Mixed-Methods Study of Disability Self-Management in Mexican Americans With Osteoarthritis.

BACKGROUND: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. OBJECTIVE: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. METHODS: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. RESULTS: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. DISCUSSION: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.

Non-permissive human conventional CD1c+ dendritic cells enable trans-infection of human primary renal tubular epithelial cells and protect BK polyomavirus from neutralization.

The BK polyomavirus (BKPyV) is a ubiquitous human virus that persists in the renourinary epithelium. Immunosuppression can lead to BKPyV reactivation in the first year post-transplantation in kidney transplant recipients (KTRs) and hematopoietic stem cell transplant recipients. In KTRs, persistent DNAemia has been correlated to the occurrence of polyomavirus-associated nephropathy (PVAN) that can lead to graft loss if not properly controlled. Based on recent observations that conventional dendritic cells (cDCs) specifically infiltrate PVAN lesions, we hypothesized that those cells could play a role in BKPyV infection. We first demonstrated that monocyte-derived dendritic cells (MDDCs), an in vitro model for mDCs, captured BKPyV particles through an unconventional GRAF-1 endocytic pathway. Neither BKPyV particles nor BKPyV-infected cells were shown to activate MDDCs. Endocytosed virions were efficiently transmitted to permissive cells and protected from the antibody-mediated neutralization. Finally, we demonstrated that freshly isolated CD1c+ mDCs from the blood and kidney parenchyma behaved similarly to MDDCs thus extending our results to cells of clinical relevance. This study sheds light on a potential unprecedented CD1c+ mDC involvement in the BKPyV infection as a promoter of viral spreading.

Effector Memory-Expressing CD45RA (TEMRA) CD8+ T Cells from Kidney Transplant Recipients Exhibit Enhanced Purinergic P2X4 Receptor-Dependent Proinflammatory and Migratory Responses.

BACKGROUND: The mechanisms regulating CD8+ T cell migration to nonlymphoid tissue during inflammation have not been fully elucidated, and the migratory properties of effector memory CD8+ T cells that re-express CD45RA (TEMRA CD8+ T cells) remain unclear, despite their roles in autoimmune diseases and allotransplant rejection. METHODS: We used single-cell proteomic profiling and functional testing of CD8+ T cell subsets to characterize their effector functions and migratory properties in healthy volunteers and kidney transplant recipients with stable or humoral rejection. RESULTS: We showed that humoral rejection of a kidney allograft is associated with an accumulation of cytolytic TEMRA CD8+ T cells in blood and kidney graft biopsies. TEMRA CD8+ T cells from kidney transplant recipients exhibited enhanced migratory properties compared with effector memory (EM) CD8+ T cells, with enhanced adhesion to activated endothelium and transmigration in response to the chemokine CXCL12. CXCL12 directly triggers a purinergic P2×4 receptor-dependent proinflammatory response of TEMRA CD8+ T cells from transplant recipients. The stimulation with IL-15 promotes the CXCL12-induced migration of TEMRA and EM CD8+ T cells and promotes the generation of functional PSGL1, which interacts with the cell adhesion molecule P-selectin and adhesion of these cells to activated endothelium. Although disruption of the interaction between functional PSGL1 and P-selectin prevents the adhesion and transmigration of both TEMRA and EM CD8+ T cells, targeting VLA-4 or LFA-1 (integrins involved in T cell migration) specifically inhibited the migration of TEMRA CD8+ T cells from kidney transplant recipients. CONCLUSIONS: Our findings highlight the active role of TEMRA CD8+ T cells in humoral transplant rejection and suggest that kidney transplant recipients may benefit from therapeutics targeting these cells.

Revision and Psychometric Evaluation of the Diabetes Knowledge Questionnaire for People With Type 2 Diabetes.

