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OBJECTIVE: This epigenomics sub-study embedded within a randomized controlled trial examined whether an evidenced-based behavioral intervention model that decreased stimulant use altered leukocyte DNA methylation (DNAm). METHODS: Sexual minority men with HIV who use methamphetamine were randomized to a five-session positive affect intervention (n = 32) or an attention-control condition (n = 21), both delivered during three months of contingency management for stimulant abstinence. All participants exhibited sustained HIV virologic control - an HIV viral load less than 40 copies/mL at baseline and six months post-randomization. The Illumina EPIC BeadChip measured leukocyte methylation of cytosine-phosphate-guanosine (CpG) sites mapping onto five a priori candidate genes of interest (i.e., ADRB2, BDNF, FKBP5, NR3C1, OXTR). Functional DNAm pathways and soluble markers of immune dysfunction were secondary outcomes. RESULTS: Compared to the attention-control condition, the positive affect intervention significantly decreased methylation of CpG sites on genes that regulate ß2 adrenergic and oxytocin receptors. There was an inconsistent pattern for the direction of the intervention effects on methylation of CpG sites on genes for glucocorticoid receptors and brain-derived neurotrophic factor. Pathway analyses adjusting for the false discovery rate (padj < 0.05) revealed significant intervention-related alterations in DNAm of Reactome pathways corresponding to neural function as well as dopamine, glutamate, and serotonin release. Positive affect intervention effects on DNAm were accompanied by significant reductions in the self-reported frequency of stimulant use. CONCLUSIONS: There is an epigenetic signature of an evidence-based behavioral intervention model that reduced stimulant use, which will guide the identification of biomarkers for treatment responses.
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Metilação de DNA , Infecções por HIV , Leucócitos , Metanfetamina , Minorias Sexuais e de Gênero , Humanos , Masculino , Adulto , Infecções por HIV/genética , Infecções por HIV/tratamento farmacológico , Leucócitos/metabolismo , Leucócitos/efeitos dos fármacos , Pessoa de Meia-Idade , Epigênese Genética , Fator Neurotrófico Derivado do Encéfalo/genética , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Proteínas de Ligação a Tacrolimo/genética , Afeto/efeitos dos fármacos , Transtornos Relacionados ao Uso de Anfetaminas/genética , Receptores de Glucocorticoides/genética , Receptores de Glucocorticoides/metabolismo , Terapia Comportamental/métodos , Receptores de Ocitocina/genéticaRESUMO
The syndemic theoretical framework has been used in health disparities research to explain several co-occurring epidemics, particularly in populations facing disparate health conditions. A prominent example of this is seen in Singer's Substance Abuse, Violence and HIV/AIDS (SAVA) syndemic theory. However, even though numerous studies support some of the theoretical underpinnings of the SAVA syndemic, the empirical applications of the theory remain methodologically underdeveloped. The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), to present the state of the science of methodologies examining SAVA constructs using the syndemic framework. Seven bibliographic databases were searched with no language or date restrictions. Studies were synthesized by author, year of publication, study location, total sample size, study population, SAVA outcomes, analytic method of SAVA measurement, intervention type, level of influence, disease interaction and concentration, main findings of the study, and possible future areas of research. Our search yielded a total of 967 articles, and 123 were included in the review. Methodologic and statistical innovation is needed to elevate the impact of syndemic theory for elucidating the synergistic effects of determinants leading to health disparities.
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Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Humanos , Síndrome da Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/epidemiologia , Sindemia , Violência , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
Over the last 50 years, the Latino population in the US has grown and changed. Latinos are the nation's largest minority group and among this group, there is incredible diversity. Much of Latino health research and outcomes have been treated interchangeably with immigrant health, but as the US Latino population evolves so should the focus of Latino health research. We contend that as maternal and child health (MCH) outcomes are an utmost important indicator of a country's health, and as Latinos make up 18% of the US's population, it is imperative that we move past dated research frameworks to a more nuanced understanding of the health of Latina women and children. We summarize how acculturation has been used to describe differences in MCH outcomes, discuss how the umbrella term "Latino" masks subgroups differences, explore Afro-Latinidad in MCH, examine the effects of the sociopolitical climate on the health of families, and demonstrate the limited representation of Latinos in MCH research. We conclude that a deeper understanding of Latino health is necessary to achieve health equity for Latina women and their children.
