Just Plain Hot: Examining Summer Daily High Heat Indices and Community-Level Social Vulnerability on Emergency Medical Services On-Scene Responses in San Antonio, Texas, 2015-2018.

Introduction Increased summer heat has a deleterious effect on people's health and the healthcare system. Emergency Medical Services (EMS) are at the healthcare system frontline, responsive to the community and environmental conditions. The present study examined how EMS on-scene response is affected by community-level social vulnerability and heat. Methods The Centers for Disease Control and Prevention's Social Vulnerability Index, heat and humidity data from the National Weather Service, and City of San Antonio EMS data were collected. Data were analyzed using negative binomial regression models with time-stratified case-crossover design to observe independent and interactive effects of heat and social vulnerability on EMS on-scene response over four constricted calendar years. Results Results indicated that community-based social vulnerability and heat, independently and interactively, are associated with increased EMS on-scene responses. Conclusion Even when examining normal summertime heat conditions, there is evidence of the relationships between geographic and environmental conditions and the healthcare system.

Presenteeism Among Healthcare Providers, Staff, and Students in Jalisco, Mexico: A Descriptive Study.

Objective We measured presenteeism (continuing to attend work or other activities while sick) in a sample of healthcare workers in Jalisco, Mexico to better understand the phenomenon, which can place patients at risk of infection. Methods An online survey link was distributed to all healthcare professionals, staff, and students registered with the Jalisco Ministry of Health starting in March 2020. Completed surveys (n = 196) collected between March and July 2020 were analyzed using bivariate and descriptive statistics including Kruskal-Wallis rank sum tests and Fisher's tests. Results Most participants (67.5%) reported working while sick. Primary reasons included concerns about patients and continuity of care. Approximately 97% of respondents believed that working while sick could put patients at risk but still attended work with multiple symptoms. Conclusion These presenteeism rates and motivations are comparable to data from the US and other countries. We suggest that state and federal medical organizations address presenteeism to prevent nosocomial outbreaks.

Knowledge, Attitudes, Behavior, and Practices of Self Breast Examination in Nicaragua.

Self breast examination (SBE) has been recommended as an important preventative practice for the early identification of breast cancer in women. However, our understanding of women's knowledge, attitudes, and practices of self breast examination in Nicaragua is limited. In the present study, we conducted a cross-sectional study of women aged 18 years and over (n=500) living in selected urban and rural areas of Nicaragua. Measures included the survey reflected knowledge, attitudes, behaviors, and practices related to self breast examination. We compared these measures between women living in urban and rural areas and women aged 18-39 years and 40+ years. Using a t-test, we tested the significance of these differentials. Results indicate widespread and significant differentials in basic knowledge and behaviors on self-breast examination practices among women living in rural and urban locations in Nicaragua. Further, while younger women reported significant and lower overall knowledge about breast cancer (BC), purpose and reasons for SBE, characteristics of women who tend to be at higher risk for BC, and strategies and steps women take performing SBE compared to women who were in the 40+ age group. Study results call for location and population-specific programs and policies addressing disparities in breast cancer prevention efforts in the country.

Consultation length, process quality and diagnosis quality of primary care in rural China: A cross-sectional standardized patient study.

OBJECTIVE: Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. METHODS: We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. RESULTS: The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (ß = 1.39, 95%CI 1.01-1.78) and tuberculosis (ß = 0.89, 95%CI 0.69-1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002-0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005-0.021). CONCLUSIONS: The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. PRACTICE IMPLICATIONS: We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.

Knowledge, Attitudes, Behavior, and Practices of Self-Breast Examination in Jalisco, Mexico.

The importance of self-breast examination to identify early signs of breast cancer has been widely discussed in scientific literature. We conducted a cross-sectional survey of women aged 18 years and over (n = 547) living in urban and rural areas in the State of Jalisco, Mexico. Survey questions included measures on knowledge, attitudes, behaviors, and practices related to self-breast examination. We compared these measures between women living in urban and rural areas and women aged 18-39 years and 40+ years. Using t-test, we tested the significance of these differentials. Our results indicate that there is no significant difference in knowledge, attitudes, behavior, and practices regarding self-breast examination between women living in urban and in rural areas of Jalisco. However, we found some difference in these measures between women in 18-39 years and 40+ years. While the State of Jalisco has taken significant steps toward promoting significance of cancer prevention, further attention to women in the older cohort is recommended.