Objective: Diabetes knowledge is associated with health, including lower A1C levels. The Diabetes Knowledge Questionnaire (DKQ-24), developed 30 years ago for Mexican Americans with type 2 diabetes and since used with diverse samples in many countries, contains outdated items that no longer accurately assess current knowledge needed for diabetes self-management. We revised the DKQ-24 and tested psychometric properties of the DKQ-Revised (DKQ-R) with a diverse sample. Methods: We conducted a five-phase instrumentation study as follows: 1) DKQ-24 items were revised to reflect current diabetes care standards; 2) the Delphi method was used to evaluate the DKQ-R's content validity (n = 5 experts); 3) cognitive interviews were conducted with people with type 2 diabetes (n = 5) to assess their interpretations of DKQ-R items; 4) cross-sectional administration of the DKQ-R to adults with type 2 diabetes was carried out to assess internal consistency reliability and convergent validity; and 5) an item analysis was conducted using discrimination index and point biserial analysis. Results: After receiving the experts' feedback and conducting the cognitive interviews, 39 items were administered to 258 participants with type 2 diabetes (42.2% women; 29.1% Latino, 42.6% Asian, mean age 55.7 years). To select the final items, we considered the item discrimination index, as well as item-to-total correlations, content area, and participant feedback. The final 22-item DKQ-R uses the same yes/no/I don't know response format as the DKQ-24. The DKQ-R is strongly correlated with the DKQ-24 (r = 0.71, P <0.01) and is weakly correlated with diabetes numeracy (r = 0.23, P <0.01), indicating adequate convergent validity; a Kuder-Richardson-20 coefficient of 0.77 indicated good reliability. Conclusion: The DKQ-R is a reliable and valid updated measure of diabetes knowledge for diverse populations with type 2 diabetes.

Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review.

AIMS: To identify the barriers and facilitators to healthcare for people without documentation status. DESIGN: We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. METHODS: Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social-ecological model. DATA SOURCES: Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. RESULTS: The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti-immigrant rhetoric) and policy-related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety-net clinics and supportive federal policies emerged as key facilitators. CONCLUSION: These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. IMPACT: This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. REPORTING METHOD: The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was needed. TRIAL AND PROTOCOL REGISTRATION: The study protocol was registered with the PROSPERO database (registration number: CRD42022366289).

The influences of depression and loneliness on A1C among middle-aged and older adults with diabetes.

Even before increased social isolation associated with the COVID-19 pandemic, 43% of adults aged 60 and older reported experiencing loneliness. Depression and loneliness often co-exist and are significant issues faced by middle-aged as well as older adults because each condition is likely to worsen health outcomes. This study of middle-aged and older adults examined how depression and loneliness affect diabetes (DM) control (A1C levels). This study is a secondary analysis of data from the Midlife in the United States Refresher (MIDUS-R) survey, a national survey of adults aged 25-74 years. Correlation analyses were conducted, and a hierarchical logistic regression was estimated to predict A1C levels ≤7% (recommended goal) or >7 using 1) demographics and physical health (ethnicity, gender, education, age, and comorbidities), 2) family and friend support, and 3) depression and loneliness. The sample of 92 participants with DM and A1C data from the MIDUS-R had mean age = 57.37, were 51% male, 68% non-Hispanic White; 39.1% had A1C >7. The average level of depression was low (CES-D mean 9.42) and loneliness was moderate (UCLA scale mean 12.43). Loneliness was correlated with A1C (r= .26, p< .05); depressive symptoms (r= .71, p< .001), family and friends support (r= -.36, r= -.38, respectively, both p< .001). Only loneliness significantly predicted higher A1C levels. People with higher levels of loneliness had increased odds of having A1C >7 (OR = 1.18, p < .05) after controlling for depression and all other variables. Loneliness had a greater impact than depression on A1C level among persons with DM. Healthcare providers should assess patients for loneliness as well as depression and reduce adverse health impacts by referring to psychosocial support as needed.

A slurry approach to identify nutrient critical source areas from subtropical catchment erosion.