What is already known on the subject? The Hispanic Health Paradox, the phenomenon that Latinos have better health outcomes than their socioeconomic status would predict, breaks down when empirical studies extended beyond descriptive research and examined Latino subgroups. Substantial heterogeneity within Latinos is observed is health outcomes, especially in maternal and child health.What this article adds to the literature? We provide a comprehensive demonstration of the varied determinants of maternal and child health in Latinas such as acculturation, the Latino monolith, race, policies, and representation.
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OBJECTIVE: To examine factors associated with COVID-19 vaccine uptake in a sample of Latino/a/x sexual and/or gender minority (SGM) individuals in South Florida. DESIGN: Data were collected via an online survey from March 2021 to August 2022, as part of the Community Engagement Alliance Against COVID-19 Disparities. A multivariate regression analysis was fit using completion of a COVID-19 vaccine regimen as the outcome. Key covariates included trusted sources of information (eg, doctor, media), COVID-19-related challenges (eg, accessing medication, transportation), and dominant wave of SARS-CoV-2 at the time of data collection. SETTING: Miami-Dade and Broward counties, Florida. RESULTS: White Latino/a/x, bachelor's educated respondents, and those with high levels of trust in community organizations had significantly greater odds of vaccination. CONCLUSION: Community organizations may be key to improving vaccine uptake among marginalized Latino/a/x SGM for COVID-19 and other emerging communicable diseases, such as meningitis and Mpox (monkeypox). The results of this study suggest that tailored public health messaging and additional funding for vaccine distribution are needed to better equip community organizations with the resources they need to serve this population.
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Vacinas contra COVID-19 , COVID-19 , Hispânico ou Latino , Fonte de Informação , Minorias Sexuais e de Gênero , Confiança , Humanos , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Florida/epidemiologia , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Fonte de Informação/estatística & dados numéricos , SARS-CoV-2 , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricosRESUMO
OBJECTIVE: Depression, substance use disorders, and other neuropsychiatric comorbidities are common in people with HIV (PWH), but the underlying mechanisms are not sufficiently understood. HIV-induced damage to the gastrointestinal tract potentiates residual immune dysregulation in PWH receiving effective antiretroviral therapy. However, few studies among PWH have examined the relevance of microbiome-gut-brain axis: bidirectional crosstalk between the gastrointestinal tract, immune system, and central nervous system. METHODS: A narrative review was conducted to integrate findings from 159 articles relevant to psychoneuroimmunology (PNI) and microbiome-gut-brain axis research in PWH. RESULTS: Early PNI studies demonstrated that neuroendocrine signaling via the hypothalamic-pituitary-adrenal axis and autonomic nervous system could partially account for the associations of psychological factors with clinical HIV progression. This review highlights the need for PNI studies examining the mechanistic relevance of the gut microbiota for residual immune dysregulation, tryptophan catabolism, and oxytocin release as key biological determinants of neuropsychiatric comorbidities in PWH (i.e., body-to-mind pathways). It also underscores the continued relevance of neuroendocrine signaling via the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and oxytocin release in modifying microbiome-gut-brain axis functioning (i.e., mind-to-body pathways). CONCLUSIONS: Advancing our understanding of PNI and microbiome-gut-brain axis pathways relevant to depression, substance use disorders, and other neuropsychiatric comorbidities in PWH can guide the development of novel biobehavioral interventions to optimize health outcomes. Recommendations are provided for biobehavioral and neurobehavioral research investigating bidirectional PNI and microbiome-gut-brain axis pathways among PWH in the modern antiretroviral therapy era.
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Microbioma Gastrointestinal , Infecções por HIV , Encéfalo/fisiologia , Eixo Encéfalo-Intestino , Microbioma Gastrointestinal/fisiologia , Infecções por HIV/tratamento farmacológico , Humanos , Sistema Hipotálamo-Hipofisário , Ocitocina/metabolismo , Sistema Hipófise-Suprarrenal , Psiconeuroimunologia , TriptofanoRESUMO
This report introduces the COVID-19 Family Environment Scale (CHES), which aims to measure the impact of social distancing due to COVID-19 on household conflict and cohesion. Existing measures do not capture household experiences relevant to the pandemic, in which families are largely confined to their homes while sharing a life-threatening situation. Using best practice guidelines, we developed a pool of items and revised them with review by a panel of experts, and cognitive interviewing with community respondents. We administered the CHES by online survey to 3,965 adults. The CHES consists of 15 items for each of two subscales, household conflict (α = .847) and household cohesion (α = .887). Exploratory factor analysis yielded two factors, corresponding to the intended conflict and cohesion items, which accounted for 29% of variance. Confirmatory factor analysis partially supported the 2-factor model (RMSEA = .057; CFI = .729, TLI = .708, and SRMR = .098). The CHES also contains 25 optional items to describe respondent and household characteristics, and household-level COVID-19 exposure. The CHES, publicly available at https://elcentro.sonhs.miami.edu/research/measures-library/covid-19/index.html, provides a tool for measuring the impact of the COVID-19 pandemic on important determinants of resilience in the face of major stressful events. Further work is needed to address the factor structure and establish validity of the CHES.
