Constance R. Uphold

Prevalence and correlates of obesity in preschool children

Obesity, a common nutritional disorder in childhood, is a complex problem that is poorly understood. The purpose of this study was to identify the prevalence of obesity in preschool children, and to examine the relationships between obesity and gender, race, socioeconomic status, and health problems. Data were collected from 309 charts of children enrolled in a Head Start program. Ninety-nine (32%) of the children were obese. Obese children had significantly higher blood pressure readings than those who were not obese. This study represents a beginning effort to learn more about the prevalence of, and factors associated with, obesity in preschoolers.

Predictors of complementary/alternative medicine use and intensity of use among men with HIV infection from two geographic areas in the United States.

&NA; This descriptive, cross‐sectional study explored the factors associated with frequency and intensity of complementary/alternative medicine (CAM) use in 301 HIV‐infected men from southern California (n = 75) and northern Florida/southern Georgia (n = 226). Logistic regression analysis was conducted to identify which demographic, biomedical, psychosocial, and health behavior variables (risk and health‐promoting behaviors) were predictors of CAM use and intensity of use. The majority (69%) of participants reported CAM use. The types of CAM most frequently cited were dietary supplements (71%) and spiritual therapies (66%). Odds of CAM use increased with more depressive symptoms and more health‐promoting behaviors. The odds of CAM use intensity increased with greater symptom frequency and more health‐promoting behaviors. Living in California was predictive of both use frequency and intensity of CAM use. High levels of CAM use should alert health care providers to assess CAM use and to incorporate CAM‐related patient education into their clinical practices.

HIV‐related Pneumocystis carinii Pneumonia in Older Patients Hospitalized in the Early HAART Era

OBJECTIVE: To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocystis carinii pneumonia (PCP), as determined in our prior study from the 1980s.DESIGN: Retrospective chart review.PATIENTS/SETTING: Patients (1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997.MEASUREMENTS: Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality.MAIN RESULTS: Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes (70% vs 82%, P<.001), have mild or moderately severe PCP cases at admission (89% vs 96%, P<.002), receive anti-PCP medications within the first 2 days of hospitalization (86% vs 93%, P<.002), and survive hospitalization (82% vs 90%, P<.003). However, age was not a significant predictor of mortality after adjustment for severity of PCP and timeliness of therapy.CONCLUSIONS: While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illness at admission, and delays in initiation of PCP-specific treatments among older individuals—factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged.

Oxidative stress and antioxidant capacity in smoking and nonsmoking men with HIV/acquired immunodeficiency syndrome

BACKGROUND Past studies document decreased levels of antioxidants and selenium and increased levels of oxidative stress in people living with HIV/acquired immunodeficiency syndrome (AIDS). Cigarette smoking is another source of oxidative stress. Excessive oxidative stress can induce HIV replication, resulting in disease progression. The purpose of this study was to determine whether subjects with HIV/AIDS who smoke cigarettes have increased oxidative stress and decreased antioxidant status compared with nonsmokers with HIV/AIDS. METHODS Thirty-one men with HIV/AIDS (adhering to highly active antiretroviral therapy for the previous 3 months) were recruited during regular visits to a Veterans Affairs Medical Center Infectious Disease Clinic in a southeastern US city. Plasma was obtained from a 1-time blood draw for this comparison study. Plasma lipid peroxide (LPO) was used as a marker of oxidative stress. Indicators of antioxidant capacity included plasma glutathione peroxidase (GPx, the functional indicator of selenium status), vitamin C, and antioxidant potential (AOP). RESULTS Fifteen smokers and 10 nonsmokers with HIV/AIDS were enrolled. Median plasma LPO level was above the normal range of 0-1.3 micromol/L in both nonsmokers (2.5 [0-23.4] micromol/L, median [range]) and smokers (4.0 [0-47.5] micromol/L), but there was no difference between groups. Plasma GPx concentration was significantly lower in smokers (169 [118-295] mumol/min/L) compared with nonsmokers (197 [149-414] micromol/min/L). Vitamin C and AOP levels were not different between groups. CONCLUSIONS This pilot study suggests that effects of smoking on oxidative stress are not additive, as no striking differences were observed in oxidative stress or antioxidant capacity between clinically stable smoking and nonsmoking men with HIV/AIDS.

