of exact probabilities of Fisher was carried out. A t student test was also done to determine sig... more of exact probabilities of Fisher was carried out. A t student test was also done to determine significant defferencies among age averages. The RR was estimated by means of OR in tables 232, and its statistic meaning was determined through a CI at 95%, the aproximation of Woolf was used. Results The age average in infertile women was of 30.4 years and in fertile woman 24.3 years. (4.486-07), which is a highly significant difference. Bacterial vaginosis was detected in 72% of the infertile women and 30.9 % of pregnant women. Candida spp in 20% of infertile women and 65.4% of the controlled group. The presence of a highly significant statistic difference was proved when Fisher Test was applied. This difference was related to the distribution of microrganisms in both groups (p<0.0001). Mycoplasma hominis was isolated in 17% of infertile women and in 10% of fertile women. In the group of infertile women, Ureaplasma urealyticum was obtained in 42.70% of positive cultures; while in pregnant women, 2% was obtained. U urealyticum was not isolated in 57.30% of the infertile woman and in 98% of the pregnant ones. OR 83.92. CL for OR at 95% (17.37 to 397.05) statistically significant. In 54.30% of the infertile women and 98% of the pregnant ones, Chlamydia trachomatis was not isolated. Conclusions The presence of bacterial vaginosis, U urealyticum, C trachomatis resulted to be a risk factor of female infertility.
To develop a simple clinical staging system based on CD4 count and clinical variables that predic... more To develop a simple clinical staging system based on CD4 count and clinical variables that predicts progression to AIDS in HIV-infected non-AIDS patients. Retrospective cohort study. A primary care outpatient clinic for HIV-infected patients at a VA Medical Center. One hundred seventy-six HIV-infected non-AIDS patients seen at the Houston VA Special Medicine Clinic between January 1986 and December 1990 and followed for a mean of 22 months. Fifty-four patients (31%) progressed to AIDS during follow-up. The medical records were reviewed, and data corresponding to the initial (baseline) clinic visit and subsequent six-month visits were extracted. &quot;Predictive&quot; baseline variables (i.e., those associated with progression to AIDS) were first identified and then examined in Cox proportional hazards modeling. In the final model, CD4 category, oral thrush, and night sweats made significant independent contributions. A three-stage prognostic system was constructed by assigning points to the three variables: CD4 &gt; 500 cells/mm3 = 0; 500 &gt; or = CD4 &gt; or = 200 = 1; CD4 &lt; 200 = 2; presence of oral thrush = 1; presence of night sweats = 1. Stages were assigned as follows: stage I = 0 points, stage II = 1-2 points, and stage III = 3-4 points. The proportions of patients who progressed to AIDS were: stage I, 6/39 (15%); stage II, 31/106 (29%); and stage III, 17/31 (55%). These results demonstrate that simple, clinically sensible prognostic staging systems that predict progression to AIDS can be constructed using CD4 count and clinical variables.
African-American (AA) women may help to explain the disproportionate incidence of HIV/STDs seen i... more African-American (AA) women may help to explain the disproportionate incidence of HIV/STDs seen in this population. Single women with children by multiple fathers may engage in unprotected sex with the fathers of their children; these men are called Baby Daddies. Baby Daddy sex as a risk factor is complicated and based in a sexual reality grounded in poverty and power. This analysis focused on women who have continued sexual relationships with the father of their children in addition to other sexual relationships. We explored the psychosocial factors surrounding women who engage in unprotected Baby Daddy sex. Methods We conducted in-depth interviews with AA women living in low-income housing projects in Houston, TX. Study participants were at least 18 years old and involved in multiple sexual relationships. Interviews were conducted in participants' homes and lasted 1½ h. Each interview was digitally-recorded and transcribed verbatim. Participants were paid $20 US for their time. Qualitative analysis was conducted using MAXQDA10 software. We identified and organised codes, categories, and themes to form a comprehensive picture of the behaviours of our sample. Results Our sample included 26 AA women aged 21 to 40 years. Themes that emerged illustrated the contextual environment of women's sexual decisions and included: financial insecurity, parenting, relationship ideals, loneliness, and baby daddy sex. Participants characterised their choice to have unprotected baby daddy sex through the following categories: trust/bond based on shared child, love, compensation for financial support of children, pleasure, and longing for past relationship. These findings identified the importance and implied intimacy of the baby daddy relationships and suggested reasons for unprotected sex. Conclusions These findings indicate risk implications because they add concurrent sexual relationships with unprotected sex, thus increasing the potential for exposure and transmission of HIV/ STDs. More importantly, this study reflects the lasting importance of a relationship resulting in children and how that relationship influences sexual health. Interventions that focus on poor urban AA women in Houston should acknowledge the cultural constructions of both sexuality and relationships in this population, both related to socioeconomic and power inequalities.