Este informe presenta la Escala del Entorno Familiar de la COVID-19 (COVID-19 Family Environment Scale, CHES), cuyo fin es medir el efecto del distanciamiento social debido a la COVID-19 en el conflicto familiar y la cohesión familiar. Las herramientas de medición actuales no captan las experiencias familiares relevantes de la pandemia, en la cual las familias están en su gran mayoría confinadas en sus hogares mientras comparten una situación que pone en riesgo la vida. Utilizando pautas de mejores prácticas, desarrollamos un conjunto de ítems y los revisamos con un grupo de expertos, e hicimos entrevistas cognitivas a personas de la comunidad. Administramos la CHES mediante una encuesta en línea a 3965 adultos. La CHES consta de 15 ítems para cada una de dos subescalas, la de conflicto familiar (α = .847), y la de cohesión familiar (α = .887). El análisis factorial exploratorio dio dos factores correspondientes a los ítems planeados de conflicto y cohesión, que representaron el 22 % de la varianza. El análisis factorial confirmatorio respaldó parcialmente el modelo de dos factores (RMSEA = .057; CFI = .729, TLI = .708 y SRMR = .098). La CHES también contiene 25 ítems opcionales para describir las características de los encuestados y la familia, y el nivel de exposición de la familia a la COVID-19. La CHES, disponible públicamente en https://elcentro.sonhs.miami.edu/research/measures-library/covid-19/index.html ofrece una herramienta para medir el efecto de la pandemia de la COVID-19 en determinantes importantes de resiliencia ante situaciones de gran estrés. Se necesitan más trabajos para abordar la estructura factorial y establecer la validez de la CHES.
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COVID-19/psicologia , Infecções por Coronavirus/psicologia , Conflito Familiar/psicologia , Relações Familiares/psicologia , Pneumonia Viral/psicologia , Escalas de Graduação Psiquiátrica/normas , Quarentena/psicologia , Adolescente , Adulto , Betacoronavirus , COVID-19/prevenção & controle , Criança , Infecções por Coronavirus/prevenção & controle , Análise Fatorial , Características da Família , Terapia Familiar/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Distanciamento Físico , Pneumonia Viral/prevenção & controle , Reprodutibilidade dos Testes , SARS-CoV-2 , Adulto JovemRESUMO
Although most adults experience at least one traumatic event in their lifetime, a smaller proportion will go on to be clinically diagnosed with post-traumatic stress disorder (PTSD). Persons diagnosed with PTSD have a greater likelihood of developing gastrointestinal (GI) disorders. However, the extent to which subclinical levels of post-traumatic stress (PTS) correspond with the incidence of GI issues in a normative sample is unclear. Resting state fMRI, medical history, psychological survey, and anthropometric data were acquired from the Enhanced Nathan Kline Institute-Rockland Sample (n = 378; age range 18-85.6 years). The primary aim of this study was to test the main effect of subclinical PTS symptom severity on the number of endorsed GI issues. The secondary aim was to test the moderating effect of high versus low resting state functional connectivity (rsFC) of the central executive network (CEN) on the relationship between PTS symptom severity and GI issues. Trauma Symptom Checklist-40 (TSC-40) scores were positively associated with the number of endorsed GI issues (b = -0.038, SE = .009, p < .001). The interaction between TSC-40 scores and rsFC within the CEN was significant on GI issues after controlling for sociodemographic and cardiometabolic variables (b = -0.031, SE = .016, p < .05), such that above average rsFC within the CEN buffered the effect of TSC-40 scores on GI issues. Our findings of higher rsFC within the CEN moderating the magnitude of coincidence in PTS and GI symptom severity may reflect the mitigating role of executive control processes in the putative stress signaling mechanisms that contribute to gut dysbiosis.
