Public Health Nursing Case Management for Women Receiving Temporary Assistance for Needy Families: A Randomized Controlled Trial Using Community-Based Participatory Research

Objectives. We evaluated the effectiveness of a community-based participatory research–grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. Methods. We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months. Results. Medicaid knowledge and skills improved (P<.001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR]=1.92; P=.007), and this likelihood increased in higher-risk subgroups (OR=2.03 and 2.83; P=.04 and .006, respectively). Depression and functional status improved in the intervention group over time (P=.016 for both). No differences were found in routine or preventive care, or general health. Conclusions. Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population

Depressive symptoms and cortisol variability prior to surgery for suspected endometrial cancer

Endometrial cancer (EC) is the most common type of gynecologic cancer affecting women; however, very little research has examined relationships between psychological factors and hypothalamic-pituitary-adrenal (HPA) axis dysregulation in this population. The current study examined relations between depressive/anxious symptoms and salivary cortisol diurnal rhythm and variability in women undergoing surgery for suspected endometrial cancer. Depressive and anxious symptoms were measured prior to surgery using the Structured Interview Guide for the Hamilton Depression Inventory (SIGH-AD). Saliva was collected four times a day for the three days prior to surgery and then assayed by ELISA to obtain cortisol concentrations. Cortisol slopes and intraindividual variability were then calculated across subjects. Relations between depressive/anxious symptoms and cortisol indices were examined using multilevel modeling and linear regression analyses. Participants were 82 women with nonmetastatic endometrial cancer. Anxious symptoms were not associated with either cortisol slope or intraindividual variability, and depressive symptoms were unrelated to cortisol slope. However, after controlling for presence of poorer prognosis cancer subtypes, greater depressive symptoms (excluding symptoms possibly/definitely due to health/treatment factors) in the week preceding surgery were significantly related to greater cortisol intraindividual variability (β=.214; p<.05). These results suggest that depressive symptoms prior to surgery for suspected endometrial cancer are related to greater cortisol intraindividual variability, which is suggestive of more erratic HPA axis arousal. Future research should examine whether mood symptoms may be associated with compromised health outcomes via erratic HPA axis arousal in this population

Pessimism and emotional repression in the progression of squamous intraepithelial lesions (SIL) and human immunodeficiency virus (HIV)-related immunosuppression and disease in HIV-1 seropositive black women co-infected with human papillomavirus (HPV)

HIV+ women are at increased risk for HIV-related gynecological conditions, such as squamous intraepithelial lesions (SIL), herpes simplex virus (HSV) outbreaks, pelvic inflammatory disease (PID), and vaginal candidiasis. These disease processes may be mediated by deficient host immune response. While it has been demonstrated that psychosocial factors are associated with immune functioning and disease outcome in HIV-negative and HIV-positive individuals, no research to date has addressed the role of psychosocial factors in the progression of HIV-related gynecological conditions and immunosuppression in HIV+ women with HPV. This study was the first to examine prospectively the role of stressful life events, emotional repression, and pessimism on the progression of SIL and HIV-related immunosuppression and disease in low socioeconomic (SES) status, HIV+ women of color. Results indicated that these psychosocial factors were associated with numerous clinical outcomes, cell-mediated immunity, and natural immunity at follow-up. Higher impact of negative life events was associated with higher SIL levels, the progression or persistence of SIL, greater number of HSV outbreaks, and decrements in percentages of T lymphocytes and NK (CD56+CD3--) cells at 1-year. Pessimism did not significantly predict clinical or immune outcomes, which may be due to measurement limitations. Of the emotional repression constructs investigated, greater ambivalence over emotional expression predicted lower SIL levels and the nonprogression or regression of SIL at one year. This latter finding may indicate HIV+ women of color who described themselves as carefully weighing and monitoring the intrapsychic and interpersonal effects of their emotional expression experienced clinical benefits. This may be a gender- and culturally-specific emotional intelligence that ensures safety in expressing oneself in order to maintain connections with others for tangible and emotional purposes. Overall, these findings have significant implications for psychosocial group interventions for HIV+ women of color. Interventions should focus heavily on exploring mechanisms of coping with stressors both related and unrelated to HIV. However, the unexpected protective function of ambivalence over emotional expression suggests that these coping mechanisms must be explored within the context of gender, culture, SES, and disease status

