Joan G. Turner

Relationships Between Perception of Engagement with Health Care Provider and Demographic Characteristics, Health Status, and Adherence to Therapeutic Regimen in Persons with HIV/AIDS

The purpose of this descriptive, correlational study was to examine the relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. The convenience sample of 707 non-hospitalized persons receiving health care for HIV/AIDS was recruited from seven U.S. sites. All measures were self-report. Perception of engagement with health care provider was measured by the newly developed Engagement with Health Care Provider scale. Adherence to therapeutic regimen included adherence to medications, provider advice, and appointments. Health status was measured by the Medical Outcomes Study Short Form 36 (MOS SF-36), Living with HIV scale, CD4 count, and length of time known to be HIV-positive. There were no significant relationships between engagement with health care provider and age, gender, ethnicity, and type of health care provider. Subscales of the MOS SF-36 and Living with HIV explained a significant, but modest amount of the variance in engagement. Clients who were more engaged with their health care provider reported greater adherence to medication regimen and provider advice. Clients who missed at least one appointment in the last month or who reported current or past injection drug use were significantly less engaged.

Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection.

Because effects of cigarette smoking on health-related quality of life (HRQL) have not been well described, we carried out a cross-sectional assessment of HRQL using the Medical Outcomes Survey Scale adapted for patients with human immunodeficiency virus (MOS-HIV questionnaire) in 585 HIV-infected homosexual/bisexual men, injection drug users, and female partners enrolled in a multicenter, prospective study of the pulmonary complications of HIV infection. Mean scores for the following dimensions of HRQL were calculated: general health perception, quality of life, physical functioning, bodily pain, social functioning, role functioning, energy, cognitive functioning, and depression. A multivariate model was used to determine the impact on HRQL of the following factors: smoking, CD4 loss, acquired immune deficiency syndrome (AIDS) diagnoses, number of symptoms, study site, education, injection drug use, gender, and age. Current smoking was independently associated with lower scores for general health perception, physical functioning, bodily pain, energy, role functioning, and cognitive functioning (all with p < 0.05). We conclude that patients with HIV infection who smoke have poorer HRQL than nonsmokers. These results support the use of smoking cessation strategies for HIV-infected persons who smoke cigarettes.

Health-Related Quality of Life in Persons Younger and Older than 50 Who are Living with HIV/AIDS

Mortality rates are higher in older persons with AIDS. The Wilson and Cleary health-related quality-of-life model was used to explore whether there were differences on health-related quality-of-life variables between persons aged 50 or older (n = 73) and younger persons (n = 640) in a national sample. Depending on the level of the data, either independent t tests or chi-squares were calculated. Older participants reported significantly more medical conditions such as diabetes or hypertension (p = .000), more limitations in physical functioning (p = .006), and self-disclosure of HIV infection to fewer people (p = .000). There were no significant differences on any of the other variables. There are relatively few differences in older as compared to younger persons living with HIV/AIDS, yet mortality rates are higher in older samples. The relationship between the areas where there are differences and whether they affect morbidity and mortality need further exploration.

Predictors of Perception of Cognitive Functioning in HIV/AIDS

This is a descriptive, correlational study of the predictors of perceived cognitive functioning. The convenience sample of 728 nonhospitalized persons receiving health care for HIV/AIDS was recruited from seven sites in the United States. All measures were self-reported. Self-perception of cognitive functioning, the dependent variable, was composed of three items from the Medical Outcomes Study HIV scale: thinking, attention, and forgetfulness. Data related to age, gender, ethnicity, education, injection drug use, CD4 count, and length of time known to be HIV-positive were collected on a demographic questionnaire. The scale from the Sign and Symptom Checklist for Persons with HIV Disease was used to measure self-reported symptoms. Data were analyzed using hierarchical multiple regression analysis. Predictors of perception of cognitive functioning explained a total of 36.3% of the variance. Four blocks--person variables (1.5%) (age, gender, education, history of injection drug use), disease status (2.3%), symptom status (26.5%), and functional status (5.4%)--significantly contributed statistically to the total variance. Among those individuals who completed the questions related to depression (n = 450), 28% of the variance in cognitive functioning was explained by this variable. The findings in this multi-site study indicate that symptom status explained the largest amount of variance in perceived cognitive functioning. Early identification of cognitive impairment can result in appropriate clinical interventions in remediable conditions and in the improvement of quality of life.