Signaling sickness: the role of recalled sickness behavior and psychosocial factors in shaping communication style.

BACKGROUND AND OBJECTIVES: Active infection results in several outward signs in humans, including visible symptoms, changes in behavior and possible alterations in skin color and gait. A potential adaptive function of these indicators is to signal distress and elicit care from close others. We hypothesized that sickness behavior, a suite of stereotypical changes in mood and behavior, also serves to communicate health status to others. We further hypothesized that such outward signals/cues of health status would vary based on context and sociocultural norms. METHODOLOGY: We explored self-reported, recalled sickness behavior, communication style, demographics and theoretically relevant cultural factors in a large national US sample (n = 1259) using multinomial probit regressions. RESULTS: In accordance with predictions, relatively few participants were willing to talk or complain about sickness to strangers. Self-reported, recalled sickness behavior was associated with some communication styles but attention received from others was more consistently associated with potential signaling. Several cultural factors, including stoicism and traditional machismo, were also associated with different sickness signaling styles. CONCLUSIONS AND IMPLICATIONS: These preliminary, self-reported data lend some tentative support to the sickness behavior signaling hypothesis, though experimental or observational support is needed. The role of cultural norms in shaping how such signals are transmitted and received also deserves further attention as they may have important implications for disease transmission. LAY SUMMARY: Evolutionary medicine hypothesizes that signs and symptoms of infectious disease-including sickness behavior-have adaptive functions, one of which might be to reliably signal one's health status to others. Our results suggest that evolved signals like these are likely shaped by cultural factors.

Association between depression and HIV treatment outcomes in a US military population with HIV infection.

BACKGROUND: Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated associations between depression, self-reported adherence, and longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with and without depression. METHODS: Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006 and 2010, with follow-up through 2015. SRA was defined as taking 95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. To analyse the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). RESULTS: Participants had a mean age of 32 (± 8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% self-reported adherence (OR 1.06, 95% CI 1.02-1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22-0.76) compared to Caucasians (OR 1.49, 95% CI 0.52-4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had an increased odds of taking ART continuously (OR 1.75, 95% CI 0.99-3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38-0.91). CONCLUSIONS: Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

A latent profile analysis of the link between sociocultural factors and health-related risk-taking among U.S. adults.

BACKGROUND: Research suggests that health/safety behaviors (e.g., drinking heavily) and medical behaviors (e.g., donating blood) may be perceived as inherently risky, and further suggests there is substantial variation in the likelihood of engaging in a particular health-related risk behavior across people. Research examining demographic and sociocultural factors related to both health/safety and medical risk-taking is highly limited. Importantly, with very few exceptions the literature examining health risks characterized by potentially hazardous health behaviors (e.g, heavy alcohol use, driving without a seatbelt) is kept separate from the literature examining health risks characterized by potentially beneficial medical behaviors (e.g., donating blood, taking medication). In the interest of health promotion, it is critical for researchers to identify - and describe - individuals who are less inclined to engage in health-harming behaviors while at the same time being more inclined to engage in health-benefiting behaviors. Identifying such a subtype of individuals was the guiding aim for this study. METHOD: A national sample of adults in the United States responded to a survey on sociocultural and demographic correlates of health behaviors. Health-related risk-taking indicators were measured using the items from the health/safety and medical subscales of the DOSPERT-M. Subtypes of risk-takers were identified using latent profile analysis (LPA). Follow-up analyses to describe subtype demographic characteristics were conducted. RESULTS: LPA identified four subtypes of risk-takers, including a subtype (n = 565, 45% of the sample; labeled "divergent") that was comprised of individuals who highly endorsed medical risk-taking (e.g., taking medicine, giving blood) and minimally endorsed health/safety risk-taking (e.g., drinking heavily, unprotected sex). Subsequent analyses suggested that, among other findings, divergent profile members were likely to be married, endorse familial interdependence, and orient toward masculinity rather than femininity. CONCLUSION: By examining potentially modifiable factors related to individuals' inclinations to engage in health protective behaviors, this study is an important step toward improving current health behavior interventions among U.S. adults.