Targeting catchment nutrient critical source areas (CSAs) (areas contributing most of the nutrients in a catchment) is an efficient way to prioritize remediation sites for reducing nutrient runoff to waterways. We tested if the soil slurry approach - with particle sizes and sediment concentrations representative of those in streams during high rainfall events - can be used to identify potential CSAs within individual land use types, examine fire impacts, and identify the contribution of leaf litter in topsoil to nutrient export in subtropical catchments. We first confirmed the slurry approach met the prerequisite to identify CSAs with relatively higher nutrient contribution (not absolute load estimation) by comparing the slurry sampling with stream nutrient monitoring data. We validated that: 1) differences in slurry total nitrogen to phosphorus mass ratios from different land uses were consistent with stream monitoring data; and 2) our estimated nutrient export contribution from agricultural land, via the slurry approach, was comparable to that derived from monitoring data. Additionally, we found nutrient concentrations in slurries differed across soil types and management practice within individual land uses, correlating with nutrient concentrations in fine particles. These results indicate the slurry approach can be used to identify potential small-scale CSAs. Slurry results from burnt soils were also comparable to other studies showing increased levels of dissolved nutrient loss and higher nitrogen than phosphorus loss, than non-burnt soils. The slurry method also showed the contribution of leaf litter to slurry nutrient concentrations from topsoil was greater for dissolved nutrients than particulate nutrients, indicating different forms of nutrients need to be considered for impacts of vegetation. Our study reveals that the slurry method can be used to identify potential small-scale CSAs within the same land use from erosion and can account for impacts of vegetation and bushfires, providing timely information to guide catchment restoration actions.

Scientific challenges and biophysical knowledge gaps for implementing nutrient offset projects.

Nutrient offsetting allows nutrient point source polluters to pay for diffuse source nutrient reductions, or improvements in nutrient load reductions from alternative point sources. These programs have the potential to provide a more cost-effective approach to achieve water quality goals in waterways compared to infrastructure upgrades. However, worldwide adoption of nutrient offset/trading has not been realized. Here, we identified the biophysical-chemical knowledge gaps that can act as barriers to adopting these programs and summarized areas where further research is needed. This includes a) evaluating if any appropriate spatial scale (local-, catchment-, or regional-scale) and time scale (especially for areas with dry/wet cycles) exists to achieve nutrient load management goals, and b) quantifying nutrient characteristic differences and load contributions between point and diffuse sources to determine possible offsets between the two. Where offsets are appropriate, there is also a need to 1) improve monitoring design and reduce modelling uncertainties to better quantify diffuse nutrient loads; 2) quantify and manage uncertainties in catchment interventions to reduce nutrient loads, and design effective long-term monitoring and maintenance to sustain intervention outcomes; 3) prioritize areas within catchments that are key nutrient sources for catchment interventions to achieve the optimal outcomes for nutrient load management and catchment and aquatic ecosystem health; and 4) develop methodologies to determine the environmental equivalency ratio between different nutrient sources in terms of ecosystem effects. This would include identifying the best metric to quantify equivalency ratios, determining discharge patterns for different nutrient sources, and linking this with ecosystem responses across seasons and in the downstream receiving environment. Addressing the identified knowledge gaps will improve the program feasibility assessment process as well as confidence and certainty in the environmental outcomes of nutrient offsetting.

Health status and Healthcare Access of Southeast Asian refugees in the United States: An integrative review.

OBJECTIVE: Since 2010, more than 527,000 refugees have resettled in the United States (US), most from Asia, fleeing war, violence, and persecution. However, there is little research that integrates findings about health among Southeast Asian refugees (SEAR). DESIGN: We conducted an integrative review of studies that examined health status, risk factors, and barriers to healthcare access among SEAR in the US. We synthesized findings of studies published from 1980, when the Refugee Act was enacted, to 2022 using five databases. We reviewed 20 articles and data were extracted into a table for synthesis. RESULTS: Participants were from Cambodia, Vietnam, Laos, Burma and the Thailand-Myanmar border. Hypertension (12%-64%), hypercholesterolemia (37%-39%), diabetes (0.6%-27%), heart disease (7%), bone and muscle problems (23%-50%), and chronic pain (8%-51%) were most common physical health problems; and PTSD (45%-86%) and depression (20%-80%) were the most common mental health problems. Trauma, resettlement stress, lack of community or religious engagement were associated with mental health problems. Language differences, transportation, and lack of health insurance were the most significant obstacles to receiving healthcare. CONCLUSION: SEAR experienced worse physical and mental health than the general US population. Different patterns of disease were identified depending on gender, time settled in the US, and ethnic group. Qualitative and longitudinal studies will elucidate refugees' experience and should guide interventions.

