Management of Sleep-Disordered Breathing in a Spinal Cord Injury Rehabilitation Center: Model of Care Adaptation and Implementation.

Background: Obstructive sleep apnea (OSA) is highly prevalent and poorly managed in spinal cord injury (SCI). Alternative management models are urgently needed to improve access to care. We previously described the unique models of three SCI rehabilitation centers that independently manage uncomplicated OSA. Objectives: The primary objective was to adapt and implement a similar rehabilitation-led model of managing OSA in an SCI rehabilitation center in Australia. Secondary objectives were to identify the local barriers to implementation and develop and deliver tailored interventions to address them. Methods: A clinical advisory group comprised of rehabilitation clinicians, external respiratory clinicians, and researchers adapted and developed the care model. A theory-informed needs analysis was performed to identify local barriers to implementation. Tailored behavior change interventions were developed to address the barriers and prepare the center for implementation. Results: Pathways for ambulatory assessments and treatments were developed, which included referral for specialist respiratory management of complicated cases. Roles were allocated to the team of rehabilitation doctors, physiotherapists, and nurses. The team initially lacked sufficient knowledge, skills, and confidence to deliver the OSA care model. To address this, comprehensive education and training were provided. Diagnostic and treatment equipment were acquired. The OSA care model was implemented in July 2022. Conclusion: This is the first time a rehabilitation-led model of managing OSA has been implemented in an SCI rehabilitation center in Australia. We describe a theory-informed method of adapting the model of care, assessing the barriers, and delivering interventions to overcome them. Results of the mixed-methods evaluation will be reported separately.

Heart rate recovery after orthostatic challenge and cardiopulmonary exercise testing in older individuals: prospective multicentre observational cohort study.

Background: Impaired vagal function in older individuals, quantified by the 'gold standard' delayed heart rate recovery after maximal exercise (HRRexercise), is an independent predictor of cardiorespiratory capacity and mortality (particularly when HRR ≤12 beats min-1). Heart rate also often declines after orthostatic challenge (HRRorthostatic), but the mechanism remains unclear. We tested whether HRRorthostatic reflects similar vagal autonomic characteristics as HRRexercise. Methods: Prospective multicentre cohort study of subjects scheduled for cardiopulmonary exercise testing (CPET) as part of routine care. Before undergoing CPET, heart rate was measured with participants seated for 3 min, before standing for 3 min (HRRorthostatic). HRRexercise 1 min after the end of CPET was recorded. The primary outcome was the correlation between mean heart rate change every 10 s for 1 min after peak heart rate was attained on standing and after exercise for each participant. Secondary outcomes were HRRorthostatic and peak VO2 compared between individuals with HRRexercise <12 beats min-1. Results: A total of 87 participants (mean age: 64 yr [95%CI: 61-66]; 48 (55%) females) completed both tests. Mean heart rate change every 10 s for 1 min after peak heart rate after standing and exercise was significantly correlated (R2=0.81; P<0.0001). HRRorthostatic was unchanged in individuals with HRRexercise ≤12 beats min-1 (n=27), but was lower when HRRexercise >12 beats min-1 (n=60; mean difference: 3 beats min-1 [95% confidence interval 1-5 beats min-1]; P<0.0001). Slower HRRorthostatic was associated with lower peak VO2 (mean difference: 3.7 ml kg-1 min-1 [95% confidence interval 0.7-6.8 ml kg-1 min-1]; P=0.039). Conclusion: Prognostically significant heart rate recovery after exhaustive exercise is characterised by quantitative differences in heart rate recovery after orthostatic challenge. These data suggest that orthostatic challenge is a valid, simple test indicating vagal impairment. Clinical trial registration: researchregistry6550.

The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida.