Alarmingly high malnutrition in childhood and its associated factors: A study among children under 5 in Yemen.

ABSTRACT: Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level - the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55-0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36-0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59-0.76).The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.

Can Nepal achieve nutritional targets by 2030? A trend analysis of childhood undernutrition in Nepal from 2001 to 2016.

OBJECTIVE: This study assesses the prevalence of childhood undernutrition from 2001 to 2016 and estimate projections of undernutrition for 2016-2030 in Nepal. DESIGN: The study used data from four rounds of a cross-sectional survey of Nepal Demographic and Health Survey (NDHS) conducted in 2001, 2006, 2011 and 2016. Descriptive analyses were conducted to calculate prevalence, binary logistic regression was used to test the significance of trends over time and autoregressive integrated moving average model was used to forecast the prevalence of childhood undernutrition. SETTINGS: The children and household member datasets from four NDHS were merged to assess the trends of childhood undernutrition in Nepal. PARTICIPANTS: A total of 16 613 children (8399 male and 8214 female) under 5 years of age were selected for anthropometric measurements using a stratified cluster random sampling method. RESULTS: Overall results show a decline in prevalence of stunting from 57·2 % to 35·8 % (P < 0·001), underweight from 42·7 % to 27 % (P < 0·001) and wasting from 11·2 % to 9·7 % (P < 0·05) from 2001 to 2016. However, different population subgroups have a higher prevalence of undernutrition than national average. Further, the analyses show that the prevalence of stunting will decline to 14·3 % and wasting to 8·4 % by 2030. CONCLUSION: A remarkable decrease in the prevalence of stunting and underweight has been observed over the last 15 years. Nepal is likely to achieve the nutritional targets for stunting but not for wasting by 2030. Given large subpopulation variations, further improvement in undernutrition require more specific, targeted and localised programmes.

Substance abuse and HIV/STD prevention at a Hispanic-serving institution in South Texas: A study of racial/ethnic and gender heterogeneity and intersectionality.

The purpose of this study is to examine racial/ethnic and gender variations and intersectionality in the knowledge, attitudes, intentions, and behaviors pertaining to substance abuse (SA) and human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevention among racial/ethnic minority college students (ages 18-24) in South Texas. A total of 535 minority students completed a baseline survey between 2014 and 2016 (N = 535). Results revealed statistically significant (ranging from p < .05 to p < .001) racial/ethnic and gender variations in SA and HIV/STD prevention-related knowledge, attitudes, intentions, and behaviors. However, the significant interaction effects (i.e., intersectionality) were observed only for two of the nine composite variables. That is, although male minority students exhibited lower levels of awareness of sexual risks and safe sex negotiation skills than female minority students, Hispanic male students appeared to fare better in both awareness of sexual risks (p < .01) and safe sex negotiation skills (p < .05) compared to students of other racial/ethnic origin. Implications for prevention and intervention work involving minority college students are discussed.

Effects of social vulnerability and heat index on emergency medical service incidents in San Antonio, Texas, in 2018.

BACKGROUND: Excessive heat is a leading weather-related cause of fatalities in the USA. Vulnerable populations can face greater exposure to health risks during extreme heat events. The aim of this study is to examine the effects of excessive heat and community-level social vulnerability on morbidity in San Antonio, Texas, in 2018. METHODS: Heat Index (HI) data are from the National Oceanic and Atmospheric Administration. Social vulnerability is measured using the Centres for Disease Control and Prevention's Social Vulnerability Index (SVI). Morbidity is measured as the number of emergency medical service (EMS) incidents. Sixty-one zip codes were analysed for the 153 constrained calendar days from 1 May to 30 September 2018. Negative binomial regression analysis with the time-stratified case-crossover design was conducted to predict the effects of HI and SVI on the rate of EMS incidents. RESULTS: HI is significantly and positively associated with the rate of EMS incidents. Social vulnerability has a statistically significant association with EMS incidents, with higher levels of community-level social vulnerability associated with higher rates of EMS incidents. The effect of the HI on the rate of EMS incidents is significantly and positively moderated by the SVI. CONCLUSIONS: Social vulnerability and excessive heat increase the rate of EMS incidents. As the number of excessive heat days increases and San Antonio continues to have extreme disparities by location, there will be an effect on health systems, including EMSs.