To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we e... more To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of
Journal of Immigrant and Minority Health, Oct 2, 2011
This paper describes HIV testing behaviors among undocumented Central American immigrant women li... more This paper describes HIV testing behaviors among undocumented Central American immigrant women living in Houston, Texas, USA. Respondent driven sampling was used to recruit participants for an HIV behavioral survey. HIV testing items included lifetime history of testing, date and location of the most recent test, and reason for testing. Multivariate logistic regression was used to assess the demographic, behavioral, and structural characteristics associated with testing. The lifetime prevalence of HIV testing was 67%. Half of those who tested did so within the past 2 years and almost 80% received their most recent test in a healthcare setting. The primary reason for testing was pregnancy. Lifetime testing was associated with being from Honduras, having over a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Our results suggest that expanding access to healthcare services may increase the prevalence of HIV testing in this population.
Objective-Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the vo... more Objective-Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The primary objective was to summarize control of leakage around the VP after conservative management of enlarged TEP. Study Design-Retrospective cohort study. Methods-This 5-year cohort included 194 patients who underwent total laryngectomy (± pharyngectomy) and TEP at the University of Texas MD Anderson Cancer Center. Control of leakage around the VP was analyzed at last follow-up after enlarged TEP. Adverse events were compared in patients with and without enlarged TEP. Results-The incidence of enlarged TEP was 18.6% (36/194, 95% CI: 13.0%-24.1%). Conservative methods commonly attempted in lieu of complete TEP closure included placement of an enlarged-flange VP (34/36, 94%), temporary VP removal (14/36, 39%), and TEP-site injection (8/36, 22%). At last follow-up, conservative methods controlled leakage around the VP in 81% (29/36) of patients. Only 2 patients required complete TEP closure due to persistent leakage after enlarged TEP. Unresolved leakage was more common in patients with recurrent cancer after laryngectomy (p=0.081) and irregular TEP contour (p=0.003). Relative to controls without TEP enlargement, patients with enlarged TEP had 3-fold higher risk of pneumonia (RR: 3.4, 95% CI: 1.9-6.2) and aspiration of the prosthesis (RR: 3.3, 95% CI: 0.8-14.1). Conclusions-Although the rate of enlarged TEP is relatively low, the complication significantly elevates risk of pneumonia. Prosthetic leakage related to TEP enlargement can often be managed conservatively to avoid complete closure of the TEP.
Background: In collaboration with the Houston Department of Health and Human Services, the author... more Background: In collaboration with the Houston Department of Health and Human Services, the authors implemented and evaluated a urine-based chlamydia screening program in incarcerated youth in Harris County, Texas, and assessed predictor variables for infection. Goal: To implement and evaluate chlamydia screening in incarcerated youth. Study Design: The authors determined prevalence of chlamydial infection, treatment rates, and predictor variables in 589 youth and repeated the measures 6 months later in 975 additional youth. Results: Initially, the prevalence of infection was 9.6% in males and 28.1% in females; 88% of infected youth were treated while incarcerated. White males had a significantly lower prevalence of chlamydial infection; however, consistent condom use was not associated with a lower prevalence of chlamydia. In the 6-month assessment of chlamydia prevalence in 975 youth, prevalence and treatment rates remained high and predictor variables were similar. Conclusion: The authors instituted a screening program for chlamydial infection in incarcerated youth that was performing well at reassessment 6 months later. The authors thank John Paffel, Ann Doggett, Doris Brooks, and Virginia Doty of the Houston Department of Health and Human Services for making this program possible. Jennifer Ludlam and Meena Murti helped with data entry and analysis.
