Hispanic and non-Hispanic menopausal women.

BACKGROUND: Height and weight information is commonly used in clinical trials and in making therapeutic decisions in medical practice. In both settings, the data are often obtained by self-report. If erroneous, this practice could lead to inaccuracies in estimating renal function and medication doses or to inaccurate outcomes of research studies. Previous publications have reported lack of reliability of self-reported weight and height in the general population but have not addressed age-specific and ethnicity-specific subgroups in the U.S. population. The inaccuracy of self-reported weight and height could be particularly significant in times of considerable changes in body weight, such as at menopause, which is often associated with weight gain. METHODS: We assessed the validity of self-reported height and weight in 428 women within the first 5 years of menopause, 70.6% of whom were Hispanic. RESULTS: Participants overestimated their height by 2.2±3.5 cm (mean±standard deviation [SD]) and underestimated their weight by 1.5±2.9 kg. As a group, based on self-reported measures, 33.3% were misclassified with respect to body mass index (BMI) category, and the difference between measured BMI and self-reported BMI was similar between Hispanic white and non-Hispanic white women, positively related to measured weight, and inversely related to measured height, years from menopause, and multiple parity. CONCLUSIONS: From the public health perspective, inaccurate self-report could lead to a considerable underestimation of the current obesity prevalence rates. In our study population, the prevalence of obesity (BMI ≥30 kg/m(2)) was 6.3% based on self-reported values and 18% based on measured height and weight, representing a 3-fold underestimation.

Use of HIV primary care by HIV-positive Haitian immigrants in Miami, Florida.

Little is known about the use of HIV primary care among Haitian immigrants in the USA. The present study utilizes data from a survey of HIV-positive Haitians recruited from an HIV primary care clinic in Miami, Florida, to examine barriers and facilitators of regular use of HIV care by this population. Selection of measures was guided by the Andersen Model of Health Services Utilization for Vulnerable Populations. The dependent variable, regular use of HIV primary care, was operationalized as completion of four or more HIV primary care visits during the previous 12 months. Of the 96 participants surveyed, approximately three-fourths did not graduate from high school and reported an annual income of up to $5000. Seventy-nine percent of participants completed four or more visits in the past year. On univariate as well as multivariate analyses, participants without formal education or those with high psychological distress were significantly less likely to have used HIV primary care regularly than those who attended school or who were less distressed, respectively. The findings emphasize the need for health care practitioners to pay close attention to the education level and the mental health status of their Haitian HIV patients. The data also suggest that once these individuals are linked to care and offered assistance with their daily challenges, they are very likely to stay connected to care and to take their antiretroviral medicines.