An-Lin Cheng

Impact of Supported Housing on Clinical Outcomes Analysis of a Randomized Trial Using Multiple Imputation Technique

In 1992, the US Department of Housing and Urban Development (HUD) and the US Department of Veterans Affairs (VA) established the HUD-VA Supported Housing (HUD-VASH) Program to provide integrated clinical and housing services to homeless veterans with psychiatric and/or substance abuse disorders at 19 sites. At four sites, 460 subjects were randomly assigned to one of the three groups: (1) HUD-VASH, with both Section 8 vouchers and intensive case management; (2) case management only; and (3) standard VA care. A previous publication found HUD-VASH resulted in superior housing outcomes but yielded no benefits on clinical outcomes. Since many participants missed prescheduled visits during the follow-up period and follow-up rates were quite different across the groups, we reanalyzed these data using multiple imputation statistical methods to account for the missing observations. Significant benefits were found for HUD-VASH in drug and alcohol abuse outcomes that had not previously been identified.

What college women know, think, and do about human papillomavirus (HPV) and HPV vaccine.

OBJECTIVES This cross-sectional study, guided by Ajzens Theory of Planned Behavior, aimed to identify factors that influence the decision to obtain an HPV vaccine among college women and to examine the relationships among these factors. METHODS An electronic self-administered survey was utilized to collect data. An email invitation was sent to 3074 college women attending a large, public university in southern California, aged between 18 and 26 years. The email directed the recipient to click on a link to a web-based survey if she wanted to participate in the study. RESULTS Participants in this study were college women (n=384; 175 HPV non-vaccinees and 209 HPV vaccinees). Women in this study knew that a Pap test is still needed after HPV vaccination and that the HPV vaccine does not protect against other Sexually Transmitted Infections. Both non-vaccinees and vaccinees had positive attitudes about mandating HPV vaccine. Knowledge and attitudes toward the vaccine were not directly linked to the outcome predictors - intention to obtain the vaccine and vaccine uptake. Attitude about receiving HPV vaccine, subjective norms (complying with the expectations of others), and perceived behavioral control were correlated with the outcome predictors. Subjective norms consistently predicted intention to obtain HPV vaccine and vaccine uptake. CONCLUSIONS A proposal to mandate the HPV vaccine among young girls/women was acceptable to this population. Vaccination promotion strategies to increase the vaccine uptake rate among the catch-up group (aged 13-26) should include attention to college womens subjective norms. Health care providers recommendation and encouragement from significant others (i.e., mother and peers) are critical in order for the college women to obtain the vaccine.

Heart and Soul Physical Activity Program for African American Women

African American women are less physically active than White women and have a higher prevalence of inactivity-related diseases. Increased physical activity is known to reduce the risks for many chronic diseases. Positive health behavior changes have resulted from health promotion interventions conducted in African American churches. Eighteen midlife African American women participated in the Heart and Soul Physical Activity Program (HSPAP), a church-based physical activity intervention conceptualized in appraisal, belonging, tangible, and self-esteem domains of social support. Feasibility of the HSPAP was tested by determining changes in time and intensity of physical activity and social support for physical activity from baseline to 6 weeks. Data analyses were conducted utilizing paired t tests. Significant increases in time spent in physical activity from a mean of 412 min/week at baseline to 552 min/week at 6 weeks were noted. Participants reported increases in social support for physical activity in the 6-week study.

Impact of a Bilingual/Bicultural Care Team on HIV-Related Health Outcomes

The purpose of this retrospective study was to examine the impact of a bilingual/bicultural care team on HIV‐related health outcomes among Hispanic/Latino adults (N = 43) who received care in an academic HIV specialty clinic. Demographic and health data extracted from medical records from March 2005 to March 2007 were compared over two time periods: 1 year before and 1 year after implementation of the care team. Results indicated that there were more clinic visits per patient and that a higher percentage of individuals had suppressed HIV viral loads to < 50 copies/ml during the year after the team was implemented compared with the previous year. Results from this study suggest that provision of care by health care workers who are bilingual/bicultural, together with the use of culturally and linguistically appropriate patient education materials, may enhance health outcomes among Hispanic adults living with HIV infection.

