Health Care Utilization in HIV-Infected Patients: Assessing the Burden of Hepatitis C Virus Coinfection

Health care utilization for HIV-1–infected patients appears to be declining in the United States as a result of highly active antiviral therapy (HAART); yet the opposite appears true in the HIV/hepatitis C virus (HCV) coinfected population. The reasons for this difference are not well understood. We examined the rates and reasons for emergency department visits and hospital admissions at an academic tertiary care medical center for HIV/HCV coinfected patients as compared to HIV-1 monoinfected patients, using a retrospective matched cohort study design. HIV/HCV coinfected patients had higher rates of health care utilization (emergency department visits 43.9 versus 7.1 per 100 person-years; hospital admissions 18.2 versus 6.7 per 100 person-years, for HIV coinfected and monoinfected, respectively). This increase was not solely due to liver related events. Instead, comorbidities such as diabetes, renal disease, and psychiatric/substance abuse played a larger role in the health-care utilization in the HIV/HCV coinfected population

Childhood Trauma and Health Outcomes in HIV-Infected Patients: An Exploration of Causal Pathways

Traumatic life histories are highly prevalent in people living with HIV/AIDS (PLWHA) and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics

Are Rural Clergy Worse Off?: An Examination of Occupational Conditions and Pastoral Experiences in a Sample of United Methodist Clergy.” Sociology of Religion 73

Scholars have shown that clergy work can be stressful, and that these occupational strains can lead to negative physical and mental health outcomes. Despite the fact that nearly one-third of all congregations in the United States are rural, little work has examined how occupational conditions and clergy experiences might vary systematically by geographical context. This study uses recent data from United Methodist Church clergy in North Carolina to test extant depictions of rural ministry, which typically portray rural churches as challenging occupational settings. It finds that although rural clergy face several unique challenges (such as multichurch ministry and lower salaries), they report lower levels of several stressors and more positive experiences. These differences disappear once controls are added, suggesting that rural ministry per se is neither particularly harmful nor beneficial when compared with ministry in other settings. Key words: Rural churches; Clergy/Ministers/Religious Professionals; United States of America; Protestant Christianity. Research over the past several decades has demonstrated that clergy, like many professionals, face a great deal of job-related stress. Studies have shown that clergy often face high demands on their time, a lack of privacy, pressures from frequent relocation, and criticism from church member

Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening.

OBJECTIVE:Cervical cancer screening usually requires use of a speculum to provide a clear view of the cervix. The speculum is one potential barrier to screening due to fear of pain, discomfort and embarrassment. The aim of this paper is to present and demonstrate the feasibility of a tampon-sized inserter and the POCkeT Colposcope, a miniature pen sized-colposcope, for comfortable, speculum-free and potentially self-colposcopy. STUDY DESIGN:We explored different designs using 3D computer-aided design (CAD) software and performed mechanical testing simulations on each. Designs were rapid prototyped and tested using a custom vaginal phantom across a range of vaginal pressures and uterine tilts to select an optimal design. Two final designs were tested with fifteen volunteers to assess cervix visualization, comfort and usability compared to the speculum and the optimal design, the curved-tip inserter, was selected for testing in volunteers. RESULTS:We present a vaginal inserter as an alternative to the standard speculum for use with the POCkeT Colposcope. The device has a slim tubular body with a funnel-like curved tip measuring approximately 2.5 cm in diameter. The inserter has a channel through which a 2 megapixel (MP) mini camera with LED illumination fits to enable image capture. Mechanical finite element testing simulations with an applied pressure of 15 cm H2O indicated a high factor of safety (90.9) for the inserter. Testing of the device with a custom vaginal phantom, across a range of supine vaginal pressures and uterine tilts (retroverted, anteverted and sideverted), demonstrated image capture with a visual area comparable to the speculum for a normal/axial positioned uteri and significantly better than the speculum for anteverted and sideverted uteri (p<0.00001). Volunteer studies with self-insertion and physician-assisted cervix image capture showed adequate cervix visualization for 83% of patients. In addition, questionnaire responses from volunteers indicated a 92.3% overall preference for the inserter over the speculum and all indicated that the inserter was more comfortable than the speculum. The inserter provides a platform for self-cervical cancer screening and also enables acetic acid/Lugol's iodine application and insertion of swabs for Pap smear sample collection. CONCLUSION:This study demonstrates the feasibility of an inserter and miniature-imaging device for comfortable cervical image capture of women with potential for synergistic HPV and Pap smear sample collection