Cultural and quality-of-life considerations when administering corticosteroids as a therapeutic strategy for African American women living with systemic lupus erythematosus

OBJECTIVE

This study investigated the association among corticosteroids, emotional health, physical health, and work/regular activities of daily living in an ethnically diverse sample of women with systemic lupus erythematosus.

METHODS

A secondary analysis of data from the Medical University of South Carolina Lupus Database was conducted between confirmed cases of lupus (n = 224) and controls (n = 60). The sample comprised 57 Caucasian Americans, 141 Gullah African Americans (a subpopulation of African Americans from the Sea Islands of South Carolina and Georgia), and 86 non-Gullah African Americans.

RESULTS

Emotional health outcomes were better for women with systemic lupus erythematosus compared with controls. High emotional health scores may be influenced by cultural factors such as masking emotion, disease-coping mechanisms, religion, and strong familial and social support. Although a significant association was not detected between emotional health and work/regular activities of daily living, relationships were significant after adjusting for corticosteroid use.

CONCLUSION

These findings suggest corticosteroid use does influence the strength of the association between emotional health and work/regular activities of daily living.

Cytokine balance and behavioral intervention; findings from the Peer Approaches to Lupus Self-Management (PALS) project

The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.

Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring

Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.

The impact of arthritis and joint pain on individual healthcare expenditures: findings from the Medical Expenditure Panel Survey (MEPS), 2011

BACKGROUND

Joint pain, including back pain, and arthritis are common conditions in the United States, affecting more than 100 million individuals and costing upwards of $200 billion each year. Although activity limitations associated with these disorders impose a substantial economic burden, this relationship has not been explored in a large U.S. cohort.

METHODS

In this study, we used the Medical Expenditures Panel Survey to investigate whether functional limitations explain the difference in medical expenditures between patients with arthritis and joint pain and those without. We used sequential explanatory linear models to investigate this relationship and accounted for various covariates.

RESULTS

Unadjusted mean expenditures were $10,587 for those with joint pain or arthritis, compared with $3813 for those without. In a fully adjusted model accounting also for functional limitations, those with joint pain or arthritis paid $1638 more than those without, a statistically significant difference.

CONCLUSIONS

The growing economic and public health burden of arthritis and joint pain, as well as the corresponding complications of functional, activity, and sensory limitations, calls for an interdisciplinary approach and heightened awareness among providers to identify strategies that meet the needs of high-risk patients in order to prevent and delay disease progression.

Seafood consumption habits of South Carolina shrimp baiters

Shrimp baiting is a fishing technique used by many South Carolinians and has been regulated in the state since the late 1980s. A postcard survey was developed and included with 400 South Carolina Department of Natural Resources (SCDNR) annual surveys of registered shrimp baiters over a two-year period. The survey contained questions concerning frequency, portion size, baiting locations, and preparation techniques for shrimp as well as other species consumed and demographic information. An overall response rate of 37% was received. The majority of respondents were men over the age of 55 years. Charleston and Beaufort counties were the most common locations for shrimp baiting. Almost half (45.9%) of respondents reported eating locally caught shrimp at least 2-3 times per month. The most common portion size was ½ pound (8 oz. or 277 g), with 44.8% of respondents reporting this as their typical amount of shrimp ingested at one meal. Only 3.7% of respondents reported typically eating the whole shrimp, while all other respondents ingested shrimp with the head removed. The most commonly consumed species besides shrimp were blue crab, oysters, and flounder. According to the US Food and Drug Administration mercury (Hg) guidelines, the majority (97%) of our respondents were not at risk for consuming unsafe levels of Hg from locally caught shrimp. However, this does not take into account other local seafood eaten or other contaminants of concern. These consumption results may be used in conjunction with data on contaminant levels in shrimp to determine potential adverse health risks associated with consumption of locally caught shrimp.

I too, am America: a review of research on systemic lupus erythematosus in African-Americans

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.

Intervention to Improve Quality of life for African-AmericaN lupus patients (IQAN): study protocol for a randomized controlled trial of a unique a la carte intervention approach to self-management of lupus in African Americans

BACKGROUND

Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease that can impact any organ system and result in life-threatening complications. African-Americans are at increased risk for morbidity and mortality from lupus. Self-management programs have demonstrated significant improvements in health distress, self-reported global health, and activity limitation among people with lupus. Despite benefits, arthritis self-management education has reached only a limited number of people. Self-selection of program could improve such trends. The aim of the current study is to test a novel intervention to improve quality of life, decrease indicators of depression, and reduce perceived and biological indicators of stress in African-American lupus patients in South Carolina.