Background-Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication afte... more Background-Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure. Methods-A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model. Results-Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP-site injections were the most commonly reported conservative treatments. Prosthetic diameter (p =.076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported. Conclusion-The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.
To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors... more To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors compared active surveillance with passive surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive surveillance, 802 were validated to be cerebrovascular events. When passive surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive surveillance for cerebrovascular disease. More uniform surveillance methods would allow comparisons across studies and communities.
Presented at the American Public Health Association\u27s 129th Meeting, Atlanta, GA, October 21-2... more Presented at the American Public Health Association\u27s 129th Meeting, Atlanta, GA, October 21-25, 2001
The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke stud... more The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke study comparing Mexican Americans and non-Hispanic whites. Extensive effort is made to detect all patients regardless of ethnicity and ensure equal participation in the interview among both groups. We describe here the study's design and process evaluation with a focus on reducing bias in case ascertainment and participation. During the first 28 months of the project, 11,829 subjects were screened. Availability of neuroimaging did not differ by ethnicity (P=0.22), nor did confidence in the validated diagnosis of stroke (P=0.10). Participation rate in the interview also did not differ by ethnicity (P=0.92). There was excellent agreement of ethnic classification between chart abstraction and self-report (kappa=0.94, P<0.001). We conclude that multi-ethnic stroke comparison studies are feasible. Utilizing epidemiologic principles to design, recruit and analyze data are critical. Process evaluation to examine for sources of bias is important to study conduct.
Introduction: Despite reductions in cervical cancer (CC) incidence in the US due to screening, CC... more Introduction: Despite reductions in cervical cancer (CC) incidence in the US due to screening, CC continues to disproportionately affect certain populations, including immigrant women. Immigrant women are significantly less likely than US-born women to receive Pap test screening for CC. Barriers to screening are heightened among undocumented immigrants (without valid US visas or residency papers), who face additional obstacles that limit access and use of healthcare services. While undocumented status is a known barrier to CC screening, additional research is needed to explore causal factors for CC screening disparities among undocumented and legal immigrants. Methodological barriers to research among undocumented immigrants arise from the lack of a sampling frame from which to draw probability-based samples and from individuals’ reluctance to participate in research due to privacy concerns. Respondent driven sampling (RDS) is a new probability-based method that overcomes these barriers by accessing members of such “hidden populations” through their social networks. Despite its success in multiple populations, RDS has had minimum application among undocumented immigrants in the US. The purpose of this pilot study was to determine the effectiveness of using RDS to study healthcare behaviors among undocumented Central American immigrant women in Houston, Texas. Central Americans are the fastest-growing sector of the US Hispanic immigrant population and have high rates of CC. Methods: Recruitment was initiated by 3 non-randomly selected “seeds.” Seeds and eligible participants were given 3 serially-numbered coupons to recruit peers. Women were eligible to participate if they were from Guatemala, Honduras, or El Salvador, ages 18 to 50 years, and currently living in Houston without a valid US visa or residency papers. Participants received monetary compensation for completing the interview and for recruiting peers. RDS relies on key data to generate population-based estimates from the sample: 1) the size of each participant's social network (SN); and 2) recruitment patterns (who recruited whom). Recruitment patterns and homophily were used as an indicator of social clustering by country of origin and number of years of residency in the US (≤5 years vs. &gt;5 years). Homophily (H) is a measure of the likelihood that recruiters recruit individuals like themselves; scores range from −1 to 1, where 1 indicates 100% homophily and 0 indicates random recruitment. Attainment of a stable equilibrium sample composition in regard to demographic and healthcare characteristics was used as an indicator of RDS's ability to generate population-based estimates. Analyses were conducted using RDSAT 6.0. Results: Beginning with 3 initial participants, we recruited a sample of 226 immigrant women over 16 weeks. Participants adopted the recruitment system with reasonable ease (46% recruited ≥ 1 peer) and SNs were dense (mean SN size=20). Homophily was moderate by country of origin (Guatemalans: H=0.52; El Salvadorans: H=0.42) and low by number of years of residency in the US (H≤0.25). Equilibrium was attained for all demographic and healthcare characteristics. Conclusions: This study is the first to evaluate RDS in a US immigrant population. SNs in this population were dense, allowing recruitment to be sustained. While recruitment was moderately influenced by country of origin, women did not affiliate exclusively with those like themselves. This sociometric diversity allowed the sample to attain an equilibrium composition independent of initial participants. Overall, RDS was easy to implement, attained a large sample in a relatively short period of time, and reached an otherwise hidden population. RDS is an effective method for recruiting undocumented Central American immigrant women for research on healthcare and CC screening behaviors. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B52.
