Mental health pathways from interpersonal violence to health-related outcomes in HlV-Positive sexual minorify men

Objective: We examined mental health pathways between interpersonal violence (IPV) and healthrelated outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N ϭ 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban setting. Participants (M age ϭ 44.1 years, 36% non-White) filled out a computer-assisted survey and had health-related data extracted from their electronic medical records. We used structural equation modeling to test associations among the latent factors of adult abuse and partner violence (each comprising indicators of physical, sexual, and psychological abuse) and the measured variables: viral load, health-related quality of life (HRQOL), HIV medication adherence, and emergency room (ER) visits. Mediation was tested for the latent construct mental health problems, comprising depression, anxiety, symptomatology of posttraumatic stress disorder, and suicidal ideation. Results: The final model demonstrated acceptable fit, 2 (123) ϭ 157.05, p ϭ .02, CFI ϭ .95, TLI ϭ .94, RMSEA ϭ .04, SRMR ϭ .06, accounting for significant portions of the variance in viral load (13%), HRQOL (41%), adherence (7%), and ER visits (9%), as well as the latent variable mental health problems (24%). Only 1 direct link emerged: a positive association between adult abuse and ER visits. Conclusions: Findings indicate a significant role of IPV and mental health problems in the health of people living with HIV/AIDS. HIV care providers should assess for IPV history and mental health problems in all patients and refer for evidence-based psychosocial treatments that include a focus on health behaviors

Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.[EN] Background: The objective of the study is to estimate the frequency of multimorbidity in type 2 diabetes patients classified by health statuses in a European region and to determine the impact on pharmaceutical expenditure. Methods: Cross-sectional study of the inhabitants of a southeastern European region with a population of 5,150,054, using data extracted from Electronic Health Records for 2012. 491,854 diabetic individuals were identified and selected through clinical codes, Clinical Risk Groups and diabetes treatment and/or blood glucose reagent strips. Patients with type 1 diabetes and gestational diabetes were excluded. All measurements were obtained at individual level. The prevalence of common chronic diseases and co-occurrence of diseases was established using factorial analysis. Results: The estimated prevalence of diabetes was 9.6 %, with nearly 70 % of diabetic patients suffering from more than two comorbidities. The most frequent of these was hypertension, which for the groups of patients in Clinical Risk Groups (CRG) 6 and 7 was 84.3 % and 97.1 % respectively. Regarding age, elderly patients have more probability of suffering complications than younger people. Moreover, women suffer complications more frequently than men, except for retinopathy, which is more common in males. The highest use of insulins, oral antidiabetics (OAD) and combinations was found in diabetic patients who also suffered cardiovascular disease and neoplasms. The average cost for insulin was 153€ and that of OADs 306€. Regarding total pharmaceutical cost, the greatest consumers were patients with comorbidities of respiratory illness and neoplasms, with respective average costs of 2,034.2€ and 1,886.9€. Conclusions: Diabetes is characterized by the co-occurrence of other diseases, which has implications for disease management and leads to a considerable increase in consumption of medicines for this pathology and, as such, pharmaceutical expenditure.This study was financed by a grant from the Fondo de Investigaciones de la Seguridad Social Instituto de Salud Carlos III, the Spanish Ministry of Health (FIS PI12/0037).Sancho Mestre, C.; Vivas Consuelo, DJJ.; Alvis, L.; Romero, M.; Usó Talamantes, R.; Caballer Tarazona, V. (2016). Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data. BMC Health Services Research. 16(394):1-8. https://doi.org/10.1186/s12913-016-1649-2S1816394Whiting DR, Guariguata L, Weil C, Shaw J. 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Multimorbidity in a cohort of patients with type 2 diabetes. Eur J Gen Pract. 2013;19:17–22. Available from: http://informahealthcare.com/doi/abs/10.3109/13814788.2012.714768 , http://www.ncbi.nlm.nih.gov/pubmed/23432037Hughes JS, Averill RF, Eisenhandler J, Goldfield NI, Muldoon J, Neff JM, et al. Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care management. Med Care. 2004;42:81–90. [cited 2016 Feb 29]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14713742Vivas-Consuelo D, Alvis-Estrada L, Uso-Talamantes R, Caballer-Tarazona V, Buigues-Pastor L, Sancho-Mestre C. Multimorbidity Pharmaceutical Cost of Diabetes Mellitus. Value in Health. 2014;17:A341–2. Elsevier [cited 2016 Apr 21]. Available from: http://www.sciencedirect.com/science/article/pii/S1098301514026102Inoriza JM, Pérez M, Cols M, Sánchez I, Carreras M. 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A mixed methods approach to investigate partner violence in HIV-positive outpatients