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Gastroenteropatias , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Adolescente , Gastroenteropatias/psicologia , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Adulto Jovem , Idoso de 80 Anos ou mais , Imageamento por Ressonância Magnética , Índice de Gravidade de DoençaRESUMO
Studies examining occupational exposures and cancer risk frequently report mixed findings; it is thus imperative for researchers to synthesize study results and identify any potential sources that explain such variabilities in study findings. However, when synthesizing study results using meta-analytic techniques, researchers often encounter a number of practical and methodological challenges. These challenges include (1) an incomparability of effect size measures due to large variations in research methodology; (2) a violation of the independence assumption for meta-analysis; (3) a violation of the normality assumption of effect size measures; and (4) a variation in cancer definitions across studies and changes in coding standards over time. In this paper, we first demonstrate these challenges by providing examples from a real dataset collected for a large meta-analysis project that synthesizes cancer mortality and incidence rates among firefighters. We summarize how each of these challenges has been handled in our meta-analysis. We conclude this paper by providing practical guidelines for handling challenges when synthesizing study findings from occupational cancer literature.
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Metanálise como Assunto , Neoplasias , Exposição Ocupacional , Humanos , Neoplasias/epidemiologia , Doenças Profissionais/epidemiologia , Bombeiros , Projetos de Pesquisa , IncidênciaRESUMO
Background: Sexual minority men (SMM) with HIV who use stimulants may experience greater difficulties with antiretroviral therapy adherence which amplifies risk for unsuppressed HIV viral load (VL). Remote monitoring of VL could support efforts to rapidly respond to sub-optimal adherence. Methods: This qualitative study enrolled 24 SMM with HIV who use stimulants to examine experiences with two different dried blood spots (DBS) self-sampling devices (i.e., Tasso-M20 vs. HemaSpot HD) to measure VL. Participants were asked to complete self-sampling of DBS using both devices, and then participated in a 45-minute semi-structured interview. Interviews focused on ease of use, device preference, experiences with receiving and mailing kits, and barriers to participating in research. A thematic analysis was conducted to analyze interviews transcripts. Results: Twenty-two participants (92%) returned the Tasso-M20 and 21 (88%) returned the Hemaspot HD devices. Among the 22 participants that completed qualitative interviews, twenty-three codes were identified and collapsed within seven themes. Preferences for devices were based on convenience, pain and prior experiences with finger-pricking technology. Participants emphasized that clearer instructions with contingency plans for self-sampling of DBS would improve the user experience with self-sampling of DBS. Intersectional stigma (e.g., HIV, sexual minority status, and substance use) was noted as an important consideration in implementing self-sampling of DBS. Promoting decision making, or the option to choose sampling method based on personal preferences, may improve engagement and likelihood of DBS completion. Conclusions: Findings will guide the broader implementation of self-sampling of DBS to optimize VL monitoring in SMM with HIV who use stimulants.
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BACKGROUND: The Miami-CFAR Diversity, Equity & Inclusion Pathway Initiative (Miami CDEIPI) is designed to promote a diverse scientific workforce that reflects the communities at the highest risk of HIV in South Florida. SETTING AND METHODS: The focus of the Miami CDEIPI is to help train the next generation of Underrepresented Minorities (URM) and Black, Indigenous, People of Color (BIPOC) in HIV/AIDS-related research through a team science experience. The Miami CDEIPI objectives are to facilitate the interaction of URM/BIPOC students with the network of CFAR-affiliated investigators and to enable these students to access the cutting-edge technologies at the Miami-CFAR and the Sylvester Comprehensive Cancer Center and other resources at the University of Miami. RESULTS: Five URM/BIPOC students supported by the program in year 1 have been carrying out projects in collaboration with mentors at their parent institution and Miami-CFAR investigators. The students used the state-of-the-art laboratories and core facilities. They began their research with a proposal designed to integrate the cutting-edge technologies now available to them. Their training included participation in Miami-CFAR-sponsored activities such as seminars, an annual conference, and a national HIV workshop. Candidates in the Miami CDEIPI are in the process of developing their research proposals, integrating cutting-edge technologies into their doctoral dissertation research. Their projects are now in the completion phase. CONCLUSIONS: The Miami CDEIPI focuses its resources on one of the conspicuous gaps in the career paths of URM/BIPOC researchers-the dearth of leading URM/BIPOC scientists in the field. The Miami CDEIPI provides a professional network that supports the participation of URM/BIPOC trainees in innovative research and career skill training.