... Luisa Franzini, PhD 1 , Maria Eugenia Fernandez-Esquer, PhD 1 , Norma Perez, MD 1 , Melissa M... more ... Luisa Franzini, PhD 1 , Maria Eugenia Fernandez-Esquer, PhD 1 , Norma Perez, MD 1 , Melissa Montoya 1 , Margaret Caughy, PhD 1 , John ... University of Texas School of Public Health, 1200 Herman Pressler, RAS E 703, Houston, TX 77030, (3) San Antonio satellite, University ...
Purpose. This project was designed to describe the association between wasting and CD4 cell count... more Purpose. This project was designed to describe the association between wasting and CD4 cell counts in HIV-infected men in order to better understand the role of wasting in progression of HIV infection. Methods. Baseline and prevalence data were collected from a cross-sectional survey of 278 HIV-infected men seen at the Houston Veterans Affairs Medical Center Special Medicine Clinic, from June 1, 1991 to January 1, 1994. A follow-up study was conducted among those at risk, to investigate the incidence of wasting and the association between wasting and low CD4 cell counts. Wasting was described by four methods. Z-scores for age-, sex-, and height-adjusted weight; sex-, and age-adjusted mid-arm muscle circumference (MAMC); and fat-free mass; and the ratio of extra-cellular mass (ECM) to body-cell mass (BCM) $\u3e$ 1.20. FFM, ECM, and BCM were estimated from bioelectrical impedance analysis. MAMC was calculated from triceps skinfold and mid-arm circumference. The relationship between wasting and covariates was examined with logistic regression in the cross-sectional study, and with Poisson regression in the follow-up study. The association between death and wasting was examined with Cox\u27s regression. Results. The prevalence of wasting ranged from 5% (weight and ECM:BCM) to almost 14% (MAMC and FFM) among the 278 men examined. The odds of wasting, associated with baseline CD4 cell count $\u3c$200, was significant for each method but weight, and ranged from 4.6 to 12.7. Use of antiviral therapy was significantly protective of MAMC, FFM and ECM:BCM (OR $\approx$ 0.2), whereas the need for antibacterial therapy was a risk (OR 3.1, 95% CI 1.1-8.7). The average incidence of wasting ranged from 4 to 16 per 100 person-years among the approximately 145 men followed for 160 person-years. Low CD4 cell count seemed to increase the risk of wasting, but statistical significance was not reached. The effect of the small sample size on the power to detect a significant association should be considered. Wasting, by MAMC and FFM, was significantly associated with death, after adjusting for baseline serum albumin concentration and CD4 cell count. Conclusions. Wasting by MAMC and FFM were strongly associated with baseline CD4 cell counts in both the prevalence and incidence study and strong predictors of death. Of the two methods, MAMC is convenient, has available reference population data, may be the most appropriate for assessing the nutritional status of HIV-infected men
of exact probabilities of Fisher was carried out. A t student test was also done to determine sig... more of exact probabilities of Fisher was carried out. A t student test was also done to determine significant defferencies among age averages. The RR was estimated by means of OR in tables 232, and its statistic meaning was determined through a CI at 95%, the aproximation of Woolf was used. Results The age average in infertile women was of 30.4 years and in fertile woman 24.3 years. (4.486-07), which is a highly significant difference. Bacterial vaginosis was detected in 72% of the infertile women and 30.9 % of pregnant women. Candida spp in 20% of infertile women and 65.4% of the controlled group. The presence of a highly significant statistic difference was proved when Fisher Test was applied. This difference was related to the distribution of microrganisms in both groups (p<0.0001). Mycoplasma hominis was isolated in 17% of infertile women and in 10% of fertile women. In the group of infertile women, Ureaplasma urealyticum was obtained in 42.70% of positive cultures; while in pregnant women, 2% was obtained. U urealyticum was not isolated in 57.30% of the infertile woman and in 98% of the pregnant ones. OR 83.92. CL for OR at 95% (17.37 to 397.05) statistically significant. In 54.30% of the infertile women and 98% of the pregnant ones, Chlamydia trachomatis was not isolated. Conclusions The presence of bacterial vaginosis, U urealyticum, C trachomatis resulted to be a risk factor of female infertility.