Thesis (Ph. D.)--University of Washington, 2007.Individuals with HIV face a variety of long-term physical and mental health issues related to their HIV disease, including indefinite andretroviral treatment with numerous side effects, the stigma around HIV status disclosure, and high rates of anxiety and depression. Affecting up to 67% of HIV-infected outpatients in recent studies, partner violence (PV) may be a significant barrier to achieving optimal health for this population, given the overlapping risk factors for the two phenomena, including elevated rates of poverty and drug use. With high prevalence and well-documented decrements in physical and mental health as consequences in HIV-negative samples, it is possible that PV exacerbates potentially negative health outcomes in HIV-positive individuals because of their increased psychological and immunological vulnerability. The present inquiry attempts to increase understanding of the overlapping epidemics of PV and HIV through a mixed methods approach. Qualitative methods were employed to elucidate further key aspects of PV as they intersect in the lives of HIV-positive individuals receiving outpatient medical care. Results of the qualitative study informed the development and refinement of the survey study to follow, a cross-sectional study conducted on a demographically similar sample of HIV-positive outpatients. This dissertation reports the results of this inquiry in the following three chapters: (a) a comprehensive literature review of U.S.-based studies of PV among HIV-positive individuals through February January 2007; (b) a qualitative study (N=28) detailing the lived experience of HIV-positive men who have sex with men who experienced PV; and (c) a survey study measuring the prevalence of physical, sexual, and psychological PV. Further, data from the survey study were used to test a theoretical model that hypothesizes mental health as a mediator between interpersonal violence experienced and physical health and functioning

Social Anxiety and Barriers to Resilience Among Lesbian, Gay, and Bisexual Adolescents

This chapter describes analyses that examine a potential pathway toward depression and suicidality in lesbian, gay, and bisexual (LGB) youths. First, we review a previous study by our team (Safren & Heimberg, 1999) providing evidence that differences between LGB adolescents and their heterosexual peers in depression and suicidality could be accounted for by risk and protective factors: stress, engagement in positive events, social support, and coping. Second, to examine a potential barrier to some of the protective factors (positive events and social support), we present additional, previously unpublished analyses of social anxiety in this sample. We reasoned that social anxiety may be a barrier to obtaining social support as well as to engaging in positive events for the following reasons. Sexual-minority youths typically experience adolescent development with various social pressures, including pressures to conform to heterosexual social and dating behaviors and experiences and thus to hide their sexual orientation from others. Fear and avoidance of social interactions (social anxiety) can inhibit the ability to attain satisfactory social support from peers and engage in positive, competence-building activities. (PsycINFO Database Record (c) 2009 APA, all rights reserved

The Impact of Pre-Exposure Prophylaxis on Sexual Communication and Sexual Behavior of Urban Gay and Bisexual Men

Pre-exposure prophylaxis (PrEP) has altered the public health landscape for gay, bisexual, and other men who have sex with men (GBM) by significantly increasing protection against HIV infection. Early epidemiologic data showed GBM generally used PrEP as prescribed, i.e., as an additional protective tool over and above barrier protection, although subsequent reports have been equivocal. Irrespective of population-level trends, some GBM appear to have reevaluated their HIV risk tolerance and changed their interactions with sex partners. Scant published data have focused on factors that influence PrEP-using GBM's decisions about sexual behavior-including condom use as well as sex with HIV-positive partners-and sexual communication practices. Thus, in this study, we investigated those research concerns qualitatively via content analysis of individual interviews conducted with 103 GBM in New York City (M age 32.5 years, 50% White, 64% on PrEP > 6 months). Emergent themes reflect (1) participants' strong HIV knowledge; (2) changing GBM community norms about condom use on PrEP; (3) increased focus on risk tolerance with individual differences in post-PrEP condom use; (4) appreciation for routine sexually transmitted infection (STI) screening in PrEP care concomitant with some STI knowledge deficits; (5) decreased stigma concerning, and greater comfort with, HIV-positive sex partners; and (6) increased confidence discussing HIV status and condom use preferences with partners. Findings have implications for future research as well as for clinical practice, such as enhanced STI education and provider-initiated discussions about risk compensation, serosorting, and sexual communication skills