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Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Humanos , Pesquisa Interdisciplinar , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Estudantes , FloridaRESUMO
BACKGROUND: Sexual minority men (SMM) report high rates of stimulant use (e.g., crystal methamphetamine, cocaine) and HIV infection. Stimulant use contributes to immune dysfunction, which enhances risk for HIV acquisition and pathogenesis. Research is needed to examine the independent and interactive relationships of stimulant use and HIV infection with systemic immune dysregulation among SMM, especially during the COVID-19 pandemic. METHODS: From 2020-2022, 75 SMM in Miami, Florida with and without HIV completed an online survey and provided biospecimens to assess HIV status and viral load (VL), recent stimulant use, and soluble markers of immune activation and inflammation in plasma, including soluble CD14 (sCD14) and elevated high-sensitivity C-reactive protein (hs-CRP > 1.0mg/L). Sociodemographics and prior SARS-CoV-2 infection were compared across HIV status/stimulant use groups. Moderation models examined the independent and interactive associations of stimulant use and HIV status with sCD14 and elevated hs-CRP. RESULTS: Thirty participants were persons living with HIV (PWH) (50% with stimulant use), and 45 were HIV-negative (44% with stimulant use). SARS-CoV-2 infection was not associated with stimulant use/HIV groups or immune outcomes. HIV-negative SMM without stimulant use had lower sCD14 compared to other SMM, as well as lower odds of elevated hs-CRP compared to PWH who used stimulants. Stimulant use showed independent associations with immune dysregulation that persisted after controlling for HIV status and VL, whereas HIV status was only independently associated with elevated hs-CRP in one model not controlling for VL. CONCLUSIONS: Among SMM, stimulant use was independently associated with elevated immune activation and inflammation.
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COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Masculino , Humanos , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Proteína C-Reativa , Receptores de Lipopolissacarídeos , Pandemias , SARS-CoV-2 , Inflamação , Homossexualidade MasculinaRESUMO
Skills to effectively communicate research findings are important to expand meaningful inclusion of the public in research, but attempts to summarize findings may be challenging given increasing reliance on succinct communications. Led by our Ethics Advisory Board and within the context of this work with the Precision Medicine and Health Disparities Collaborative, the authors decided to engage in the iterative process of developing video summaries. Our stakeholders taught us to incorporate novel strategies to engage broader audiences, leading to the production of two video summaries, a public summary toolbox and an adapted process for developing video summaries. The authors refreshed the static concept of 'research summaries' and found ways of producing summaries which emphasized a dynamic reframing of the shared benefits of science.
Health communications related to research (like summaries about research studies) are important to the health of diverse communities. It is up to investigators to publicize the findings of their research, and written communications may not be the most effective way of getting the public excited about or interested in science. Our Ethics Advisory Board encouraged us to pursue a more dynamic format to report scientific findings. Led by our Ethics Advisory Board and other investigators of a collaborative precision medicine research center, the authors created two video summaries based on the findings of two research articles. In this article, the authors describe an iterative, stakeholder-centered process of creating video summaries to engage nonscientists in research, and make science more relevant and meaningful to the general public.
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Medicina de Precisão , HumanosRESUMO
During the Spring of 2021 in Miami-Dade County, four virtual focus groups were held with 31 participants from four diverse local Latinx communities as part of the Florida Community Engagement Alliance (FL-CEAL) Against COVID-19 Disparities project. The main objective was to explore attitudes about COVID-19 information and prevention strategies among South Florida's diverse Latinx populations, across a broad geographical area. The study used a semi-structured focus group qualitative design and chose participants from four well established Latinx neighborhoods. Participants were mostly women, diversity was strong with birth regions including the Caribbean, North, Central and South America. Though a third (n = 11) were born in the United States, almost all (n = 28) reported speaking Spanish at home. Three themes and six subthemes were identified to underscore Latinx attitudes toward COVID-19 vaccine uptake or hesitancy. These were: (1) Attitudes regarding vaccine intake; (2) Sources of Information; and (3) Science Education. The degree to which each of these themes exercised influence on vaccine intake or hesitancy varied. The multi origin Latinx participation in the focus groups strengthened findings by broadening representation and discussion. In the end and despite the various national origins, all participants indicated receiving most of their information on COVID-19 related topics from their family, physicians, social networks, and some form of media.