To develop a simple clinical staging system based on CD4 count and clinical variables that predic... more To develop a simple clinical staging system based on CD4 count and clinical variables that predicts progression to AIDS in HIV-infected non-AIDS patients. Retrospective cohort study. A primary care outpatient clinic for HIV-infected patients at a VA Medical Center. One hundred seventy-six HIV-infected non-AIDS patients seen at the Houston VA Special Medicine Clinic between January 1986 and December 1990 and followed for a mean of 22 months. Fifty-four patients (31%) progressed to AIDS during follow-up. The medical records were reviewed, and data corresponding to the initial (baseline) clinic visit and subsequent six-month visits were extracted. &quot;Predictive&quot; baseline variables (i.e., those associated with progression to AIDS) were first identified and then examined in Cox proportional hazards modeling. In the final model, CD4 category, oral thrush, and night sweats made significant independent contributions. A three-stage prognostic system was constructed by assigning points to the three variables: CD4 &gt; 500 cells/mm3 = 0; 500 &gt; or = CD4 &gt; or = 200 = 1; CD4 &lt; 200 = 2; presence of oral thrush = 1; presence of night sweats = 1. Stages were assigned as follows: stage I = 0 points, stage II = 1-2 points, and stage III = 3-4 points. The proportions of patients who progressed to AIDS were: stage I, 6/39 (15%); stage II, 31/106 (29%); and stage III, 17/31 (55%). These results demonstrate that simple, clinically sensible prognostic staging systems that predict progression to AIDS can be constructed using CD4 count and clinical variables.
African-American (AA) women may help to explain the disproportionate incidence of HIV/STDs seen i... more African-American (AA) women may help to explain the disproportionate incidence of HIV/STDs seen in this population. Single women with children by multiple fathers may engage in unprotected sex with the fathers of their children; these men are called Baby Daddies. Baby Daddy sex as a risk factor is complicated and based in a sexual reality grounded in poverty and power. This analysis focused on women who have continued sexual relationships with the father of their children in addition to other sexual relationships. We explored the psychosocial factors surrounding women who engage in unprotected Baby Daddy sex. Methods We conducted in-depth interviews with AA women living in low-income housing projects in Houston, TX. Study participants were at least 18 years old and involved in multiple sexual relationships. Interviews were conducted in participants' homes and lasted 1½ h. Each interview was digitally-recorded and transcribed verbatim. Participants were paid $20 US for their time. Qualitative analysis was conducted using MAXQDA10 software. We identified and organised codes, categories, and themes to form a comprehensive picture of the behaviours of our sample. Results Our sample included 26 AA women aged 21 to 40 years. Themes that emerged illustrated the contextual environment of women's sexual decisions and included: financial insecurity, parenting, relationship ideals, loneliness, and baby daddy sex. Participants characterised their choice to have unprotected baby daddy sex through the following categories: trust/bond based on shared child, love, compensation for financial support of children, pleasure, and longing for past relationship. These findings identified the importance and implied intimacy of the baby daddy relationships and suggested reasons for unprotected sex. Conclusions These findings indicate risk implications because they add concurrent sexual relationships with unprotected sex, thus increasing the potential for exposure and transmission of HIV/ STDs. More importantly, this study reflects the lasting importance of a relationship resulting in children and how that relationship influences sexual health. Interventions that focus on poor urban AA women in Houston should acknowledge the cultural constructions of both sexuality and relationships in this population, both related to socioeconomic and power inequalities.