METHODS/DESIGN

In a three armed randomized, wait list controlled trial, we will evaluate the effectiveness of a patient-centered 'a-la-carte' approach that offers subjects a variety of modes of interaction from which they can choose as many or few as they wish, compared to a 'set menu' approach and usual care. This unique 'a-la-carte' self-management program will be offered to 50 African-American lupus patients participating in a longitudinal observational web-based SLE Database at the Medical University of South Carolina. Each individualized intervention plan will include 1-4 options, including a mail-delivered arthritis kit, addition and access to an online message board, participation in a support group, and enrollment in a local self-management program. A 'set menu' control group of 50 lupus patients will be offered a standardized chronic disease self-management program only, and a control group of 50 lupus patients will receive usual care. Outcomes will include changes in (a) health behaviors, (b) health status, (c) health care utilization, and (d) biological markers (urinary catecholamines).

DISCUSSION

Such a culturally sensitive educational intervention which includes self-selection of program components has the potential to improve disparate trends in quality of life, disease activity, depression, and stress among African-American lupus patients, as better outcomes have been documented when participants are able to choose/dictate the content and/or pace of the respective treatment/intervention program. Since there is currently no "gold standard" self-management program specifically for lupus, this project may have a considerable impact on future research and policy decisions.

TRIAL REGISTRATION

NCT01837875 ; April 18, 2013.

A Case Study of Community Involvement Influence on Policy Decisions: Victories of a Community-Based Participatory Research Partnership

The Buffalo Lupus Project was a community-university partnership that investigated associations between exposure to a local waste site and high rates of lupus and other autoimmune diseases. The partnership's major accomplishment was successful advocacy for containment and clean-up of the site. As a result of community education, the remediation plan suggested by the community was adopted. Additionally, when a local childhood lead poisoning testing program was canceled, community members signed a letter to legislators urging them to replace the funding, which was restored within one week. This demonstrated how coordinated community-based capacity-building efforts can influence health policy.

The systemic lupus erythematosus travel burden survey: baseline data among a South Carolina cohort

BACKGROUND

Many studies on the impact of systemic lupus erythematosus or lupus have identified patient travel costs as being problematic. We administered a survey that examined the impact of self-rated travel burden on lupus patients. The systemic lupus erythematosus travel burden survey included 41 patients enrolled in the systemic lupus erythematosus database project at the Medical University of South Carolina.

RESULTS

Most participants reported that travel caused medications to be discontinued or appointments to be missed. In unadjusted logistic regressions of the relationship between these outcomes and medical travel burden, both distance to rheumatologists and time to lupus medical care were significant.

CONCLUSIONS

Our findings suggest that more research is needed to examine the influence of travel burden among this population, but data from this report could help to inform physicians, academic researchers, and other health professionals in South Carolina and other areas with significant rural populations on how travel burden may impact patients receiving care for lupus and provide an opportunity for the development of interventions aimed at assisting lupus patients with management of stressors related to travel burden.

Quantifying the Seafood Consumption Patterns of Recreational Anglers in Charleston and Berkeley Counties, South Carolina

This study was designed to provide self-reported data on the frequency of fish consumption and shellfish consumption in Charleston and Berkeley (CB) counties, South Carolina. While commercial fishing and recreational fishing have played an important role in the culture and history of the area, information on the specific patterns of consumption by recreational anglers has been previously unavailable. The pilot data presented here will help determine the feasibility of a large-scale survey of seafood consumption in coastal South Carolina. The study's sampling frame consisted of CB county anglers who had purchased a recreational saltwater fishing license for the 2005/2006 year with oversampling in North Charleston. Survey recipients were asked to provide information on fish consumption and shellfish consumption, general angling habits, perception of water and fishing quality, and demographics. Of the 2500 individuals who were sent questionnaires, about one-fourth responded. Respondents were generally white, middle, or upper class and highly educated. The majority fished by boat and most often ate flounder, spotted sea trout, and red drum. Most respondents ate shrimp several times a month and also supplemented their recreational catch with seafood purchased from grocery stores, markets, and restaurants. Almost all respondents had eaten some seafood in the last year, and more than one-fourth ate seafood twice a week or more. Most anglers responded positively about the area's fishing and water qualities, but many referred to areas where they would hesitate to eat their catch. Further research may need to incorporate direct distribution of surveys to underrepresented groups and financial incentives to encompass a more diverse population of anglers.

