Gwen van Servellen

Building culturally sensitive substance use prevention and treatment programs for transgendered populations

Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.

Selection of family members for communication of cancer risk and barriers to this communication before and after genetic cancer risk assessment

Purpose: The impact of genetic cancer risk assessment on communication of cancer risk information within families is not fully known. We compared womens selection of family members for cancer risk communication and perceived barriers to this communication before genetic cancer risk assessment and 6 months afterward.Methods: Mailed surveys were used to collect prospective data from consenting women undergoing genetic cancer risk assessment because of a personal and/or family history of breast or ovarian cancers. Analysis included descriptive statistics, chi-square and McNemar tests, and paired t tests.Results: A total of 122 women met the study criteria. Although risk communications increased with first-degree relatives (84%–90% for females; 53%–62% for males) and decreased with non–first-degree relatives (21%–9%) before and after genetic cancer risk assessment, the degree of change was nonsignificant. The most commonly cited communication barrier was loss of contact (30%). Demographics, personal or family cancer history, and BRCA status did not significantly influence findings.Conclusions: There was a high degree of cancer risk communications with female first-degree relatives, but less so with male first-degree relatives, both before and after genetic cancer risk assessment. For the majority of women, interpersonal barriers did not preclude risk discussions. Further research is needed to identify how best to facilitate risk communication.

Burn-out in hospital nurses: a comparison of acquired immunodeficiency syndrome, oncology, general medical, and intensive care unit nurse samples

Previous research has shown that job-related stress and burn-out are associated with high levels of demand placed on the worker, especially in situations where influence is low. This study examined burn-out among nurses working on acquired immunodeficiency syndrome (AIDS) special care units (SCUs), oncology SCUs, medical intensive care units (ICUs) and general medical units to measure the extent to which delivery method (SCU, ICU, and general unit), patient diagnosis, or other key personal and work-related characteristics were associated with the level of distress in these nurses. A sample of 237 nurses from 18 units in seven hospitals were surveyed using the Maslach Burnout Inventory. This study showed no significant differences in burn-out scores across nurse samples representing variations in patient diagnosis and delivery method. Specifically, nurses on AIDS SCUs, oncology SCUs, medical ICUs, and general medical nursing units reported similar levels of distress on the burn-out subscales. There was one exception: medical ICU nurses scored significantly lower on the Personal Accomplishment subscale (P < .001). Regression analyses for the Emotional Exhaustion and Personal Accomplishment subscales indicated that greater job influence had a significant protective effect on emotional exhaustion and enhanced personal accomplishment (P < .05). As expected, job tension was a key predictor of exhaustion (P < .001), and being white was associated with greater feelings of accomplishment (P < .002). Working in a medical ICU continued to show a negative impact on accomplishment when race and other important covariates were controlled for (P < .05), and working on an AIDS SCU was predictive of exhaustion in a multivariate context (P < .05).

Supportive relationships and medication adherence in HIV-infected, low-income Latinos.

Inadequate social support and poor communications with health care providers can affect adherence to antiretroviral therapy. The magnitude of independent effects of these factors on adherence is not fully known. This study examined the relationship of perceived emotional or informational social support from family and friends, quality of physician-patient communications and relationships, and medication adherence in a sample of low-income, Spanishspeaking, HIV-positive Latino men and women receiving treatment in community-based clinics (n = 85). Results of the study indicated that, whereas emotional or informational support was significantly associated with level of dose adherence (OR, 1.04, 95% CI, 1.01-1.08;p = .03), quality of physician-patient communications or relationships was significantly associated with adherence to medication schedule,t(6, 71) = 4.45,p < .001. Quality of patient-physician relationship accounted for 22% of the variance in adherence to medication schedule. Both kinds of support were associated with better adherence in this population but may affect adherence behaviors in different ways.

Women with HIV: Living with Symptoms

This exploratory study used a semistructured interview to describe womens experiences coping with HIVsymptoms, their descriptors of their worst and best days, and their attempts to control symptoms. A convenience sample of44 women, largely women of color, of lower socioeconomic status, unemployed, seeking treatment in one of six outpatient clinics in Los Angeles, were interviewed. Fatigue, the most frequently reported worst symptom, was present in 98% of these women. Feeling physicallysick and having negative mood were mentioned most often in descriptions of worst days; being active, feeling physically healthy, and having positive mood were descriptors of best days. Of the total, 59% used rest/sleep to control symptoms, and this often was used in conjunction with healthy diet. The results of this study reveal aspects ofwomens day-to-day experiences with HIV-related symptoms.