Antiretroviral Therapy Anchor-based Trends in Body Mass Index Following Treatment Initiation Among Military Personnel with HIV.

INTRODUCTION: Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the U.S. Military HIV Natural History Study (NHS). MATERIALS AND METHODS: NHS participants with available baseline weight and height data initiating ART from 2006 to 2017 were considered for analysis. Antiretroviral therapy was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI (<25 vs ≥25 kg/m2) at ART start and anchor drug class. These models were adjusted for demographic- and HIV-related characteristics. RESULTS: Of 961 NHS participants started on initial ART between 2006 and 2017, 491 men who had available baseline BMI data and were virally suppressed (<200 c/mL) at 1 and 2 years of follow-up were included. Overall, the predicted BMI increased at each time point over 2 years regardless of baseline BMI. There was a trend toward less weight gain for non-INSTI regimens regardless of demographic- or HIV-related factors (-0.65 kg/m2/yr, P = .070). In participants with BMI <25, all regimens were associated with BMI gains except in those with high viral load (≥100,000 copies/mL) started on PI regimens (-1.91 kg/m2/yr, P = .000; n = 13). For those participants with BMI ≥25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54 kg/m2/y, P = .000; PI 0.39 kg/m2/yr, P = .006). Non-nucleoside reverse transcriptase inhibitors were not associated with weight gain regardless of race- or HIV-related characteristics. African Americans with BMI ≥25 were more likely to gain weight as compared to Whites (0.99 kg/m2/yr, P = .016). Specific anchor drug-based predictions revealed that only INSTI use among African Americans was significantly associated with BMI gains (1.85 kg/m2/yr, P = .007); NNRTI- and PI-related weight change was not significant as compared to Whites. CONCLUSIONS: In our cohort of young military members with HIV infection, those with BMI <25 experienced BMI gains across all ART classes. Among those with BMI ≥25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.

Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1).

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the "safety-net" of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

The Contribution of Sociocultural Factors in Shaping Self-Reported Sickness Behavior.

Sickness behavior is an evolutionarily conserved phenomenon found across a diverse range of animals involving a change in motivational priorities to theoretically maximize energetic investment in immune function and recovery. Typical components of sickness behavior include reduced sociability and activity, changes in diet, and depressed affect. Importantly, however, sickness behavior appears to be subject to other demands of life history in animal models, including reproduction and offspring survival. Thus, "feeling sick" is often context dependent with possible effects on morbidity and mortality. While humans may not always face the same life history trade-offs, sociocultural norms and values may similarly shape sickness behavior by establishing internalized parameters for "socially appropriate sickness." We explore the role of these factors in shaping sickness behavior by surveying a national U.S. sample (n = 1,259). Self-reported and recalled sickness behavior was measured using the SicknessQ instrument, which has previously been validated against experimentally induced sickness behavior. After post-stratification weighting and correction for Type I error, generalized linear models showed that sickness behavior is significantly affected by various factors across sex and racial/ethnic groupings. Income below the national mean (b = 1.85, adj. p = 0.025), stoic endurance of pain and discomfort (b = 1.61, adj. p < 0.001), and depressive symptomology (b = 0.53, adj. p < 0.001) were each associated with greater sickness behavior scores. Familism (b = 1.59, adj. p = 0.008) was positively associated with sickness behavior in men, but not women. Endurance of pain and discomfort was associated with greater sickness behavior in Whites only (b = 1.94, adj. p = 0.002), while familism approached significance in African Americans only (b = 1.86, adj. p = 0.057). These findings may reflect different social contexts of sickness across demographic groups, which may in turn have important implications for pathogen transmission and recovery times, potentially contributing to health disparities.

Buddhism and Depressive Symptoms among Married Women in Urban Thailand.