Barriers to cervical cancer screening among low-income HIV-positive African American women

This study elucidates the perspective of low-income HIV-positive African American women who have not received cervical cancer screening for five or more years, on the barriers they face in accessing and using reproductive health care. We focused on how women who live in a severely economically depressed and racially segregated neighborhood experience barriers to cervical cancer screening. Andersen's Behavioral Model of Health Services Use, which allows for the organization of conditions and situations that bar utilization of health services, served as the theoretical framework. Findings from individual semi-structured interviews with 35 participants revealed the importance of psychological and emotional barriers as well as the more commonly reported economic, social, and health care system barriers. We suggest how access to care for this population can be increased by including psychological and emotional components in intervention efforts

Virally mediated cervical cancer in the iatrogenically immunocompromised: Applications for psychoneuroimmunology

Oncogenic or high-risk (HR) human papillomavirus (HPV) infection is implicated in the pathogenesis of a number of cancers, including cervical cancer. HPV infected individuals who are immunocompromised secondary to acquired (e.g., human immunodeficiency virus [HIV]) or iatrogenic (e.g., systemic lupus erythematosus [SLE] patients and organ and hematopoeitic stem cell transplant recipients undergoing immunosuppressive therapy) immune deficiency are particularly at risk for HPV-initiated cervical neoplasia and cancer. Psychoneuroimmunologic (PNI) research has demonstrated that psychosocial factors such as stress, pessimism, and sleep quality may play a role in the promotion of HPV-mediated cervical neoplasia in HIV-positive women. However, no research to our knowledge has examined PNI mechanisms of HPV-mediated cervical neoplasia and cancer in women who are undergoing iatrogenic immunosuppressive therapy for the treatment of autoimmune disease or the prevention of graft-rejection. This article reviews the PNI mechanisms that may underlie the promotion of HPV-mediated cervical neoplasia and applies this model to HPV-infected women who are iatrogenically immunosuppressed, an understudied population at-risk for cervical cancer. Female transplant recipients, one such group, may provide a unique paradigm in which to explore further PNI mechanisms of HPV-mediated cervical neoplasia

The Psychoneuroimmunological Influences of Recreational Marijuana

Background: Marijuana is the most widely used illicit substance in the USA and self-reported use has remained steady over the past decade. Numerous publications examine the influence of marijuana use on various facets of human physiology including neurocognitive function, immune function, and illness symptom control, each discussing marijuana's influence in a narrow or compartmentalized fashion. However, there is a scant literature discussing the empirical and clinical implications of the intersection of these constructs. The primary objective of this review is to review and synthesize this disparate literature and propose future research directions. Thus, this review examines the literature that relates the influence of marijuana to: (1) neurocognitive function; (2) immune function; (3) treatment uses; and (4) propose future directions. Methods: Clinical and nonclinical empirical studies were collected and utilized to inform this review. The authors used PubMed search engine as the primary mechanism used to identify relevant articles. Conclusion: Given the legalization efforts of recreational marijuana use, there is a need to discuss health and treatment effects of marijuana use from a more comprehensive, psychoneuroimmunological or biopsychosocial framework. We will discuss the need for an interdisciplinary research and future steps regarding the examination of marijuana use

Inhibited interpersonal coping style predicts poorer adherence to scheduled clinic visits in human immunodeficiency virus infected women at risk for cervical cancer