Emotional distress in men with life-threatening illness

This descriptive survey explored the relationship of health status, functional status, stressful life events, stress resistance resources and emotional distress in 60 men with life-threatening illness (N = 30 with cancer and N = 30 with AIDS). Sixty-two percent met CES-D criteria for clinical depression. This studys results supported the hypotheses that poorer functional status and greater negative stressors are associated with both higher levels of hopelessness and depression. Twenty-four patients constituted a group with severe emotional distress. This group was significantly different from the less vulnerable group with poorer functional status (KPS), a greater number and severity of negative stressors, less satisfaction with social support, and less hopefulness.

Differential predictors of emotional distress in HIV-infected men and women.

Changes in the AIDS epidemic in many areas of the United States require information about the experience of the growing segment of women afflicted. This study compared patterns of emotional distress between men and women with symptomatic HIV and examined potential predictors of different levels of vulnerability. A sample of 126 low socioeconomic men and women seeking care from HIV treatment centers was surveyed using measures of physical and psychological well-being. Women had more HIV symptoms, poorer functioning, and greater disruptions in physical and psychosocial well-being. Physical health status and optimism were primary predictors of emotional distress in both men and women. More than 50% of men and women had scores indicative of clinical anxiety. Approximately 1 out of 10 had clinically relevant scores for depression. Gender differences may provide potentially useful information for tailoring assessment interventions for emotional distress in people infected with HIV.

Personality Hardiness, Work-Related Stress, and Health in Hospital Nurses

Personality hardiness is a set of beliefs about oneself and the world one lives in. Hardier persons take control of their lives, believe that commitment to goals will result in positive outcomes, and perceive daily stressors as challenges. Hardiness has been linked with less stress and fewer health problems among various occupational groups. This study found that among 237 hospital nurses, work-related stress and emotional exhaustion were associated with greater health problems in the form of anxiety, depression, and somatic complaints. Hardier nurses reported less work-related stress, less emotional exhaustion, and less anxiety, depression, and somatization. This article discusses considerations for strengthening future studies concerned with the relationships between personality hardiness, work-related stress, and health in nurses.

Acculturation, socioeconomic vulnerability, and quality of life in Spanish-speaking and bilingual latino HIV-infected men and women.

Little is known about the health-related QOL (HRQOL) of low-income, Latino men and women living with HIV. Monolingual Spanish-speaking Latino individuals may be at greater risk than bilingual men and women for poor HRQOL due to problems associated with language and cultural barriers. This study examined the health status and HRQOL of these two groups of clinic patients. The monolingual group had significantly lower levels of acculturation but did not differ from the bilingual group on any dimension of health status. This group also reported more disruptions on several dimensions of HRQOL. In a multivariate context, health status variables (as a block) accounted for the greatest proportion of variance in all three measures of HRQOL. The results did not support the hypothesis that acculturation mediates the impact of health status on HRQOL. More studies are needed to examine the impact of acculturation and socioeconomic vulnerability on health outcomes.

Comparison of Latina and non-Latina white women's beliefs about communicating genetic cancer risk to relatives.

Breast cancer accounts for 30% of cancer among Latinas, and ovarian cancer is more common in Latinas than in non-Latina Whites. Latinas with a personal or family history of these cancers are increasingly referred for genetic cancer risk assessment (GCRA), but little is known about their perspectives regarding informing relatives of genetic cancer risk. We described and compared the pre-GCRA beliefs about informing relatives of genetic cancer risk, using survey data previously collected within a larger study. The sample included 475 Latina (N = 183; 39%) and non-Latina (N = 292; 61%) White women with a personal or family history of breast or ovarian cancers. Data analysis used descriptive statistics, chi-square and Wilcoxon rank-sum tests, and logistic regression. Findings revealed that most women believed their relatives should be informed of genetic cancer risk (92%), that informing was strictly a personal duty (88%), and that informing should be done only in person (60%). Multiple logistic regression demonstrated that education (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.15–5.66), Latina ethnicity (odds ratio [OR] 0.22, 95% CI, 0.09–0.53), and Spanish as primary language (OR, 0.17, 95% CI, 0.06–0.47) were independently associated with the belief that a clinician should be the informant.