Systemic lupus erythematosus observations of travel burden: A qualitative inquiry

AIMS

Explorations of travel impediments among patients suffering from rheumatic diseases have been very limited. Research has consistently indicated a shortage of rheumatologists, resulting in patients potentially having to travel long distances for care. The purpose of our study was to explore how systemic lupus erythematosus (SLE) patients experience travel issues differentially by race and socio-economic status.

METHODS

We conducted semi-structured interviews and a brief demographic survey with 10 patients diagnosed with SLE. Interview transcripts were coded and analyzed using NVivo Analysis Software to facilitate the reporting of recurrent themes and supporting quotations, and an initial codebook was independently developed by two researchers on the study team and then verified together.

RESULTS

Patients described three major areas of concern with respect to travel burden in accessing their rheumatologists: reliance on caregivers; meeting financial priorities; and pain and physical limitations.

CONCLUSIONS

Our data suggest general traveling challenges interfering with medical appointment compliance for several participants and the importance of socio-economic issues when considering travel issues. This study highlights an important area with implications for adherence to medical appointments and participation in research among patients with SLE.

Stress and Depression in Relation to Functional Health Behaviors in African American Patients with Systemic Lupus Erythematosus

OBJECTIVE

While increased psychological distress in SLE has been clinically and empirically reported, the relationship between emotional distress, treatment adherence, and disease activity are complex and even more unclear in African American lupus patients. In an effort to elucidate this phenomenon in these patients, this exploratory study aimed to investigate relationships between stress, depression, and various health behaviors in this group.

METHODS

Thirty patients invited to participate in this study were African American systemic lupus erythematosus (SLE) patients attending rheumatology clinics at the Medical University of South Carolina (MUSC). This study was part of a larger interventional pilot study, the Balancing Lupus Experiences with Stress Strategies (BLESS) study, that included a comprehensive battery of psychosocial, quality of life, and behavior change measures.

RESULTS

When looking at the association between anxiety/stress and functionality, levels of reported stress had strong effects upon functionality, especially between health distress and functionality. When looking at the association between depressive symptoms and functionality, depressive symptoms had moderate effects upon social/role limitations and nights spent in the hospital.

CONCLUSION

Not only did the larger pilot project demonstrate significant reductions in stress and depression as a result of workshop participation; this nested study also showed that those improvements were positively associated with improved health behaviors. These results could have implications for developing interventions to improve disease experience and quality of life in SLE patients with stress and depression.

Toward a high-throughput screening platform for directed evolution of enzymes that activate genotoxic prodrugs

Engineering of enzymes to more efficiently activate genotoxic prodrugs holds great potential for improving anticancer gene or antibody therapies. We report the development of a new, GFP-based, high-throughput screening platform to enable engineering of prodrug-activating enzymes by directed evolution. By fusing an inducible SOS promoter to an engineered GFP reporter gene, we were able to measure levels of DNA damage in intact Escherichia coli and separate cell populations by fluorescence activating cell sorting (FACS). In two FACS iterations, we were able to achieve a 90,000-fold enrichment of a functional prodrug-activating nitroreductase from a null library background.

Biomechanical strategies for accuracy and force generation during stone tool production

Multiple hominin species used and produced stone tools, and the archaeological record provides evidence that stone tool behaviors intensified among later members of the genus Homo. This intensification is widely thought to be the product of cognitive and anatomical adaptations that enabled later Homo taxa to produce stone tools more efficiently relative to earlier hominin species. This study builds upon recent investigations of the knapping motions of modern humans to test whether aspects of our upper limb anatomy contribute to accuracy and/or efficiency. Knapping kinematics were captured from eight experienced knappers using a Vicon motion capture system. Each subject produced a series of Oldowan bifacial choppers under two conditions: with normal wrist mobility and while wearing a brace that reduced wrist extension (∼30°-35°), simulating one aspect of the likely primitive hominin condition. Under normal conditions, subjects employed a variant of the proximal-to-distal joint sequence common to throwing activities: subjects initiated down-swing upper limb motion at the shoulder and proceeded distally, increasing peak linear and angular velocities from the shoulder to the elbow to the wrist. At the wrist, subjects utilized the 'dart-thrower's arc,' the most stable plane of radiocarpal motion, during which wrist extension is coupled with radial deviation and flexion with ulnar deviation. With an unrestrained wrist, subjects achieved significantly greater target accuracy, wrist angular velocities, and hand linear velocities compared with the braced condition. Additionally, the modern wrist's ability to reach high degrees of extension (≥28.5°) following strike may decrease risk of carpal and ligamentous damage caused by hyperextension. These results suggest that wrist extension in humans contributes significantly to stone tool-making performance.