To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we e... more To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of
Journal of Immigrant and Minority Health, Oct 2, 2011
This paper describes HIV testing behaviors among undocumented Central American immigrant women li... more This paper describes HIV testing behaviors among undocumented Central American immigrant women living in Houston, Texas, USA. Respondent driven sampling was used to recruit participants for an HIV behavioral survey. HIV testing items included lifetime history of testing, date and location of the most recent test, and reason for testing. Multivariate logistic regression was used to assess the demographic, behavioral, and structural characteristics associated with testing. The lifetime prevalence of HIV testing was 67%. Half of those who tested did so within the past 2 years and almost 80% received their most recent test in a healthcare setting. The primary reason for testing was pregnancy. Lifetime testing was associated with being from Honduras, having over a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Our results suggest that expanding access to healthcare services may increase the prevalence of HIV testing in this population.
Objective-Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the vo... more Objective-Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The primary objective was to summarize control of leakage around the VP after conservative management of enlarged TEP. Study Design-Retrospective cohort study. Methods-This 5-year cohort included 194 patients who underwent total laryngectomy (± pharyngectomy) and TEP at the University of Texas MD Anderson Cancer Center. Control of leakage around the VP was analyzed at last follow-up after enlarged TEP. Adverse events were compared in patients with and without enlarged TEP. Results-The incidence of enlarged TEP was 18.6% (36/194, 95% CI: 13.0%-24.1%). Conservative methods commonly attempted in lieu of complete TEP closure included placement of an enlarged-flange VP (34/36, 94%), temporary VP removal (14/36, 39%), and TEP-site injection (8/36, 22%). At last follow-up, conservative methods controlled leakage around the VP in 81% (29/36) of patients. Only 2 patients required complete TEP closure due to persistent leakage after enlarged TEP. Unresolved leakage was more common in patients with recurrent cancer after laryngectomy (p=0.081) and irregular TEP contour (p=0.003). Relative to controls without TEP enlargement, patients with enlarged TEP had 3-fold higher risk of pneumonia (RR: 3.4, 95% CI: 1.9-6.2) and aspiration of the prosthesis (RR: 3.3, 95% CI: 0.8-14.1). Conclusions-Although the rate of enlarged TEP is relatively low, the complication significantly elevates risk of pneumonia. Prosthetic leakage related to TEP enlargement can often be managed conservatively to avoid complete closure of the TEP.
Background: In collaboration with the Houston Department of Health and Human Services, the author... more Background: In collaboration with the Houston Department of Health and Human Services, the authors implemented and evaluated a urine-based chlamydia screening program in incarcerated youth in Harris County, Texas, and assessed predictor variables for infection. Goal: To implement and evaluate chlamydia screening in incarcerated youth. Study Design: The authors determined prevalence of chlamydial infection, treatment rates, and predictor variables in 589 youth and repeated the measures 6 months later in 975 additional youth. Results: Initially, the prevalence of infection was 9.6% in males and 28.1% in females; 88% of infected youth were treated while incarcerated. White males had a significantly lower prevalence of chlamydial infection; however, consistent condom use was not associated with a lower prevalence of chlamydia. In the 6-month assessment of chlamydia prevalence in 975 youth, prevalence and treatment rates remained high and predictor variables were similar. Conclusion: The authors instituted a screening program for chlamydial infection in incarcerated youth that was performing well at reassessment 6 months later. The authors thank John Paffel, Ann Doggett, Doris Brooks, and Virginia Doty of the Houston Department of Health and Human Services for making this program possible. Jennifer Ludlam and Meena Murti helped with data entry and analysis.
