Nancy Shehadeh

HIV Vaccine: Recent Advances, Current Roadblocks, and Future Directions

HIV/AIDS is a leading cause of mortality and morbidity worldwide. In spite of successful interventions and treatment protocols, an HIV vaccine would be the ultimate prevention and control strategy. Ever since identification of HIV/AIDS, there have been meticulous efforts for vaccine development. The specific aim of this paper is to review recent vaccine efficacy trials and associated advancements and discuss the current challenges and future directions. Recombinant DNA technologies greatly facilitated development of many viral products which were later incorporated into vectors for effective vaccines. Over the years, a number of scientific approaches have gained popularity and include the induction of neutralizing antibodies in late 1980s, induction of CD8 T cell in early 1990s, and combination approaches currently. Scientists have hypothesized that stimulation of right sequences of somatic hypermutations could induce broadly reactive neutralizing antibodies (bnAbs) capable of effective neutralization and viral elimination. Studies have shown that a number of host and viral factors affect these processes. Similarly, eliciting specific CD8 T cells immune responses through DNA vaccines hold future promises. In summary, future studies should focus on the continuous fight between host immune responses and ever-evasive viral factors for effective vaccines.

Selenium and vitamin E for prostate cancer--justifications for the SELECT study.

There are several studies that relate oxidative damage as possible mechanism for many cancers. Many studies have also shown that anti-oxidants like selenium and vitamin E decrease the risk for prostate cancer. The main objective of the Selenium and Vitamin E Cancer Prevention Trial (SELECT) study was to look for the benefits of selenium and vitamin E supplementation on prostate cancer. The study had a large sample size, stringent experimental conditions, very long duration, standardized laboratories for biochemical analyses and other factors that contribute to high external validity. The SELECT study failed to show any significant risk reduction for prostate cancers ascribable to selenium and vitamin E supplementations. Because of these conflicting results, many researchers argue about the methods used, supplementations administered (selenium and vitamin E) and indicators used for assessing levels of supplementations. We reviewed many epidemiological studies, clinical trials, and pre-clinical studies. With corroborative evidences we justify that SELECT study has a sound methodology and rationale. In lieu of the contrary results of the select study, researchers should focus on the probable mechanisms for these contrary findings and continue their search for newer and effective agents for prevention of prostate cancer.

Proficiency in Condom Use Among Migrant Workers

&NA; Consistent and correct use of condoms is important to prevent the transmission of HIV and other sexually transmitted diseases. We evaluated condom use skills on an 11‐point scale in which participants were observed placing a condom on a penile model. Participants were 375 sexually active African American and Hispanic migrant workers. For analysis, subjects were divided into skilled and unskilled groups by a median split of the condom use skills score. Sexual risk behaviors were analyzed between condom use skilled and unskilled groups and level of condom use skills between African Americans and Hispanics. African Americans showed better skills in using condoms, and participants in the condom‐use skilled group used condoms more frequently. Finally, a logistic regression was conducted to find predictors of condom use skills. Significant predictors were ethnicity, language, and assistance‐related social support (obtaining advice from people who could provide tangible assistance).

Health promotion and disease prevention strategies for today's physicians.

Abstract:The majority of preventable diseases in both developed and developing countries could be strategically controlled by effectively implementing existing health promotion and disease prevention (HPDP) interventions. An important juncture for the implementation of risk-reduction strategies is the point of interaction between health care providers and patients during their scheduled visits. This article targets strategies for physicians to effectively implement HPDP interventions in a clinical setting. The factors that improve delivery of HPDP interventions are discussed briefly. We subsequently introduce and discuss the conceptual framework for enhanced patient education, which is based on the information-motivation-behavioral skills model and the health belief model. The article also describes an adapted patient-practitioner collaborative model for HPDP. This adapted model may serve as a blueprint for physicians to effectively execute HPDP interventions during clinical encounters. The recommended models and our conceptual frameworks could have limitations which need to be field tested.

A review of 5-HT transporter linked promoter region (5-HTTLPR) polymorphism and associations with alcohol use problems and sexual risk behaviors.

Alcohol use and sexual risk behaviors are multidimensional phenomena involving many genetic and environmental factors. 5-HT transporter linked promoter region (5-HTTLPR) polymorphism constitutes an important factor affecting alcohol use problems and risky sexual behaviors. This paper narratively reviews studies on 5-HTTLPR polymorphism and its associations with alcohol use problems and sexual risk behaviors. We searched the electronic databases, PubMed, Ovid, and Google Scholar for articles using MeSH terms. Relevant articles were reviewed and eligible articles were selected for the study. Many studies have reported a significant but moderate association between 5-HTTLPR polymorphism and alcohol use problems. These studies have implicated the presence of at least one S allele to be associated with significant increases in alcohol use problems. Similarly, some studies associate the S allele with increased sexual risk behaviors. Effective alcohol cessation initiatives and STI/HIV prevention programs should be modified to account for 5-HTTLPR polymorphism before planning interventions; genetic effects could moderate the intervention effect.

Risky sexual behaviors: The role of ethnic identity in HIV risk in migrant workers.