Self-Management Model fails to Predict Quality of Life for People Living with Dual Diagnosis of HIV and Diabetes.

The objective of this study was to test a self-management model for self-management in people living with HIV and type 2 diabetes (PLWH + T2DM). We conducted a predictive, longitudinal study of data from a national research cohort of PLWH using lag analysis to test short- and long-term health outcomes for PLWH + T2DM. We used a dataset from the Center for AIDS Research (CFAR) Network of Integrated Clinic Systems (CNICS), a nation-wide research network of 8 clinics that serves PLWH. Patient-reported outcomes, collected at clinic visit, included depression, adherence, CD4 cell count, and health-related quality of life (HRQoL). We computed summary statistics to describe the sample. Using lag analysis, we then modeled the three variables of adherence, CD4 count, and HRQoL as a function of their predecessors in our conceptual model. In the final model, an increase of in medication adherence corresponded to a small increase in HRQoL. An increase in CD4 count corresponded to a small increase in HRQoL. An increase in lagged depression was associated with a small decrease in HRQoL. The model was not sufficient to predict short- or long-term outcomes in PLWH + T2DM. Although depression had a moderate impact, the final model was not clinically significant. For people with a dual diagnosis of HIV and T2DM, variables other than those traditionally addressed in self-management interventions may be more important.

RESUMEN: El objetivo de este estudio era evaluar un modelo de autocontrol para el autocontrol en aquellas personas que viven con VIH y diabetes de tipo 2 (PLWH + T2DM). Llevamos a cabo un estudio predictivo y longitudinal de la información proveniente de un estudio nacional de una población base de PLWH usando un análisis de retraso para evaluar los resultados en la salud a corto y largo plazo para PLWH + T2DM. Utilizamos un conjunto de datos del Center for AIDS Research [Instituto para la Investigación del SIDA] (CFAR) Network of Integrated Clinic Systems [Red de Sistemas de Clínicas Integradas] (CNICS), una red de investigación nacional que cuenta con ocho clínicas al servicio de PLWH. Los resultados que los pacientes reportaron, recolectados en una visita médica, incluyen depresión, adherencia, conteo de células CD4 y la calidad de vida relacionado con la salud (HRQoL). Calculamos el resumen estadístico para describir la muestra. Utilizando análisis de retraso, modelamos luego las tres variables de adherencia, conteo de células CD4 y el HRQoL como función de su antecesor en nuestro modelo conceptual. En el modelo final, un aumento en la adherencia al medicamento correspondió a un aumento en el HRQoL. Un aumento en el conteo de células CD4 correspondió a un aumento en el HRQoL. Se asoció un aumento de depresión retardada con una disminución en el HRQoL. El modelo no fue suficiente como para predecir resultados a corto o largo plazo en PLWH + T2DM. A pesar de que la depresión tenía un impacto moderado, el modelo final no fue clínicamente significativo. Para aquellas personas con un diagnóstico doble de VIH y T2DM, otras variables, además de las que se abordan tradicionalmente en las intervenciones de autocontrol, podrían ser más importantes.

Illness perceptions as a mediator between emotional distress and management self-efficacy among Chinese Americans with type 2 diabetes.