In 2013, Florida had the highest rate of new HIV infections and only 56% of persons living with HIV (PLWH) were virally suppressed. In response, we initiated a new HIV cohort in Florida to better understand issues affecting HIV health outcomes. This manuscript will describe the procedures of the Florida Cohort; summarize information regarding enrollment, follow-up, and findings to date; and discuss challenges and lessons learned during the establishment of a multisite cohort of PLWH. Florida Cohort participants were enrolled from eight clinics and community-based organizations geographically diverse counties across Florida. Data were obtained from participant questionnaires, medical records, and state surveillance data. From 2014-2018, 932 PLWH (44% ≥50 years, 64% male, 55% black, 20% Latinx) were enrolled. At baseline, 83% were retained in care and 75% were virally suppressed. Research findings to date have focused on outcomes such as the HIV care continuum, HIV-related comorbidities, alcohol and drug use, and mHealth interventions interest. Strengths included the diversity of the sample and the linkage of participant surveys with existing surveillance data. However, the study had several challenges during planning and follow-up. The lessons learned from this study can be helpful when initiating a new longitudinal cohort study.

A Longitudinal Analysis of the Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic among Women in the Criminal Justice System.

Using data from a randomized controlled trial of 319 women mainly recruited from a Municipal Drug Court System in St. Louis, MO, this study evaluates substance use, victimization, and HIV/AIDS risk behaviors over time. The results indicated that, for all participants, the likelihood of victimization, using drugs, and meeting the criteria for HIV/AIDS risk decreased by 46% by the eight-month follow-up; however, results did not differ significantly by intervention group. Women who were sexually abused as a child, had 4+ arrests, or believed they had sexual and drug-using behaviors that need changing at baseline were more likely to experience these issues over time.

One Step at a Time: A Latent Transitional Analysis on Changes in Substance Use, Exposure to Violence, and HIV/AIDS Risk Behaviors among Female Offenders.

The aim of this analysis is to identify latent subgroups of women based on substance use, exposure to violence, and risky sexual behaviors and quantify discrete stages of behavior change over time. Data comes from 317 women recruited from a Municipal Drug Court System in the Midwest. All participants were interviewed regarding their substance use and sexual behaviors, as well as their exposure to violence at baseline, a 4th-month follow-up, and an 8th-month follow-up. A latent transitional analysis (LTA), a longitudinal extension of a latent class analysis (LCA), was used to quantify discrete stages of behavior change. The results of our analyses revealed 4 distinct behavioral profiles in our sample: 1) women with high probabilities of risky sexual behaviors, exposure to violence, and crack/cocaine use, 2) women with a high probability of exposure to violence, and moderate sexual risk taking, 3) women characterized solely by a high probability of crack/cocaine use, 4) women with low probabilities of all factors. The proportion of women in latent statuses characterized by a high probability of crack/cocaine use did not substantially decrease over time. Women who experienced child sexual abuse, had a greater number of lifetime arrests, were older, and believed they had risky drug using behavior that needed changing at baseline were significantly more likely to be in higher-risk latent statuses. Targeted interventions tailored to crack/cocaine users, as well as a wide-spread need for trauma-informed interventions among females involved in the criminal justice system, are needed.

Barriers to Hepatitis C Screening in a Minority Population: A Comparison of Hepatitis C and Human Immunodeficiency Virus Screening Rates at a Community STD Clinic in Miami, Florida.

METHODS: 357 patients at a free STD clinic in Miami, FL were screened for HCV. Surveys were administered assessing risk factors for infectious disease transmission, and HCV and HIV screening history. RESULTS: 15.1% of participants had been screened for HCV before whereas 83.8% had been screened for HIV (n = 356). Of the patients previously screened for HCV (n = 54), 98.2% of these patients had previously been screened for HIV as well. CONCLUSION: This data shows the low prevalence of prior HCV screenings in a high-risk population in Miami, FL. Participants who had previously received an HIV screening test were more likely to report receiving a prior HCV screening. Despite the high prevalence of HCV, most HCV infections are undiagnosed. Mortality from HIV has been declining in the United States while mortality from HCV is increasing. To decrease HCV related mortality, we recommend offering HCV screening in conjunction with HIV screening.

HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others, Family, and Friends.

We evaluated the association between social support received from significant others, family, and friends and HIV-related sexual risk behaviors among African American men involved in the criminal justice system. Project DISRUPT is a cohort study among African American men released from prison in North Carolina (N = 189). During the baseline (in-prison) survey, we assessed the amount of support men perceived they had received from significant others, family, and friends. We measured associations between low support from each source (

Physical activity in Black breast cancer survivors: implications for quality of life and mood at baseline and 6-month follow-up.