Background: One of the most common gynecologic conditions among HIV+ women is cervical dysplasia, the precancerous phase of cervical cancer. Therefore, adherence to gynecology vi sits may be among the most important health care practices for HIV+ women. However, no research has evaluated the psychosocial factors associated with health care practices among HIV+ women at risk for cervical cancer.Purpose: This study examined the relationship between inhibited interpersonal coping style and adherence to primary care and obstetrics/gynecology visits in HIV+ women with Human Papillomavirus (HPV) infection.Methods: Twenty-eight HIV-1 seropositive Black, non-Hispanic women underwent a psychosocial interview, blood draw, and gynecologic examination. The Millon Behavioral Health Inventory was used to assess coping style. Medical chart review was used to assess adherence to scheduled special immunology clinic visits for 24 months following study entry.Results: Results suggested that greater inhibited coping style significantly predicted greater nonadherence to clinic visits during 1-year (β = .45, p = .04) and 2-year (β =.58, p = .02) follow-up, even after controlling for the possible confounding effects of recent depressed mood on adherence. Social support satisfaction did not mediate the relationship between inhibited coping style and nonadherence.Conclusions: These findings suggest that interpersonal coping style assessment may be a useful tool in predicting adherence in HIV+ women with HPV. Future research should assess the effect of psychosocial interventions on coping style, adherence, and cervical dysplasia in HIV+ women with HPV

Depressive symptoms, intrusive thoughts, sleep quality and sexual quality of life in women co-infected with human immunodeficiency virus and human papillomavirus

Background: Women infected with human immunodeficiency virus (HIV) experience major challenges and often report marked decreases in sexual functioning and quality of life (QOL). HIV-infected women also face challenges concerned with other commonly observed concomitant sexually transmitted organisms, such as human papillomavirus (HPV), which may further affect sexual QOL. Despite advances made in understanding factors that predict sexual functioning and QOL in men with HIV, relatively little is understood about the role of behavioural and emotional factors in women. Methods: As a preliminary inquiry into this question, this study related depressive symptoms, AIDS-related intrusive thoughts and sleep quality with sexual QOL reports in 21 HIV +HPV+ women. Results: We found that depressive symptoms, intrusive thoughts and sleep quality individually predicted poorer sexual QOL. Further analyses suggested that depression mediated the relationship between intrusive thoughts and sexual QOL. Discussion: Implications for further work and clinical interventions to address depressive symptoms in this population are discussed

Cognitive behavioral stress management effects on mood, social support, and a marker of antiviral immunity are maintained up to 1 year in HIV-infected gay men

Numerous herpesvirus infections are associated with clinically relevant outcomes as well as an accelerated HIV replication rate and subsequent disease progression. Stress managementinterventionsmayimprovemarkersofcellularimmunecontroloverlatent herpesvirus infections and these changes appear to be mediated by perceptions of increased social support availability. We examined the effects ofagroup-based cognitive behavioral stress management (CBSM) intervention on distress, dysphoria, perceived socialsupport,andherpesvirus immunoglobulin G (IgG) antibody titers during the 6to 12 months following the intervention. Of those who were initially randomized, 49 HIV-infected men were followed during the 6-to 12-month period after randomization to either a 10-week CBSM intervention (n=31) or amodified wait-list control condition (n = 18). Measures of distress, dysphoria, social support, and blood samples for herpesvirus Ig Gtiters were taken at baseline,immediately following CBSM and at-6-to 12-month follow-up. Men in CBSM displayed maintenance of previously observed intervention effects on dysphoria, reliable alliance support, and herpesvirus IgG antibody titers (i.e., Epstein-Barr virus capsid antigen; EBV-VCA). Intervention-related changes in EBV-VCA were unrelated to changes in lymphocyte subsets (i.e., CD4+, CD8+, and CD4+:CD8+) or changes in measures of dysphoria and social support during the investigation period. Data indicate that HIV-infected men participating in a CBS Mintervention maintain better psychosocial status and immunologic control of latent EBV infection up to 1 year after its conclusion