Objectives: Emotional distress and illness perceptions have been linked to patients' self-efficacy for diabetes management. This study, guided by Leventhal's Self-Regulatory Model, explores the direct effects of emotional distress (diabetes distress and depressive symptoms) on diabetes management self-efficacy, and the indirect effects through illness perceptions among Chinese Americans with type 2 diabetes (T2DM).Design: Data were obtained from a cross-sectional study of Chinese Americans with T2DM recruited from health fairs and other community settings (N = 155, 47.1% male, mean age 69.07 years). Data analyses including descriptive statistics, correlation, and PROCESS mediation models were used to examine the mediation effects of illness perceptions.Results: Diabetes distress and depressive symptoms had direct negative effects on self-efficacy. Perceived treatment control mediated the association between diabetes distress and self-efficacy, while none of the illness perceptions dimensions impacted the relationship between depressive symptoms and self-efficacy.Conclusion: Improved perceptions of treatment control can ameliorate diabetes distress and improve diabetes management self-efficacy among Chinese Americans. Health providers should elicit patients' illness perceptions as a first step in evaluating their diabetes management self-efficacy and provide appropriate culturally-tailored interventions.

Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment.

BACKGROUND: Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. PURPOSE: To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. METHODS: A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. RESULTS: Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. IMPLICATIONS FOR PRACTICE: There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. IMPLICATIONS FOR RESEARCH: Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self-management and quality of life.

AIMS AND OBJECTIVES: To synthesise empirical studies on factors related to fatigue and its impact on diabetes self-management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). BACKGROUND: Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. DESIGN: This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. METHODS: The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer-reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. RESULTS: Twenty-nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi-experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. CONCLUSIONS: Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under-represented populations. RELEVANCE TO CLINICAL PRACTICE: This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.

Counting, Coping, and Navigating the Flux: A Focused Ethnographic Study of HIV and Diabetes Self-Management.

Approximately 10-15% of people living with HIV are also diagnosed with diabetes. To manage their two chronic conditions, people must undertake certain activities and adopt behaviors. Due to overlapping symptoms, complex medication regimens, and heavy patient workloads, implementing these self-management practices can be difficult. In this focused ethnography, data were collected from semi-structured interviews and limited participant-observation with a selected subset of participants to gain insight into self-management challenges and facilitators. We conducted interviews and multiple observations with 22 participants with HIV+T2DM over the period of 9 months. Participants experienced numerous barriers to self-management in the areas of diet, medication adherence, and mental health. Social and familial support, as well as consistent access to care, were facilitators for optimal self-management. At the same time participants' lives were in a unique flux shaped by the dual diagnoses, and therefore, required constant mental and physical adjustments, thus illustrating challenges of managing chronicity.

Through fire and flames: post-burning survival and detection of dismemberment-related toolmarks in cremated cadavers.

During a homicide investigation in which fire has been used to reduce the size of the cadaver and conceal the evidence of injuries, the identification of perimortem trauma presents a challenge, in particular in cases when the perpetrator has dismembered the body followed by burning the remains. It is therefore important to understand the effects which heat causes on fresh bone. The aim of this paper is to perform a pilot study on the survival ratio of toolmarks in different anatomical regions associated with dismemberment, and a descriptive analysis of the variables that may potentially influence the post-burning survival and detection. To achieve this, three donated embalmed cadavers were used to simulate a case in which an attempted dismemberment and burning had occurred. Fifty-five pre-burning injuries were manually induced: 30 using a machete to inflict chopping trauma, and 25 with a serrated bread knife to inflict sharp force trauma, on the thigh, knee, ankle and wrist. The cadavers were cremated in a furnace at Madrid's Cementerio Sur and the burnt remains were analysed at the Laboratorio de Antropología y Odontología Forense of the Universidad Complutense de Madrid. Not all pre-burning injuries inflicted were visible after the cremation process; only 13% were detected in this experiment. Toolmarks can be masked, modified, destroyed or overlooked from the outset of the procedure due to several factors which influence the post-burning survival and detection of toolmarks and contribute to conceal the evidence of trauma. Additional research should be done to study further variables which affect the post-burning visibility of sharp force trauma.