High-fidelity simulation and legal/ethical concepts A transformational learning experience

Students in an undergraduate legal and ethical issues course continually told the authors that they did not have time to study for the course because they were busy studying for their clinical courses. Faculty became concerned that students were failing to realize the value of legal and ethical concepts as applicable to clinical practice. This led the authors to implement a transformational learning experience in which students applied legal and ethical course content in a high-fidelity human simulation (HFHS) scenario. A preliminary evaluation compared the new HFHS experience with in-person and online student groups using the same case. Based on both student and faculty perceptions, the HFHS was identified as the best of the three approaches for providing a transformational learning experience regarding legal and ethical content.

Visual gene-network analysis reveals the cancer gene co-expression in human endometrial cancer

BackgroundEndometrial cancers (ECs) are the most common form of gynecologic malignancy. Recent studies have reported that ECs reveal distinct markers for molecular pathogenesis, which in turn is linked to the various histological types of ECs. To understand further the molecular events contributing to ECs and endometrial tumorigenesis in general, a more precise identification of cancer-associated molecules and signaling networks would be useful for the detection and monitoring of malignancy, improving clinical cancer therapy, and personalization of treatments.ResultsECs-specific gene co-expression networks were constructed by differential expression analysis and weighted gene co-expression network analysis (WGCNA). Important pathways and putative cancer hub genes contribution to tumorigenesis of ECs were identified. An elastic-net regularized classification model was built using the cancer hub gene signatures to predict the phenotypic characteristics of ECs. The 19 cancer hub gene signatures had high predictive power to distinguish among three key principal features of ECs: grade, type, and stage. Intriguingly, these hub gene networks seem to contribute to ECs progression and malignancy via cell-cycle regulation, antigen processing and the citric acid (TCA) cycle.ConclusionsThe results of this study provide a powerful biomarker discovery platform to better understand the progression of ECs and to uncover potential therapeutic targets in the treatment of ECs. This information might lead to improved monitoring of ECs and resulting improvement of treatment of ECs, the 4th most common of cancer in women.

An intervention to address interpersonal violence among low-income midwestern Hispanic-American teens.

This paper reports pilot testing of “Familias En Nuestra Escuela”, an in-school interpersonal violence prevention intervention targeting Hispanic-American teens. The intervention, based on the hypothesis that the preservation and reinforcement of Hispanic cultural values can serve as a protective factor against violence, focused on the enhancement of ethnic pride. Researchers formed a partnership with a midwestern Hispanic community to test the feasibility, receptivity and preliminary impact of the intervention in a pre/post test, no control group design. Participants were low-income, predominantly first-generation Hispanic-American freshmen and sophomore students from one Hispanic-serving high school. Findings revealed a statistically significant increase in the intervention’s mediator, ethic pride. Changes in the desired direction occurred on measures of perceptions of self-efficacy for self-control, couple violence, and gender attitudes. The incidence of physical fighting and dating violence behaviors decreased over the course of an academic school year. Results provide preliminary evidence for the use of interventions based on ethnic and cultural pride as a violence prevention strategy among Hispanic-American teens, especially those who are first generation Americans.

Dating Violence and Girls in the Juvenile Justice System

The purpose of this study is to explore the prevalence and associated behaviors of dating violence among a population of girls in the juvenile justice system. A sample of 590 girls from an urban juvenile justice system completed a questionnaire assessing attitudes and self-efficacy about and occurrence of dating violence. The analysis developed a random effect model to determine a risk profile for dating violence. The strongest predictors of dating violence were (a) initial sexual experience at age 13 or earlier, (b) unwillingness of initial sexual experience, (c) drug use, and (d) low self-efficacy about preventing dating violence. The high prevalence of dating violence and associated behaviors among participants suggests the importance of implementing primary prevention programs to assist preteen girls in delaying initial sexual intercourse and in learning techniques to prevent dating violence.