Complementary and alternative medicine use among HIV-infected patients attending three outpatient clinics in the Southeastern United States.

Eisenberg and colleagues’ 1993 survey publicized the widespread use of ‘unconventional’ therapies in the USA. Subsequent surveys confirmed that approximately 20–63% of the population used complementary and alternative medicine (CAM). It is reasonable to expect that certain subgroups would be more likely to try CAM, particularly persons with illnesses that are unresponsive to mainstream therapies. This has been found in studies of patients with cancer, autoimmune diseases, arthritis, and pain. HIV-infected individuals might also be expected to use CAM at a high rate to strengthen immunity and alleviate symptoms. Most studies of CAM use during HIV/AIDS have found rates similar to the general population (i.e. between 30% and 50%), but some have found much higher CAM rates. In the general population, CAM is typically used by persons with college education, larger incomes, and poorer health status, but these associations have not been consistently replicated in HIV/AIDS studies. CAM use among HIV/AIDS persons was associated with being gay or bisexual, greater social support, and assertiveness. Physical health and illness measures have not predicted CAM use, with the exception of a study that found a positive association with duration of seropositivity. In the present study, we report rates of CAM use, types of CAM therapies used, and the intensity of use of multiple CAM therapies among HIVinfected men. We examine the correlates of CAM use. Our focus is to discover conditions under which CAM use is most prevalent and to delineate the characteristics among HIV-infected CAM users. Methods

HIV-Related Pneumonia Care in Older Patients Hospitalized in the Early HAART Era

Age-related variations in care have been identified for HIV-associated Pneumocystis carinii pneumonia (PCP) in both the 1980s and 1990s. We evaluated if age-related variations affected all aspects of HIV-specific and non-HIV-specific care for HIV-infected individuals with PCP or community-acquired pneumonia (CAP), or whether age-related variations were primarily limited to HIV-specific aspects of care. Subjects were HIV-infected persons with PCP (n = 1855) or CAP (n = 1415) hospitalized in 8 cities from 1995 to 1997. Nine percent of our study patients had received protease inhibitors and 39% had received any type of antiretroviral therapy prior to hospitalization. Data were abstracted from medical records and included severity of illness, HIV-specific aspects of care (initiation of PCP medications), general measures of care [initiation of CAP medications, intubation, and intensive care units (ICU)], and inpatient mortality. Compared to younger patients, pneumonia patients 50 years of age or older were significantly more likely to: be severely ill (PCP, 20.4% vs. 10.4%; CAP, 27.5% vs. 14.9%; each p = 0.001), receive ICU care (PCP, 22.0% vs. 12.8%, p = 0.002; CAP: 15.1% vs. 9.4%; p = 0.02), and be intubated (PCP, 14.6% vs. 8.4%, p = 0.01; CAP, 9.9% vs. 5.6%, p = 0.03). Compared to younger patients, older patients (>/=50 years) had similar rates of timely medications for CAP (48.5% vs. 50.8%) but had lower rates of receiving anti-PCP medications (85.8% vs. 92.9%, p = 0.002). Differences by age in timely initiation of PCP medications, ICU use, and intubation were limited to the nonseverely ill patients. Older hospitalized patients were more likely to die (PCP, 18.3% vs. 10.4%; CAP, 13.4% vs. 8.5%; each p < 0.05). After adjustment for disease severity and timeliness of antibiotic use, mortality rates were similar for both age groups. Physicians should develop strategies that increase awareness of the possibility of HIV infection in older individuals.

HIV and older adults: clinical outcomes in the era of HAART.

As the human immunodeficiency virus (HIV) epidemic enters its third decade, nurses are caring for increasing numbers of older adults with HIV who are on complicated medication regimens or highly active antiretroviral therapy (HAART). Although HAART has revolutionized HIV and acquired immunodeficiency syndrome (AIDS) care, little is known about how older adults respond to the new therapies. A review of the medical records of 19 older (> or = 50 years) and 18 younger (< 40 years) adults initiated on their first HAART regimen revealed both older and younger adults had similar positive clinical outcomes. Nurses need to individualize their care to patients of all ages rather than develop specific clinical guidelines for older adults with HIV.