Uterus-Sparing Surgery: Outcomes of Transvaginal Uterosacral Ligament Hysteropexy.

STUDY OBJECTIVE: Recently, there has been a paradigm shift toward uterine conservation during the surgical management of pelvic organ prolapse (POP), specifically uterine prolapse. There are few reports on transvaginal uterosacral ligament hysteropexy (TULH). This study aimed to describe our surgical technique and outcomes. DESIGN: Retrospective review and description of surgical technique. Anatomic outcome has been reported using the POP quantification system. Complications were segregated. A comparison of parametric continuous variables was performed using paired t test. Categoric variables were evaluated using the Pearson χ2 test and the Fisher exact test. A p-value <.05 was considered significant. SETTING: Teaching hospital. PATIENTS: Forty patients who underwent TULH from 2009 to 2017. INTERVENTIONS: TULH. MEASUREMENTS AND MAIN RESULTS: A total of 40 patients met the inclusion criteria. Of these, 56.1% had preoperative stage 3 prolapse. The median operative time was 116 minutes. The mean estimated blood loss was 158.5 mL. Transient ureteral obstruction occurred in 2 patients. The mean follow-up time was 17.2 months, and all patients had significant improvement of prolapse (p <.001). There was also an improvement in urinary incontinence and bladder storage symptoms (p <.001). None of the patients were reoperated on for recurrent POP. CONCLUSION: TULH is an effective uterus-preserving surgical alternative for the treatment of uterovaginal prolapse and provides good apical support. It is also associated with a low short-term recurrence and incidence of reoperation. TULH is a viable option for suitable patients with uterovaginal prolapse who desire uterine conservation.

Community engagement as a foundation for improving neighborhood health.

OBJECTIVE: Health inequities and disparities are associated with non-White race/ethnicity, immigrant status, income, and geographic location. Community engagement is essential to identify health and social needs and to plan health care and social services programs. To begin a larger community-based participatory study, the purpose of this study was to explore community residents' perceptions of barriers and facilitators to achieving and maintaining health. DESIGN, SAMPLE, AND MEASUREMENTS: This qualitative descriptive study used focus group interviews. We recruited a convenience sample (n = 50) from community meetings and gathering for five audio-recorded focus groups that used a semi-structured interview guide. Transcripts were coded to identify common topics in each group and major themes across groups. RESULTS: Participants were predominantly women (58%), Hispanic/Latinx, and Spanish-speaking (57%), who rented their homes (69%). Two main themes emerged: (a) social determinants as barriers to health and (b) need for trust to participate in health programs. CONCLUSIONS: Although health care providers are frequently concerned about providing access to care, community members identified a variety of social determinants that affected their health. Listening and responding to community members' priorities are the foundation to improving health in neighborhoods directly affected by inequities.

Integrative molecular profiling of autoreactive CD4 T cells in autoimmune hepatitis.