Impact of an integrated service system on client outcomes by gender in a national sample of a mentally ill homeless population

BACKGROUND Homeless populations with concurrent mental illness have a complex array of service needs that are often addressed in a haphazard or uncoordinated manner. Information is lacking about the effectiveness of programs and public policy in women who are both homeless and mentally ill. OBJECTIVE This study assessed the impact of gender on the outcomes of a multisite public policy intervention that implemented components of an integrated service delivery system to address the needs of mentally ill homeless men and women. METHODS A secondary analysis was performed using longitudinal data obtained from homeless men and women in the Access to Community Care and Effective Services and Supports prospective study, which was conducted at 18 sites across the United States. Outcome data from baseline, 3, 12, and 18 months across 5 annual cohorts were analyzed to determine the impact of gender on 6 clinical outcomes, including days of housing, relationships, victimization, social support, alcohol use, and drug use, in homeless men and women with mental illness. The analysis plan included multilevel modeling of longitudinal data. RESULTS Data were analyzed from a total of 7,229 participants, including 4,502 men (62%)) (mean age, 38.2 years) and 2,727 women (38%) (mean age, 37.2 years). After 18 months of follow-up, women had significantly better outcomes in terms of family relationships (estimated mean score increased 0.100), victimization (score decreased 0.164), and social support (score increased 0.363) than did men (all, P < 0.001). Being accompanied by children was significantly associated with less change in drug use among women compared with men (P < 0.01). These outcomes were the same across all 18 program sites. CONCLUSION Although the addition of services for the homeless in conjunction with clinical and support services offered by case managers had generally positive effects in this studys population, a gender-specific substance abuse treatment intervention should also be included in a comprehensive program for homeless women with mental illness.

Cellular and Physiological Effects of Dietary Supplementation with β-Hydroxy-β-Methylbutyrate (HMB) and β-Alanine in Late Middle-Aged Mice.

There is growing evidence that severe decline of skeletal muscle mass and function with age may be mitigated by exercise and dietary supplementation with protein and amino acid ingredient technologies. The purposes of this study were to examine the effects of the leucine catabolite, beta-hydroxy-beta-methylbutyrate (HMB), in C2C12 myoblasts and myotubes, and to investigate the effects of dietary supplementation with HMB, the amino acid β-alanine and the combination thereof, on muscle contractility in a preclinical model of pre-sarcopenia. In C2C12 myotubes, HMB enhanced sarcoplasmic reticulum (SR) calcium release beyond vehicle control in the presence of all SR agonists tested (KCl, P<0.01; caffeine, P = 0.03; ionomycin, P = 0.03). HMB also improved C2C12 myoblast viability (25 μM HMB, P = 0.03) and increased proliferation (25 μM HMB, P = 0.04; 125 μM HMB, P<0.01). Furthermore, an ex vivo muscle contractility study was performed on EDL and soleus muscle from 19 month old, male C57BL/6nTac mice. For 8 weeks, mice were fed control AIN-93M diet, diet with HMB, diet with β-alanine, or diet with HMB and β-alanine. In β-alanine fed mice, EDL muscle showed a 7% increase in maximum absolute force compared to the control diet (202 ± 3vs. 188± 5 mN, P = 0.02). At submaximal frequency of stimulation (20 Hz), EDL from mice fed HMB plus β-alanine showed an 11% increase in absolute force (88.6 ± 2.2 vs. 79.8 ± 2.4 mN, P = 0.025) and a 13% increase in specific force (12.2 ± 0.4 vs. 10.8 ± 0.4 N/cm2, P = 0.021). Also in EDL muscle, β-alanine increased the rate of force development at all frequencies tested (P<0.025), while HMB reduced the time to reach peak contractile force (TTP), with a significant effect at 80 Hz (P = 0.0156). In soleus muscle, all experimental diets were associated with a decrease in TTP, compared to control diet. Our findings highlight beneficial effects of HMB and β-alanine supplementation on skeletal muscle function in aging mice.