BACKGROUND: The present study sought to examine the influence of physical activity on quality of life and negative mood in a sample of Black breast cancer survivors to determine if physical activity (dichotomized) predicted mean differences in negative mood and quality of life in this population. METHODS: Study participants include 114 women diagnosed with breast cancer (any stage of disease, any type of breast cancer) recruited to participate in an adaptive cognitive-behavioral stress management intervention. The mean body mass index of the sample at baseline was 31.39 (standard deviation = 7.17). RESULTS: A multivariate analysis of covariance (MANCOVA) was conducted to determine if baseline physical activity predicted mean differences in negative mood and quality of life at baseline and at follow ups while controlling for relevant covariates. A one-way MANCOVA revealed a significant multivariate effect by physical activity group for the combined dependent variables at Time 2 (post 10-week intervention), p = .039. The second one-way MANCOVA revealed a significant multivariate effect at Time 3 (6 months after Time 2), p = .034. Specifically, Black breast cancer survivors who engaged in physical activity experienced significantly lower negative mood and higher social/family well-being at Time 2 and higher spiritual and functional well-being at Times 2 and 3. CONCLUSIONS: Results show that baseline physical activity served protective functions for breast cancer survivors over time. Developing culturally relevant physical activity interventions specifically for Black breast cancer survivors may prove vital to improving quality of life and mood in this population. Copyright © 2016 John Wiley & Sons, Ltd.

Marijuana use and viral suppression in persons receiving medical care for HIV-infection.

BACKGROUND: Marijuana use is common among persons living with HIV (PLWH), but studies on its effect on HIV clinical outcomes are limited. OBJECTIVES: We determined the association between marijuana use and HIV viral suppression among PLWH. METHODS: Data came from five repeated cross-sections (2009-2013) of the Florida Medical Monitoring Project, a population-based sample of PLWH in Florida. Data were obtained via interview and medical record abstraction (MRA). Weighted logistic regression models were used to determine the association between marijuana use (past 12 months) and durable viral suppression (HIV-1 RNA value of ≤ 200 copies/milliliter in all measurements within the past 12 months). RESULTS: Of the 1,902 PLWH receiving antiretroviral therapy, completed an interview, and had a linked MRA, 20% reported marijuana use (13% less than daily and 7% daily use) and 73% achieved durable viral suppression. In multivariable analysis, marijuana use was not significantly associated with durable viral suppression in daily [Adjusted Odds Ratio (AOR): 0.87, 95% confidence interval (CI): 0.58, 1.33] or in less than daily [AOR: 0.83, 95% CI: 0.51, 1.37] users as compared to non-users when adjusting for sociodemographic factors, time since HIV diagnosis, depressive symptoms, alcohol, cigarette and other substance use. CONCLUSION: In this sample of PLWH receiving medical care in Florida, there was no statistically significant association between marijuana use and viral suppression. However, as the limits of the confidence intervals include effects that may be considered to be clinically important, there is a need for additional evidence from other samples and settings that include more marijuana users.

Impact of a University-Community Partnership Approach to Improving Health Behaviors and Outcomes Among Overweight/Obese Hispanic Adults.

Objective. To examine the impact of a community-informed and community-based Health-Smart Church (HSC) Program on engagement in health promoting behaviors (healthy eating and physical activity) and health outcomes (body mass index, weight, and systolic and diastolic blood pressure). Design. A total of 70 overweight/obese Hispanic adults participated in an intervention group (n = 37) or a waitlist control group (n = 33) in 2 Hispanic churches in Bronx, New York. Results. Post-intervention the intervention group significantly increased in frequency of healthy eating and physical activity compared to the waitlist control group. Although no significant changes in body mass index or systolic blood pressure were found for either group, the intervention group decreased significantly in weight from pre-intervention to post-intervention. Conclusions. The results of the present study add to the growing body of literature evidencing the successful use of community-engaged and community-based participatory health promotion interventions with racial/ethnic minority populations and highlight important practices and considerations for similar health promotion interventions with these communities.

Contextualizing Psychosocial Determinants of Alcohol Use by Age Cohorts of Adults Living With HIV, Ages 50 and Older.