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COVID-19 , Vacinas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Feminino , Florida/epidemiologia , Hispânico ou Latino , Humanos , Masculino , Estados UnidosRESUMO
OBJECTIVE: Indices of cardiovascular disease (CVD) risk, vascular endothelial dilation, arterial stiffness and endothelial repair were examined in persons with HIV (PWH) on an antiretroviral therapy (ART) that included abacavir (ABC+) in comparison with PWH on ART without abacavir (ABC-), and with HIV seronegative (HIV-) individuals. APPROACH: The 115 participants (63% men), aged 30-50 years, did not have CVD, metabolic, endocrine, or chronic renal conditions. PWH were on stable ART for six-months or more. Vascular assessments included flow-mediated dilation (FMD), aortic, radial and femoral arterial stiffness (cAIx, crPWV, cfPWV), and thigh and calf arterial compliance (Vmax50). Endothelial repair was indexed by endothelial progenitor cell colony forming units (EPC-CFU). Traditional CVD risk measures included blood pressure, central adiposity, lipids, insulin resistance (HOMA-IR), CRP and ASCVD score. Analyses controlled for demographics (age, sex, education), medications (antihypertensive, statin/fibrate, antipsychotic), and substance abuse (ASSIST). RESULTS: No group differences were observed in central adiposity, HOMA-IR, CRP, or ASCVD risk score. However, the ABC- group displayed greater dyslipidemia. The ABC+ group displayed no difference on FMD, cAIx, cfPWV or calf Vmax50 compared with other groups. When CD4 count and viral load were controlled, no additional differences between the ABC+ and ABC- groups emerged. Analyses of crPWV and thigh Vmax50 suggested supported by a trend toward lower EPC-CFU in the HIV+ groups than the HIV- group. CONCLUSIONS: Findings indicate that ABC treatment of 30-50 year-old PWH on stable ART is not likely to contribute in a robust way to higher CVD risk.
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Fármacos Anti-HIV , Infecções por HIV , Doenças Vasculares , Adulto , Fármacos Anti-HIV/efeitos adversos , Contagem de Linfócito CD4 , Didesoxinucleosídeos/uso terapêutico , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/tratamento farmacológicoRESUMO
Introduction: The COVID-19 pandemic has dramatically altered the functioning of households. Because of the vulnerability of high-risk groups, such as older adults and people with compromised immune systems, households caring for these vulnerable adults may be facing elevated levels of caregiving-related stress and burden. The current study sought to examine the impact of the pandemic on conflict and cohesion in households with adults requiring caregiving versus noncaregiving households. Methods: Respondent demographic, household level, and family functioning data were collected anonymously from an international sample (N = 4,241). Responses were examined using descriptive and bivariate analyses. Results: Overall, respondents in caregiving households (n = 667) reported a significantly greater negative impact of social distancing on their family functioning, with greater increase in conflict than nonadult caregiving households (n = 3,574). Significantly more caregiving households also reported that someone had stopped working due to the pandemic. No differences were observed for cohesion between the two groups, with both reporting a little bit more cohesion when compared with the period before social distancing. Conclusions: Our findings add to a body of literature demonstrating that caregiving families experience greater disruption and strain during disaster situations such as the COVID-19 pandemic. Future research is needed to establish the causality of the collected proximal factors, such as job loss and education, with pandemic related family functioning among homes caring for adults, and examining the impact of contextual factors, such as level of caregiving need and caregiving support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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COVID-19 , Pandemias , Idoso , Características da Família , Humanos , SARS-CoV-2RESUMO
The COVID-19 pandemic is a worldwide event that has exacerbated stress and caused significant disruptions in the day-to-day living of families. Of particular concern are socially vulnerable families, which have felt the impacts of the pandemic most acutely. Because stress can alter family dynamics, it is important to understand which stressors impact families the most, and what resources can be leveraged to strengthen family functioning. The current study examined the impacts of COVID-19 on the conflict and cohesion of households with children compared to households without children. Additionally, we sought to assess how conflict and cohesion are related to social vulnerabilities in the context of the pandemic. Using an international sample, we analyzed responses to the COVID-19 Household Environment Scale (N = 4122) using descriptive and bivariate analyses. Latent class analysis was used to identify patterns of family functioning in households with and without children. We found that social vulnerability was associated with more disrupted family functioning, and that households with children (n = 2666) reported less disrupted family functioning when compared to households without children (n = 1456), despite having higher social vulnerability scores. Our exploratory latent class analysis identified a 5-class model among both subgroups. Conflict, cohesion, family functioning and social vulnerability varied significantly by subgroup and class membership. Our findings add to a body of evidence that argues that despite facing greater vulnerability, households with children have many strengths to draw from. Family interventions that help to promote family cohesion and conflict resolution can foster resilience in stressful circumstances.