A growing body of research has documented salutary associations between religious involvement and poor mental health outcomes, such as depressive symptoms and psychological distress. However, little scholarly attention has been given to the association between Buddhism, a non-Western religious faith, and depressive symptomatology in Thailand. Using random survey data collected from urban Thailand, this study examines the association between religious involvement and depressive symptoms among married women in Bangkok. Findings from multiple linear regression models reveal that (1) Buddhist respondents report significantly lower levels of depressive symptoms than their non-Buddhist counterparts, (2) the frequency of participation in religious activities is significantly and inversely associated with the level of depressive symptoms, and (3) the inverse association between religious participation and depressive symptoms is more salient for Buddhists who frequently practice their faith (i.e., significant interaction effect). Research limitations and directions for future research are discussed.

Lack of virologic suppression is associated with lower HIV-related disclosure stigma in people living with HIV.

Stigma remains a leading barrier to HIV care. To determine the influence of disclosure stigma (DS), fear of disclosing one's serostatus, on virologic suppression, a cross-sectional study was performed at the largest publicly-funded HIV clinic in South Texas. A survey was administered to participants who were: ≥18 years old, living with HIV, and receiving antiretroviral therapy. Surveys included demographics, adherence questionnaire, and a validated HIV-stigma scale with DS as the sum of 10 items ranked 0-3, with score of 30 indicating highest stigma. The primary outcome was lack of virologic suppression (LOVS): most recent HIV-1 RNA > 20 copies/ml. A bivariate analyses examined predictors of DS, dichotomized at the median. Depression score, perceived stress, and lack of friend/family support were associated with DS. Logistic regression models examined the relationship between DS, as a continuous variable, and LOVS. For 275 participants (69% Hispanic), median DS score was 18.5. DS was significantly inversely associated with LOVS (aOR 0.94 per 1 scale point; CI 0.89, 0.99) after adjustment for age, gender/sexual orientation, race/ethnicity, and drug use. The unanticipated inverse association between DS and LOVS highlights the complexity of this relationship. However, the balance of data in this cohort demonstrate an overall negative impact of DS.

Relationship between depression and risk behaviors in a US Military population with HIV infection.

This study evaluated the relationships between depression trajectories, depression diagnosis and sexual risk behaviors in the US Military HIV Natural History Study. Risk behavior survey data, a coded diagnosis of depression, available Center for Epidemiological Studies Depression measures, and self-reported depressive symptoms (n = 662) were utilized. Latent class analysis created 3 classes of depression trajectories, namely, low depression (LD, n = 378), recent-onset depression (ROD, n = 170), and high depression (HD, n = 114) trajectories. Overall, participants with clinically diagnosed depression were less likely to report often using condoms with new sexual partners in the past 3 months than those who have never been diagnosed with depression (OR 0.15, 95% CI 0.49-2.53). Participants with ROD (OR 0.52, 95% CI 0.28-0.97) and HD (OR 0.48, 95% CI 0.24-0.96) trajectories were less likely to report often using condoms with new sexual partners in the past 3 months than those with LD trajectories. Moreover, those with either ROD (OR 2.13, 95% CI 1.19-3.80) or HD (OR 2.74, 95% CI 1.43-5.24) trajectories were more likely to have had sex with ≥2 new sexual partners in the last 3 months than those with LD trajectories. Continued efforts targeting HIV-infected persons with mental health disorders are warranted to reduce sexual risk behaviors.

Lower Extremity Amputation among Diabetic Patients in San Antonio, Texas.

BACKGROUND: In the United States, ethnic minorities are disproportionately affected by diabetes-related lower extremity amputations (LEA) and have higher associated mortality rates than non-Hispanic Whites. Bexar County, a county in south Texas, had higher diabetes rates than both Texas and the national average. Bexar County also had one of the highest LEA hospital admission rates in the State. AIM: Elucidate diabetes-related LEA factors to assist policy makers and health professionals develop more effective interventions. RESULTS: For participants who had more than one amputation, the time between amputations was approximately 1 year. Hispanics endorsed more diabetic health beliefs than non-Hispanic Whites. Participants 64 and younger reported greater social support and greater depression symptomatology than participants 65 and older. Participants with an amputation reported greater ability to engage in activities that would manage their diabetes than participants without an amputation. Participants without an amputation reported greater concern of their general health than participants with an amputation. CONCLUSION: The present study demonstrated the necessity for more research on diabetic amputation and related depression among Hispanics. The study also highlighted the need to create culturally appropriate interventions to reduce the rate and frequency of additional amputations.