We examined the influence of age on associations between affective states, social support, and alcohol use by age cohorts. We recruited 96 older Black adults living with HIV from the southeastern United States in 2013 and 2014. Participants completed questionnaires assessing demographics, psychological function, and substance use. Hierarchical regression analyses assessed the relationship between psychosocial factors and alcohol use in a 50- to 59-year-old group, and a 60-years-and-older age group. After controlling for covariates, trait anger, state anger, and life stress were positively associated with alcohol consumption in the younger group, while social support was negatively associated with alcohol consumption in the older group. Interventions should target negative affective states in 50- to 59-year-old adults with HIV, and preserve social support for adults with HIV as they age, as such interventions will likely have an impact on these individuals' alcohol consumption and longstanding quality of life.

Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users.

BACKGROUND: Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. OBJECTIVES: To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. METHODS: Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. RESULTS: Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. CONCLUSIONS: The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.

Willingness of African American Women to Participate in e-Health/m-Health Research.

INTRODUCTION: Due to high rates of technology adoption, African American women are well positioned to benefit from e-health/mobile health (m-health) interventions; yet, there are limited data on understanding their use of technology and willingness to participate in e-health/m-health research. MATERIALS AND METHODS: A self-administered survey was completed by 589 African American women. Survey items measured sociodemographics, technology use and access, and willingness to participate in e-health/m-health research. Multinomial logistic regression examined associations among three age groups (18-29, 30-50, and 51+years old) and technology access, as well as motivators and barriers to participating in e-health/m-health research. RESULTS: Most participants were willing to receive text messages as part of a research study. Many reported using a health-related application in the past 30 days, with younger women more likely to do so than older women (p<0.0001). Younger women were more likely than older women to be motivated for the greater good (p<0.01) and for financial incentives (p=0.02), whereas older women were more likely than younger women to be motivated if referred by a healthcare provider (p=0.02). Younger women were more likely than older women to report concerns about data plans (p<0.01 for all), whereas older women were more likely to report a lack of a smartphone (p=0.048) and privacy concerns (p<0.001). CONCLUSIONS: Culturally tailored e-health/m-health research using smartphones may be of interest to African American women who are interested in risk reduction and chronic disease self-management. Barriers such as smartphone data plans and privacy will need to be addressed.

Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+.

Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR = 3.37, 95% CI: 1.23-9.21, p = .018 and heavy drinking, AOR = 2.47, 95% CI: 1.07-5.71, p = .033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.

Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs.

BACKGROUND: Recent studies have reported high rates of Trichomonas vaginalis among middle age and older adults. Though trichomoniasis risk factors in this age cohort remain largely unknown, illicit drug use has been associated with increased incidence of sexually transmitted infections (STIs). The number of mid-older adults using illicit drugs has increased significantly in recent years suggesting the need to understand the relationship between drug use and STIs in this age cohort. OBJECTIVES: This study examined the relationship between drug use, sexual-risk behaviors, and biologically confirmed T. vaginalis in a sample of mid-older and younger adults who reported recent drug use. METHODS: The cross-sectional design examined the relationship between past 6-month drug use, sexual risk-behaviors, and PCR-confirmed T. vaginalis in 264 adults age 18-64 who were recruited from Baltimore, Maryland. These relationships were also explored in the age-stratified sample among those 18-44 years ("younger") and individuals 45+ years ("mid-older"). RESULTS: Trichomoniasis prevalence did not differ significantly between younger (18.8%) and mid-older (19.1%) adults. Mid-older adults that tested positive for T. vaginalis were more likely to have used marijuana and crack in the past 6 months. Among younger adults, there were no associations between trichomoniasis and past 6-month drug use and sexual-risk behavior. CONCLUSIONS/IMPORTANCE: Age- and drug-related immune decline is hypothesized to contribute to increase susceptibility to T. vaginalis in mid-older adults. Broad screening for trichomoniasis, particularly among older adults who are often not regarded as at risk for STIs, is needed to control this often asymptomatic infection.

Increased risk for substance use and health-related problems among homeless veterans.