Emotional Bonds and Social Support Exchange Between Men Living With HIV Infection and Their Mothers

Men infected with HIV are often faced with caregiving responsibilities of aging, ill parents, while simultaneously looking for support from their parents in dealing with their own health problems. Unfortunately, the reciprocal roles of HIV-positive adult sons and aging mothers as caregivers have not been examined. To address this gap in the literature, HIV-positive men (n = 118) answered open-ended questions about the support they exchanged with their mothers, completed the Depth of Relationships Inventory, and rated the importance of health-related assistance between themselves and their mothers. The men viewed themselves as important providers of both instrumental and emotional support to their mothers. Men perceived their mothers to be significant providers of emotional support but only moderately important in providing instrumental support. About a third of the men responded that the help they provided and received from the mothers in managing each other’s health and staying healthy was extremely important. Men regarded their relationships with their mothers as one of their most important social relationships. Non-White men rated the quality of their mother–son relationships more highly, exchanged more instrumental support, and provided more emotional support to their mothers than White men. Men who disclosed their HIV-positive status to their mothers rated the importance of the help they received from their mothers in managing their illnesses higher than men who had not disclosed.

The Longitudinal Effects of Spirituality on Stress, Depression, and Risk Behaviors Among Men with HIV Infection Attending Three Clinics in the Southeastern United States

ABSTRACT. We examined the associations of two measures of spirituality (i.e., spiritual growth and religious coping) and perceived stress, depression, hazardous alcohol use, and use of tobacco and illicit drugs over time among men who had tested positive for HIV. Data were collected from 226 men at baseline, 197 at a 12‐month follow‐up, and 184 at a 24‐month follow‐up. There were significant time by spiritual growth interactions found for both perceived stress and depression. Increased spiritual growth, that is, spirituality that focuses on seeking meaning, purpose, and transcendence was significantly associated with reduced perceived stress and reduced depression, and the effects varied at different time points. Spiritual growth was not associated with specific risk behaviors (hazardous alcohol use, tobacco and illicit drug use). The effects of religious coping (e.g. Bible reading, prayer, church attendance) on outcomes were consistent across all time points. Religious coping was not significantly associated with perceived stress but it was negatively associated with depression. Moreover, increased religious coping was significantly associated with the likelihood of reduced hazardous alcohol use and illicit drug use. This research was supported by a Veterans Affairs Health Services Research and Development Nursing Research Initiative Grant (#98‐182) and by a Veterans Affairs Health Services Research and Development Research Career Development Award (#99011).

Exploring the post-deployment reintegration experiences of veterans with PTSD and their significant others.

Veterans with family support have better functional recovery and reintegration outcomes. However, families’ ability to support the veteran with PTSD’s rehabilitation and reintegration oftentimes is hindered by interpersonal challenges. We report findings of a qualitative study that examined OEF/OIF veterans with PTSD/TBI and their significant others’ (SOs’) perceptions of family functioning. We conducted 24 in-depth interviews with 12 veteran/SO dyads using an adapted version of the Family Assessment Device Structured Interview. Descriptive qualitative analytic methods were used to analyze the data. Data show that the impact of deployment and the resulting changes in the individuals and the family dynamics lingered years after the veterans returned home and had a lasting influence on veterans’ and SOs’ perceptions of family functioning. Most couples acknowledged growth in their relationships several years postdeployment. However, many continued to struggle with disruptions generated by deployment. Four themes emerged from the data: individual changes, coping strategies, relationship changes, and a “new normal.” Postdeployment family functioning was influenced by a dynamic interplay of individual and relationship factors and the development of coping strategies and a new normal. This study contributes to the understanding of the prolonged postdeployment family reintegration experiences of veterans and their SOs. Findings underscore the importance of continuing to advance the current knowledge base about the long-term impact of deployment on veterans and their families, especially factors that contribute to positive postdeployment family functioning. Additional empirical studies are needed to provide more in-depth understanding of the long-term postdeployment reintegration experiences of veterans and their families.