Assessment of Particulate Matter Levels in Vulnerable Communities in North Charleston, South Carolina prior to Port Expansion

INTRODUCTION

The Port of Charleston, one of the busiest US ports, currently operates five terminals. The fifth terminal is being planned for expansion to accommodate container ships from the proposed Panama Canal expansion. Such expansion is expected to increase traffic within local vulnerable North Charleston neck communities by at least 7,000 diesel truck trips per day, more than a 70% increase from the present average rate of 10,000 trucks per day. Our objective was to measure the current particulate matter (PM) concentrations in North Charleston communities as a baseline to contrast against future air pollution after the proposed port expansion.

METHODS

Saturation study was performed to determine spatial variability of PM in local Charleston neck communities. In addition, the temporal trends in particulate air pollution within the region were determined across several decades. With the BGI sampler, PM samples were collected for 24 hours comparable to the federal reference method protocol. Gravimetric analysis of the PM filter samples was conducted following EPA protocol.

RESULTS

The range of the PM10 annual average across the region from 1982 to 2006 was 17.0-55.0 μg/m3. On only two occasions were the records of PM10 averaged above the 50.0 μg/m3 national standard. In the case of PM2.5, the annual average for 1999-2006 ranged from 11.0 to 13.5 μg/m3 and no annual average exceeded the 15.0 μg/m3 PM2.5 annual standard.

CONCLUSIONS

Although ambient PM levels have fallen in the Charleston region since the 1960s due to aggressive monitoring by the stakeholders against air pollution, local air pollution sources within the North Charleston neck communities have consistently contributed to the PM levels in the region for several decades. This baseline assessment of ambient PM will allow for comparisons with future assessments to ascertain the impact of the increased truck and port traffic on PM concentrations.

Predictors of non-response and non-compliance in African American lupus patients: Findings from the Balancing Lupus Experiences with Stress Strategies (BLESS) Study

Arthritis self-management education has demonstrated significant improvements in health distress, self-reported global health, and activity limitation, with trends toward improvement in self efficacy and mental stress management. Consequently, numerous national agencies have recommended arthritis self-management education to complement medical care. Despite these recommendations, arthritis self-management education has reached only a limited number of people. Compliance is also a persistent problem in standardized programs. As part of the Balancing Lupus Experiences with Stress Strategies (BLESS) Study, a validated psychosocial stress intervention was piloted among a cohort of African American lupus patients participating in an SLE database project at the Medical University of South Carolina (MUSC). Recruitment attempts were made with the 330 database participants who met eligibility requirements for the study. While enrollment was limited to 30 participants (n=15 controls and n=15 intervention), two of the participants assigned to the intervention group did not attend any intervention sessions and several participants did not complete post-intervention questionnaires. Therefore, data were analyzed on 30 participants at baseline, 25 (n=13 controls and n=12 intervention) at post-intervention, and 22 (n=12 controls and n=10 intervention) at four months post-intervention. In an effort to characterize those who fully participated in the study and those who were non-compliant or non-responsive to recruitment attempts, we obtained descriptive data from African-American Lupus patients participating in the SLE Clinic Database Project. This information can be used to develop and refine future intervention activities.

Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.

An Intervention to Reduce Psychosocial and Biological Indicators of Stress in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies Study

OBJECTIVE

Very little is known about the impact of psychosocial stress on African American lupus patients. Due to the exposure of African Americans to a unique trajectory of stressors throughout life, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group.

METHODS

The Balancing Lupus Experiences with Stress Strategies (BLESS) study piloted the validated "Better Choices, Better Health" Chronic Disease Self-Management Program (CDSMP) in 30 African-American lupus patients participating in the SLE Clinic Database Project at the Medical University of South Carolina (MUSC). Measures of psychosocial and biological indicators of stress were collected in all of the patients in each of the study conditions before and after intervention activities, as well as four months post-intervention, to assess the effectiveness of the program in reducing perceived and biological indicators of stress.

RESULTS

Participation in the workshops had large effects upon depression (d=1.63 and d = 1.68), social/role activities limitations (d =1.15), health distress (d =1.13 and d = 0.78), fatigue (d =1.03), pain (d =0.96), and lupus self-efficacy (d =0.85). Neither the differences in cortisol or DHEA levels pre- and post-intervention were found to be significantly different between intervention participants and controls.