Background-Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication afte... more Background-Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure. Methods-A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model. Results-Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP-site injections were the most commonly reported conservative treatments. Prosthetic diameter (p =.076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported. Conclusion-The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.
To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors... more To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors compared active surveillance with passive surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive surveillance, 802 were validated to be cerebrovascular events. When passive surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive surveillance for cerebrovascular disease. More uniform surveillance methods would allow comparisons across studies and communities.
Presented at the American Public Health Association\u27s 129th Meeting, Atlanta, GA, October 21-2... more Presented at the American Public Health Association\u27s 129th Meeting, Atlanta, GA, October 21-25, 2001
The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke stud... more The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke study comparing Mexican Americans and non-Hispanic whites. Extensive effort is made to detect all patients regardless of ethnicity and ensure equal participation in the interview among both groups. We describe here the study's design and process evaluation with a focus on reducing bias in case ascertainment and participation. During the first 28 months of the project, 11,829 subjects were screened. Availability of neuroimaging did not differ by ethnicity (P=0.22), nor did confidence in the validated diagnosis of stroke (P=0.10). Participation rate in the interview also did not differ by ethnicity (P=0.92). There was excellent agreement of ethnic classification between chart abstraction and self-report (kappa=0.94, P<0.001). We conclude that multi-ethnic stroke comparison studies are feasible. Utilizing epidemiologic principles to design, recruit and analyze data are critical. Process evaluation to examine for sources of bias is important to study conduct.
Introduction: Despite reductions in cervical cancer (CC) incidence in the US due to screening, CC... more Introduction: Despite reductions in cervical cancer (CC) incidence in the US due to screening, CC continues to disproportionately affect certain populations, including immigrant women. Immigrant women are significantly less likely than US-born women to receive Pap test screening for CC. Barriers to screening are heightened among undocumented immigrants (without valid US visas or residency papers), who face additional obstacles that limit access and use of healthcare services. While undocumented status is a known barrier to CC screening, additional research is needed to explore causal factors for CC screening disparities among undocumented and legal immigrants. Methodological barriers to research among undocumented immigrants arise from the lack of a sampling frame from which to draw probability-based samples and from individuals’ reluctance to participate in research due to privacy concerns. Respondent driven sampling (RDS) is a new probability-based method that overcomes these barriers by accessing members of such “hidden populations” through their social networks. Despite its success in multiple populations, RDS has had minimum application among undocumented immigrants in the US. The purpose of this pilot study was to determine the effectiveness of using RDS to study healthcare behaviors among undocumented Central American immigrant women in Houston, Texas. Central Americans are the fastest-growing sector of the US Hispanic immigrant population and have high rates of CC. Methods: Recruitment was initiated by 3 non-randomly selected “seeds.” Seeds and eligible participants were given 3 serially-numbered coupons to recruit peers. Women were eligible to participate if they were from Guatemala, Honduras, or El Salvador, ages 18 to 50 years, and currently living in Houston without a valid US visa or residency papers. Participants received monetary compensation for completing the interview and for recruiting peers. RDS relies on key data to generate population-based estimates from the sample: 1) the size of each participant's social network (SN); and 2) recruitment patterns (who recruited whom). Recruitment patterns and homophily were used as an indicator of social clustering by country of origin and number of years of residency in the US (≤5 years vs. &gt;5 years). Homophily (H) is a measure of the likelihood that recruiters recruit individuals like themselves; scores range from −1 to 1, where 1 indicates 100% homophily and 0 indicates random recruitment. Attainment of a stable equilibrium sample composition in regard to demographic and healthcare characteristics was used as an indicator of RDS's ability to generate population-based estimates. Analyses were conducted using RDSAT 6.0. Results: Beginning with 3 initial participants, we recruited a sample of 226 immigrant women over 16 weeks. Participants adopted the recruitment system with reasonable ease (46% recruited ≥ 1 peer) and SNs were dense (mean SN size=20). Homophily was moderate by country of origin (Guatemalans: H=0.52; El Salvadorans: H=0.42) and low by number of years of residency in the US (H≤0.25). Equilibrium was attained for all demographic and healthcare characteristics. Conclusions: This study is the first to evaluate RDS in a US immigrant population. SNs in this population were dense, allowing recruitment to be sustained. While recruitment was moderately influenced by country of origin, women did not affiliate exclusively with those like themselves. This sociometric diversity allowed the sample to attain an equilibrium composition independent of initial participants. Overall, RDS was easy to implement, attained a large sample in a relatively short period of time, and reached an otherwise hidden population. RDS is an effective method for recruiting undocumented Central American immigrant women for research on healthcare and CC screening behaviors. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B52.