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Over the last year, COVID-19 has emerged as a highly transmissible and lethal infection. As we address this global pandemic, its disproportionate impact on Black, Indigenous, and Latinx communities has served to further magnify the health inequities in access and treatment that persist in our communities. These sobering realities should serve as the impetus for reexamination of the root causes of inequities in our health system. An increased commitment to strategic partnerships between academic and nonacademic health systems, industry, local communities, and policy-makers may serve as the foundation. Here, we examine the impact of the recent COVID-19 pandemic on health care inequities and propose a strategic roadmap for integration of clinical and translational research into our understanding of health inequities.
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Background: Clinical indications for medicinal cannabis include chronic conditions; thus users (MCUs) are at an increased risk of morbidity and mortality resulting from SARS-CoV-2 infection (COVID-19). The study aimed to provide data on cannabis use and self-reported behavioral changes among MCUs with preexisting chronic conditions in response to the pandemic.Methods: An internet-based questionnaire was administered to adults ≥18 who self-reported medicinal cannabis use within the past year. Data are from respondents between March 21 and April 23, 2020; response rate was 83.3%. Health conditions and cannabis frequency, route, and patterns of use were assessed via the COVID-19 Cannabis Health Questionnaire (Vidot et al. 2020).Results: Participants (N = 1202) were predominantly non-Hispanic white (82.5%) and 52.0% male (mean age 47.2 years). Mental health (76.7%), pain (43.7%), cardiometabolic (32.9%), respiratory (16.8%), and autoimmune (12.2%) conditions were most reported. Those with mental health conditions reported increased medicinal cannabis use by 91% since COVID-19 was declared a pandemic compared to those with no mental health conditions (adjusted odds ratio: 1.91, 95% CI: 1.38-2.65). 6.8% reported suspected COVID-19 symptoms. Two percent (2.1%) have been tested for COVID-19 with only 1 positive test result. Some MCUs (16%) changed their route of cannabis administration, switching to nonsmoking forms.Conclusions: The majority of MCUs reported at least one preexisting chronic health condition. Over half report fear of COVID-19 diagnosis and giving the virus to someone else; yet only some switched from smoking to nonsmoking forms of cannabis. Clinicians may consider asking about cannabis use among their patients, particularly those with chronic health conditions.
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COVID-19/psicologia , Doença Crônica/epidemiologia , Usuários de Drogas/psicologia , Maconha Medicinal/uso terapêutico , Transtornos Mentais/epidemiologia , Automedicação/estatística & dados numéricos , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Autorrelato , Estados Unidos/epidemiologiaRESUMO
Nurses currently disinfect their hands with antibacterial soap and hand sanitizer. This comparative, descriptive study evaluated skin bacteria at baseline and 30 days after jewelry removal in intensive care unit nurses. Identified bacteria species were: (1) Bacillus, (2) Micrococcus, (3) coagulase negative Staphylococcus, (4) Diphtheroid, ( 5) Streptococcus, and (6) nonenteric gram-negative rods. The majority of the bacteria was found on skin at baseline. Bacterial counts significantly decreased at 30 days.
Assuntos
Higienizadores de Mão , Joias , Bactérias , Mãos , Desinfecção das Mãos , Hospitais , HumanosRESUMO
BACKGROUND: Historically, nursing curricula have not offered opportunities for students to develop hands-on political competence. A public health policy simulation can improve students' ability to be change agents for health policy through advocacy. METHOD: The public health policy simulation was a combination of didactic preparation and hands-on application of advocacy training. At the simulation, held at the State Capitol, students visited legislators, gave an oral testimony before a mock hearing committee, and received feedback from legislators. RESULTS: In general, students expressed being more knowledgeable and confident about the legislative process, advocacy for public health issues, communication with legislators, and the role of nursing in the public health policy arena. Students reported increased likelihood of advocacy for public health issues. CONCLUSION: Public health policy simulation should be part of nursing curricula to help to create a culture that dictates that public health policy is an integral component of the nursing profession. [J Nurs Educ. 2019;58(3):178-181.].