BACKGROUND & AIMS: In most autoimmune disorders, crosstalk of B cells and CD4 T cells results in the accumulation of autoantibodies. In autoimmune hepatitis (AIH), the presence of anti-soluble liver antigen (SLA) autoantibodies is associated with reduced overall survival, but the associated autoreactive CD4 T cells have not yet been characterised. Herein, we isolated and deeply characterised SLA-specific CD4 T cells in patients with AIH. METHODS: We used brief ex vivo restimulation with overlapping SLA peptides to isolate and phenotype circulating SLA-specific CD4 T cells, and integrative single-cell RNA-seq (scRNA-seq) to characterise their transcriptome and T-cell receptor (TCR) repertoire. Autoreactive TCRs were cloned and used to identify dominant SLA-derived epitopes. SLA-specific CD4 T cells were tracked in peripheral blood through TCR sequencing to identify their phenotypic niche. We further characterised disease-associated peripheral blood T cells by high-content flow cytometry in 42 patients with AIH and 17 controls with non-alcoholic steatohepatitis. RESULTS: Autoreactive SLA-specific CD4 T cells were only detected in patients with anti-SLA autoantibodies and had a memory PD-1+CXCR5-CCR6-CD27+ phenotype. ScRNA-seq revealed their pro-inflammatory/B-helper profile. SLA81-100 and SLA177-204 contain dominant T-cell epitopes. Autoreactive TCR clonotypes were predominantly found in the memory PD-1+CXCR5-CD4 T cells, which were significantly increased in the blood of patients with AIH and supported B-cell differentiation through IL-21. Finally, we identified specific T-cell phenotypes linked to disease activity and IgG level during AIH. CONCLUSIONS: We provide a deep characterisation of rare circulating autoreactive CD4 T cells and identify their peripheral reservoir in AIH. We also propose a specific phenotype of autoreactive T cells related to AIH disease activity, which will be essential to track, delineate, and potentially target these pathogenic cells. LAY SUMMARY: One principal characteristic of autoimmune hepatitis (AIH), like for many other autoimmune diseases, is the accumulation of autoantibodies produced by B lymphocytes following their interaction with autoreactive CD4 T lymphocytes. In this study, we identified and characterised with high resolution these CD4 T cells. This will be essential to track, delineate, and potentially target them during AIH.

Retention in care in aging adults with a dual diagnosis of HIV infection and type 2 diabetes mellitus: a longitudinal retrospective cross-sectional study.

BACKGROUND: This study aimed to investigate the measures of retention in care (RIC) in persons living with HIV (PLWH) and type 2 diabetes mellitus (T2DM) by age group (younger vs. older adults). METHODS: This was a longitudinal retrospective cross-sectional study that used secondary data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We examined RIC in 798 adult PLWH + T2DM who visited a CNICS clinic at least once in 2015. Six measures of RIC were examined: missed visits [measured as a continuous variable (total number of missed visits) and dichotomous variable (0 = never missed, 1 = missed)], visit adherence, 6-month visit gap, 4-month visit constancy, and the Health and Resources Services Administration HIV/AIDS Bureau's RIC measure. We calculated Spearman correlation coefficients and conducted logistic regression and multi-group path analysis. RESULTS: Most RIC measures were significantly correlated (p < 0.05) with one another; only 4-month visit constancy was not correlated with other measures. Except for the number of missed visits in older adult PLWH + T2DM, we found no significant relationships between RIC measures and CD4 cell count using logistic regression. However, multi-group path analysis demonstrated significant positive relationships between most RIC measures and CD4 cell count in both age groups. In younger adults living with HIV (YALWH) + T2DM, HbA1c level, but not CD4 count, was significantly associated with most RIC measures. CONCLUSIONS: RIC is related to disease control (CD4 cell count and HbA1c level) in PLWH + T2DM and notably, HbA1c level was only significantly affected in YALWH + T2DM. A future study is needed to find more accurate reasons for the fact that only HbA1c level had significant relationships in YALWH + T2DM. The findings from this study provide guidance in measuring RIC in PLWH who have comorbidities.

Culturally-tailored interventions for chronic disease self-management among Chinese Americans: a systematic review.

Objectives: Literature review evaluating the effectiveness and cultural surface and deep structures of interventions designed to improve Chinese Americans' chronic disease self-management.Method: PubMed, PsycINFO, CINAHL, and Health Source databases were searched for research conducted from 1990 to 2016 on self-management interventions for Chinese Americans with chronic disease.Results: Ten articles comprised eight interventions, which each addressed a dimension of cultural surface structure, all providing linguistically appropriate messages delivered via bilingual staff. Five interventions also addressed cultural deep structure dimensions by providing culturally congruent counsellors or educators, or incorporating Chinese cultural values and social customs. Six interventions resulted in significant improvements in major outcome variables. Participants also reported high satisfaction and retention rates were high.Conclusion: Culturally-tailored interventions that incorporate surface and deep structural elements of culture are sensitive and generally effective for Chinese Americans to improve access to health care, disease awareness, social environment, and participants' ability to practice self-management skills.