... Luisa Franzini, PhD 1 , Maria Eugenia Fernandez-Esquer, PhD 1 , Norma Perez, MD 1 , Melissa M... more ... Luisa Franzini, PhD 1 , Maria Eugenia Fernandez-Esquer, PhD 1 , Norma Perez, MD 1 , Melissa Montoya 1 , Margaret Caughy, PhD 1 , John ... University of Texas School of Public Health, 1200 Herman Pressler, RAS E 703, Houston, TX 77030, (3) San Antonio satellite, University ...
Purpose. This project was designed to describe the association between wasting and CD4 cell count... more Purpose. This project was designed to describe the association between wasting and CD4 cell counts in HIV-infected men in order to better understand the role of wasting in progression of HIV infection. Methods. Baseline and prevalence data were collected from a cross-sectional survey of 278 HIV-infected men seen at the Houston Veterans Affairs Medical Center Special Medicine Clinic, from June 1, 1991 to January 1, 1994. A follow-up study was conducted among those at risk, to investigate the incidence of wasting and the association between wasting and low CD4 cell counts. Wasting was described by four methods. Z-scores for age-, sex-, and height-adjusted weight; sex-, and age-adjusted mid-arm muscle circumference (MAMC); and fat-free mass; and the ratio of extra-cellular mass (ECM) to body-cell mass (BCM) $\u3e$ 1.20. FFM, ECM, and BCM were estimated from bioelectrical impedance analysis. MAMC was calculated from triceps skinfold and mid-arm circumference. The relationship between wasting and covariates was examined with logistic regression in the cross-sectional study, and with Poisson regression in the follow-up study. The association between death and wasting was examined with Cox\u27s regression. Results. The prevalence of wasting ranged from 5% (weight and ECM:BCM) to almost 14% (MAMC and FFM) among the 278 men examined. The odds of wasting, associated with baseline CD4 cell count $\u3c$200, was significant for each method but weight, and ranged from 4.6 to 12.7. Use of antiviral therapy was significantly protective of MAMC, FFM and ECM:BCM (OR $\approx$ 0.2), whereas the need for antibacterial therapy was a risk (OR 3.1, 95% CI 1.1-8.7). The average incidence of wasting ranged from 4 to 16 per 100 person-years among the approximately 145 men followed for 160 person-years. Low CD4 cell count seemed to increase the risk of wasting, but statistical significance was not reached. The effect of the small sample size on the power to detect a significant association should be considered. Wasting, by MAMC and FFM, was significantly associated with death, after adjusting for baseline serum albumin concentration and CD4 cell count. Conclusions. Wasting by MAMC and FFM were strongly associated with baseline CD4 cell counts in both the prevalence and incidence study and strong predictors of death. Of the two methods, MAMC is convenient, has available reference population data, may be the most appropriate for assessing the nutritional status of HIV-infected men
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Papers by Jan M.h Risser