CONCLUSION

The intervention workshops acted to reduce perceived stress and improve quality of life. Our findings imply that comparable, if not more significant gains in relevant health indicators are possible in African American patients when provided the opportunity to participate in CDSMP's.

A pilot study quantifying the shape of tidal breathing waveforms using centroids in health and COPD

During resting tidal breathing the shape of the expiratory airflow waveform differs with age and respiratory disease. While most studies quantifying these changes report time or volume specific metrics, few have concentrated on waveform shape or area parameters. The aim of this study was to derive and compare the centroid co-ordinates (the geometric centre) of inspiratory and expiratory flow-time and flow-volume waveforms collected from participants with or without COPD. The study does not aim to test the diagnostic potential of these metrics as an age matched control group would be required. Twenty-four participants with COPD and thirteen healthy participants who underwent spirometry had their resting tidal breathing recorded. The flow-time data was analysed using a Monte Carlo simulation to derive the inspiratory and expiratory flow-time and flow-volume centroid for each breath. A comparison of airflow waveforms show that in COPD, the breathing rate is faster (17 ± 4 vs 14 ± 3 min(-1)) and the time to reach peak expiratory flow shorter (0.6 ± 0.2 and 1.0 ± 0.4 s). The expiratory flow-time and flow-volume centroid is left-shifted with the increasing asymmetry of the expired airflow pattern induced by airway obstruction. This study shows that the degree of skew in expiratory airflow waveforms can be quantified using centroids.

Effects of social injustice on breast health-seeking behaviors of low-income women

PURPOSE

The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity.

DESIGN

Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up.

SETTING

Individual telephone interviews were conducted with 16 women with confirmed breast anomaly.

PARTICIPANTS

Low-income women screened through a national breast cancer early detection program.

METHOD

Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package.

RESULTS

For women (16, or 72% of case management referrals) below 250% of the poverty level, the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants' health decisions.

CONCLUSION

The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development.

Electromagnetic inductance plethysmography to measure tidal breathing in preterm and term infants

Tidal breathing measurements which provide a non-invasive measure of lung function in preterm and term infants are particularly useful to guide respiratory support. We used a new technique of electromagnetic inductance plethysmography (EIP) to measure tidal breathing in infants between 32 and 42 weeks postconceptional age (PCA). Tidal breathing was measured in 49 healthy spontaneously breathing infants between 32 and 42 weeks PCA. The weight-corrected tidal volume (V(T) ) and minute volume (MV) decreased with advancing PCA (V(T) 6.5 ± 1.5 ml/kg and MV 0.44 ± 0.04 L/kg/min at 32-33 weeks, respectively; 6.3 ± 0.9 ml/kg and 0.38 ± 0.02 L/kg/min at 34-36 weeks; and 5.1 ± 1.1 ml/kg and 0.28 ± 0.02 L/kg/min at term, V(T) P < 0.001 and MV P < 0.01 for 32-33 weeks PCA vs. term; V(T) P = 0.016 and MV P = 0.015 for 34-36 weeks PCA vs. term). Respiratory frequency and the phase angle decreased significantly with advancing PCA but the flow parameter t(PTEF) /t(E) did not change significantly. Using a new technique to measure tidal breathing parameters in newborn infants, our data confirms its usability in clinical practice and establishes normative data which can guide future respiratory management of newborn infants.

Beliefs and perception of risks of HIV among women that have never been tested for HIV in the United States

PURPOSE

To assess women's attitudes, beliefs, characteristics, the perception of risks, and their relationships with not utilizing human immunodeficiency virus (HIV) testing services.

METHODS

This study is a retrospective study and secondary data analysis of the 2006 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses was performed to examine perception of HIV acquisition and the relationship with not utilizing HIV testing services among women in the United States.

RESULTS

More than half of the women in this study had never been tested for HIV (52.26%). In the multivariate analysis, using SAS callable SUDAAN, women who had not been tested for HIV that believed they had no risk of getting HIV were more likely to have never been married (odds ratio [OR], 0.37; 95% CI, 0.31-28.73; p = .0013). In addition, women who had never been tested for HIV that believed they had no risk of getting HIV were more likely to have less than a high school diploma (OR, 0.35; 95% CI, 0.15-0.78; p = .0022).

CONCLUSION

Findings from this study can lend themselves to the development of more efficient and sustainable interventions to prevent HIV infection and decrease high-risk behaviors among more susceptible populations and for the development of HIV testing policy.