&NA; Migrant workers have been shown to be at a heightened level of risk for HIV, and ethnic identity has been posited to have an impact on engagement in risky sexual behaviors. Our longitudinal study examined associations between baseline and short‐term changes in ethnic identity and high‐risk sexual behaviors. Baseline (n = 431) and 6‐month assessment (n = 270) data were obtained from a larger HIV prevention study conducted among African American and Hispanic migrant workers. Repeated‐measures multivariate analysis of covariance and multiple linear regressions were used. Ethnic identity explore, a subscale of ethnic identity, was a significant predictor of overall sexual risk [F(8, 422) = 6.953, p < .001] and unprotected vaginal acts [F(8, 422) = 8.444, p < .001] at baseline. However, ethnic identity had no bearing on changes in risky sexual behaviors. Ethnic identity explore was associated with safer sexual behaviors.

Gun Violence in United States: In Search for a Solution

From the public health perspective, the issue of gun violence could be evaluated based on the theoretical framework of social ecological model (SEM) by the Center for Disease Control and Prevention (CDC). The SEM uses four levels of influence to describe a framework that identifies factors that either places a person at-risk for or guards them from being subjected to or causing a health problem such as violence. The levels of influence in the SEM structure include the individual or intrapersonal, relationships or interpersonal, community, and society (see Figure A1 in Appendix). Each level represents a key point in the process of violence, and thereby, offers an opportunity to intervene in violence for prevention. The framework also provides a tool to use in evaluation of public health issues of firearm violence. Controlling gun violence is a complex and formidable task. It is well established that multi-level approach is needed to end gun violence. We provided some suggestions for policymakers and practitioners based on the SEM. The association between violence and the interaction between different factors, from individual to societal, suggest that addressing risk factors or devising prevention plans across various levels of the SEM may lead to decrease in incidences like Sandy Hook massacre and Navy Yard shooting. However, we acknowledge that implementing all these suggestions at a time is practically impossible. Since we don’t have a false proof mechanism to identify and intervene with people who might be potential culprits, the initial step should be to prevent the weapons getting into the hands of these people. This initial steps could be achieved by changing the social norms on guns and implementing some immediately workable policies. As the norm on the propriety of driving has changed over time, there is no reason to believe that norms about guns will not change. One such norm should be keeping the guns in safe and secure places as many perpetrators used guns which were stolen. Some of the policy changes we recommend are stricter provisions in obtaining gun license and its periodic renewal. In addition, people should undergo rigorous background checks and extensive gun safety trainings before obtaining gun. However, the challenges remain and require long term solutions. - See more at: http://journal.frontiersin.org/Journal/10.3389/fpubh.2014.00017/full#sthash.MAIQSRJD.dpuf Language: en

Newcomer Status as a Protective Factor among Hispanic Migrant Workers for HIV Risk

The HIV rate among U.S. migrant workers is 10 times that of the national rate. The highly unstable lifestyle of migrant workers places them at heightened vulnerability to sexually transmitted infections; hence, there is a need to investigate the attitudes and sexual risk factors that may play a protective role in the transmission of HIV in this population. This study examines the association between attitudes and HIV risk behaviors among Hispanic male and female migrant workers (n = 255) and their length of stay (shorter length of stay as a protective factor) in Immokalee, FL, USA. Pearson’s correlation and regression analyses were utilized to analyze the relationship between HIV risk behaviors (intention to use condoms and alcohol use) with length of stay in Immokalee. Longer length of stay positively correlated with number of drinks (p < 0.05) and frequency of drinks (p < 0.01) and negatively correlated with ethnic identity search (p < 0.05). Regression analysis showed that length of stay predicted both behavioral intention to use condoms (p < 0.05) and alcohol consumption (p < 0.05). The findings suggest that migrant workers who are new to Immokalee may have a higher likelihood of practicing protective HIV risk behaviors and having more favorable attitudes toward risk reduction than long-timers. This study might provide important new evidence on the drivers of multiple concurrent and potential protective factors against risky sexual behaviors among Hispanic migrant workers.

HIV-Related Stigma, Quality of Care, and Coping Skills: Exploring Factors Affecting Treatment Adherence among PLWH in Haiti

&NA; Stigma is a primary barrier to care and support for people living with HIV (PLWH). We explored relationships between HIV‐related stigma and treatment adherence and the effects of psychological and structural factors on these relationships. HIV treatment adherence, stigma, and coping strategies were measured with questionnaires. Participants included 285 PLWH in Haiti. Multivariable linear regression was used to estimate predictors of treatment adherence. Structural equation modeling was used to determine whether relationships between stigma and treatment adherence variables were mediated by coping variables. Mean adherence was 93.1%; 72.3% of participants reported ≥ 95% adherence. Perceived stigma and quality‐of‐care satisfaction scores significantly predicted treatment adherence. Maladaptive coping did not act as a mediator between perceived stigma and treatment adherence, which could be due to stronger effects of perceived stigma on treatment adherence. Our study may help to improve treatment adherence and the care and quality of life for PLWH.