Job analysis 1996 : Infection control professional

Abstract The Certification Board in Infection Control and Epidemiology, Inc, directed its Test and Administrative Subcommittees to compose a Job Analysis Committee in 1995. This 16-member Job Analysis Committee, in collaboration with Applied Measurement Professionals, Inc, conducted a job analysis survey of infection control professionals in the United States and Canada during 1996. The reassessment of the previous Certification Board in Infection Control and Epidemiology, Inc, task analysis, formation of a job-analysis survey tool, the actual job-analysis process, and its results are described in this article. The previous and newly revised test specification outlines are compared. The Revised Certification Examination for Infection Control offered beginning in 1997 will reflect the efforts of this endeavor. (AJIC Am J Infect Control 1999;27:145-57)

Stages of Change and Condom Use among an Internet Sample of Gay and Bisexual Men

The purpose of this descriptive correlational study using the transtheoretical model was to determine the relationship between stages of change and condom use among gay and bisexual men with primary (steady) and casual (occasional) partners. A convenience sample of 241 gay and bisexual men was recruited from the Internet. The majority of men (n = 198, 82%) never used condoms during anal, vaginal, or oral intercourse with primary partners, indicating they were in the first of five stages of change (precontemplation). Thirty percent (n = 71) of men reported using condoms every time during anal intercourse with casual partners and were in the last stage of change (maintenance). Multiple regression analysis revealed that older bisexual men who informed partners of their HIV status and who were confident and perceived more advantages in using condoms were in higher stages of change. By placing participants into various stages of change, stage specific interventions can be designed.

Pros and Cons of Condom Use Among Gay and Bisexual Men as Explored Via the Internet

The purpose of this study was to conduct a survey utilizing Internet technology related to gay and bisexual mens condom use behavior as an expression of safer sexual practices. A total of 241 self-identified gay and bisexual men responded to the questionnaire in a 3-month period of time. Confidentiality was assured by utilizing an electronic system whereby the respondents e-mail address was eliminated. The study was conceptually guided by the use of the Transtheoretical Model of Behavioral Change (TMC) and the pros and cons of condom of use were explored. Fifty-six percent of the participants reported that one advantage (pro) of using condoms with casual partners was that it would make them safer from disease. About half of the respondents (n = 119, 49%) reported a history of one or more sexually transmitted diseases. There were 14 variables found to be significantly associated with using a condom with primary and casual partners among gay and bisexual men. Essentially, findings from this study corresponded to results obtained by more traditional data collection methods. Therefore, the authors conclude that electronic data collection may well be an alternative means for collecting sensitive data such as those collected in this study. Many studies have been designed and conducted worldwide to educate high-risk group.

Anti-HIV antibody testing: Procedures and precautions

Prudent use of screening tests for infection with human immunodeficiency virus (HIV) and interpretation of test results require an understanding of the bodys immune response to HIV infection, the serologic assays currently available, and the problems associated with false-positive and false-negative test results. The methodologies of the enzyme immunoassay (enzyme-linked immunosorbent assay [ELISA]) and the Western blot assay are presented, and efficacies of these tests are evaluated. Tests for the detection of anti-HIV antibodies that are, at this time, primarily restricted to research use but that show promise for adaptation to screening (such as the ELISA with recombinant antigen) also are discussed, as is the alternative of testing for HIV antigens or HIV-specific DNA. From a personal perspective, any test for HIV infection is accompanied by certain benefits and risks. These can be discussed with the patient in the framework of pretest and posttest counseling.

The AIDS epidemic: risk containment for home health care providers.

This article deals with issues of risk containment related to the communicability of AIDS. THe US Centers for Disease Control (CDC) defines AIDS as a syndrome moderately indicative of a defect in cell-mediated immunity leaving affected individuals vulnerable to overwhelming infections and unusual and lethal neoplasms. By March of 1985 the CDC reported 8400 confirmed cases; homosexual or bisexual men accounted for just over 73% of the cases IV drug users for about 17% Haitians for less than 3% and hemophiliacs heterosexual contacts and transfusion recipients combined for less than 3%. A major breakthrough in AIDS research came in 1984 when a retrovirus human T-lymphotrophic virus 3 (HTLV-3) was implicated as the etiologic agent of AIDS. Although this has made it possible to serologically test for specific antiboby formation the sensitivity and specificity of these tests is unknown. HTLV-3 has been isolated from the blood semen and saliva of antiboby-positive persons. Cumulative epidemiologic data suggest that the virus has been transmitted via intimate contact sharing of contaminated needles transfusion of whole blood or blood cellular components and from infected mothers to children before during or just after the time of birth. The extent of the role played by saliva as a transmission modality for AIDS is uncertain. However of all 3 body fluids blood probably poses the greatest hazard to health care professionals. In 1982 the CDC published guidelines for personnel providing direct care for or handling specimens from persons with known or suspected AIDS. These precautions are clearly similar to those for hepatitis B and are designed to minimize the risk of mucosal or parenteral exposure to potentially infective materials. An important component of anticipatory guidance that will also serve to contain infection is client education. The recommendations given were developed to promote the clients ability to move about independently while taking responsible measures to avoid inadvertently infecting others. Finally an additional area of concern is the psychosocial issues associated with the disease.