Factors predicting 12-month retention in care for minority women living with HIV.

Objectives: Retention in HIV medical care is associated with improved clinical outcomes and reduced mortality. The present study was conducted to identify significant predictors of 1-year retention in care for a sample of minority women whose engagement in HIV care at baseline varied along the care continuum from newly diagnosed to lost-to-care. Methods: One hundred sixty-five cisgender and transgender women living with HIV in a southern US state were offered a multicomponent retention intervention that included outreach, medical case management (MCM), patient navigation services (PN), and a group intervention for stigma. Multilevel logistic regression analysis was performed to identify baseline and intervention predictors of retention in care at 12 months following enrollment. Results: Multilevel logistic regression analysis revealed that baseline characteristics such as working significantly reduced the odds of being retained as did increasing CD4 counts. However, greater amounts of patient navigation and medical case management services received increased the odds of being retained. Conclusion: MCM services designed to accelerate coordination and linkage or re-linkage to primary care and PN services to help navigate the complex system of HIV offered in the present study are particularly effective for minority women who lack health insurance, have low CD4 counts, and are unemployed.

Suero autólogo en úlcera vascular de larga evolución / Autologous serum in vascular ulcer of long evolution

El tratamiento de las heridas crónicas sigue siendo un tema de gran interés debido a la evolución lenta y la difícil cicatrización que presentan, a pesar del desarrollo de nuevas terapias sobre el cuidado y tratamiento de las heridas. El suero autólogo a través de los factores de crecimiento se ha venido utilizando cada vez con mayor frecuencia en diferentes ramas de la medicina como traumatología en la reparación de lesiones tendinosas y roturas de ligamentos, en oftalmología en lesiones de la conjuntiva1. El presente reporte de caso corresponde a un paciente varón, de 76 años con una ulcera vascular crónica, de 3 años de evolución, localizada en la porción distal de la pierna izquierda, con severa incompetencia de vena safena menor a predominio de miembro inferior izquierdo. Se plantea como tratamiento alternativo la aplicación de suero autólogo, logrando reactivar el proceso de reparación y posterior cicatrización de la lesión que no se lograba con el tratamiento convencional.

The treatment of chronic wounds continues to be a topic of great interest due to the slow evolution and difficult healing they present, despite the development of new therapies on wound care and treatment. We present the case of a 76 year old male patient with a chronic vascular ulcer, 3 years of evolution, located in the distal portion of the left leg, with severe incompetence of saphenous vein minor to predominance of left lower limb. The application of autologous serum is proposed as an alternative treatment, managing to reactivate the repair process and subsequent wound healing that was not achieved with conventional treatment.

Lead hazards for pregnant women and children: part 2: more can still be done to reduce the chance of exposure to lead in at-risk populations.

In the United States the risk of lead exposure is far higher among poor, urban, and immigrant populations than among other groups. And even slightly elevated blood lead levels increase children's risk of significant neurobehavioral problems extending through adolescence. Research has shown that blood lead levels in pregnant women well below the Centers for Disease Control and Prevention's "level of concern" of 10 micrograms per deciliter can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers of lead exposure, routine prenatal lead screening and education is not a standard of care in the United States. Part 1 of this two-part article (October) presented the case of a pregnant woman with lead poisoning and described the epidemiology of lead exposure in the United States, the main sources of it, and its effects on a pregnant woman and her developing fetus and child. Part 2 describes recommendations for prenatal screening and strategies for dealing with lead exposure when it occurs: education, reduction in environmental exposure, treatment options, and developmental surveillance.

Lead hazards for pregnant women and children: part 1: immigrants and the poor shoulder most of the burden of lead exposure in this country. Part 1 of a two-part article details how exposure happens, whom it affects, and the harm it can do.

Poor, urban, and immigrant populations are at far greater risk for lead exposure than are other groups in the United States. Children with even slightly elevated blood lead levels are at increased risk for significant neurobehavioral problems that can extend through adolescence. Research has shown that elevated blood lead levels in pregnant women, even those well below 10 micrograms per deciliter-the Centers for Disease Control and Prevention's "level of concern"-can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers, routine prenatal lead screening and lead education is not a standard of care. Part 1 of this two-part article presents a short case example of a pregnant mother with lead poisoning and describes the epidemiology of lead exposure in the United States, the main sources of lead exposure, and the effects of lead on the pregnant mother and the developing fetus and child. Prevention is crucial. Treatment options such as chelation must be used selectively and will not reverse damage once it's occurred. Part 2 will describe recommendations for screening, education, nutrition, reducing environmental exposures, and treatment.

Impact of HIV/AIDS education on health care provider practice: results from nine grantees of the Special Projects of National Significance Program.

The study assessed the impact of health care provider HIV/AIDS education and training on patient care from nine Special Projects of National Significance. Telephone interviews were conducted with 218 health care providers within 8 months, on average, following completion of training. Respondents provided examples of how the SPNS trainings affected their provision of patient/client care. Transcribed comments reflecting change in patient/client care were classified by independent coders under 1 of 10 broad practice change categories. Eighty-two percent of the trainees identified at least one instance of change in patient/client care as a function of their training experience. Self-reported findings included changes in the number/types of patients seen, interpersonal interactions with patients/clients, HIV testing and counseling practices, patient/family education, infection control, advocacy, referrals and collaboration, documentation, and other service changes.