BACKGROUND AND OBJECTIVES: The first aim of this study was to compare self-reported causes of homelessness between veterans and nonveterans. A second aim examined whether homeless male veterans were more likely than homeless male nonveterans to experience current problems with addictions, mental health, and physical health. Additionally, a third aim was to compare frequency of emergency room visits and treatment needs between the two groups. METHODS: Secondary data analyses compared male homeless veterans and nonveterans (N = 353) enrolled in the Alachua County Point in Time study in central Florida. Participants completed a questionnaire on demographics and health variables. Additional questions included recent emergency room visits and medical or other needs not being met. RESULTS: Veterans reported higher rates of substance use and mental health problems as a primary cause of homelessness when compared to nonveterans. Homeless veterans were more likely than nonveterans to report current problems with addictions (OR = 6.29, 95% CI: 3.43-11.53, p < .001), mental health problems (OR = 4.12, 95% CI: 2.28-7.42, p < .001), and physical problems (OR = 1.83, 95% CI: 1.08-3.67, p < .01). Finally, over half of homeless veterans (53.1%) reported an ER visit in the past year compared to only 40.9% of nonveterans (OR = 1.73, 95% CI: 1.07-2.80, p < .05). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Veterans may be more likely to become homeless due to addiction and mental health and over half of homeless veterans are presenting to hospital emergency rooms. Given the greater utilization among homeless veterans, emergency rooms may serve as a prime opportunity to provide brief treatment and referrals for needed services.

Psychosocial interventions addressing the needs of Black women diagnosed with breast cancer: a review of the current landscape.

BACKGROUND: Poorer health outcomes and lower survival rates have been well documented among African American/Black (Black) women diagnosed with breast cancer. Black women are 41% more likely to die from breast cancer than White women despite a lower incidence rate. Apart from pharmacotherapy, psychosocial interventions are recommended by the Institute of Medicine as standard medical care for breast cancer patients at all phases of treatment. The current review is the first attempt to systematically evaluate the literature on the influence of psychosocial interventions for Black women diagnosed with breast cancer. METHODS: This systematic review aimed to adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive computerized literature search of CINAHL, PsycINFO, PubMed, and Web of Science was conducted to obtain relevant studies. RESULTS: Interventions demonstrated improved mood, decreased distress, increased ability to cope with intrusive thoughts and cancer-related stress, personal growth, and improved social well-being. However, aspects unique to this population require additional scientific inquiry. Over 80% of empirical interventions focused on Black women diagnosed with breast cancer have been concentrated on the posttreatment phase. There is a paucity of work at the time of diagnosis and during treatment. CONCLUSIONS: To address gaps in the scientific literature, more work is needed to better understand how psychosocial interventions can improve the health trajectory for Black women diagnosed with breast cancer particularly in the areas of seeking help and support, identifying culturally acceptable methods for engaging support networks, and identifying best practices for enhancing coping skills.

Time Since Release from Incarceration and HIV Risk Behaviors Among Women: The Potential Protective Role of Committed Partners During Re-entry.

After release from incarceration, former female inmates face considerable stressors, which may influence drug use and other risk behaviors that increase risk for HIV infection. Involvement in a committed partnership may protect women against re-entry stressors that may lead to risky behaviors. This study measured the association between time since release from incarceration (1-6 months ago, and >6 months ago versus never incarcerated) and HIV risk behaviors and evaluated whether these associations differed by involvement in a committed partnership. Women released within the past 6 months were significantly more likely to have smoked crack cocaine, used injection drugs and engaged in transactional sex in the past month compared to never-incarcerated women and women released more distally. Stratified analyses indicated that incarceration within the past 6 months was associated with crack cocaine smoking, injection drug use and transactional sex among women without a committed partner yet unassociated with these risk behaviors among those with a committed partner.

Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders.

Depression and apathy are common among people living with HIV (PLWH). However, in PLWH, it is unclear whether depression and apathy are distinct conditions, which contribute to different patterns of disruption to cognitive processing and brain systems. Understanding these conditions may enable the development of prognostic indicators for HIV associated neurocognitive disorders (HAND). The present study examined substance use behavior and cognitive deficits, associated with depression and apathy, in 120 PLWH, using hierarchical regression analyses. Higher levels of depression were associated with a history of alcohol dependence and greater deficits in processing speed, motor and global cognitive functioning. Higher levels of apathy were associated with a history of cocaine dependence. It is recommended that PLWH get screened appropriately for apathy and depression, in order to receive the appropriate treatment, considering the comorbidities associated with each condition. Future research should examine the neurological correlates of apathy and depression in PLWH.