Internationally educated nurses in the United States: Their origins and roles. Despite the importance of the internationally educated nurse (IEN) workforce, there has been little research on the employment settings of IENs and other aspects of their employment. We analyzed data from the 2008 National Sample Survey of Registered Nurses to characterize IENs in the United States using descriptive statistics and multivariate ordinary least squares regression. We find notable differences in the decade of immigration, current age, and highest nursing education across the countries in which IENs were educated. IENs are more likely to be employed in nursing and to work full-time. They receive higher total annual earnings and earn higher average hourly wages. However, when demographic, human capital, and employment characteristics are held constant, IENs from every country except Canada earn no more than U.S.-educated nurses. Future research should seek to identify the causes of these employment and earnings differences to understand the role and impact of the IEN workforce.
Gender Affirmation: A Framework for Conceptualizing Risk Behavior among Transgender Women of Color. Experiences of stigma, discrimination, and violence as well as extreme health disparities and high rates of sexual risk behavior and substance use have been well-documented among transgender women of color. Using an intersectional approach and integrating prominent theories from stigma, eating disorders, and HIV-related research, this article offers a new framework for conceptualizing risk behavior among transgender women of color, specifically sexual risk behavior and risky body modification practices. This framework is centered on the concept of 'gender affirmation,' the process by which individuals are affirmed in their gender identity through social interactions. Qualitative data from 22 interviews with transgender women of color from the San Francisco Bay Area in the United States are analyzed and discussed in the context of the gender affirmation framework.
Association between Dog Guardianship and HIV Clinical Outcomes. Despite numerous potential health outcomes of dog guardianship, their value has not been examined in the HIV-positive population. The study objective was to examine the relationship between dog guardianship and HIV clinical outcomes (antiretroviral adherence , HIV viral load , and CD4 count) among HIV-positive individuals. The authors conducted a secondary analysis of baseline data of 370 HIV-positive men on antiretroviral regimen enrolled in the Duo Project. Current dog guardianship was reported in 28.7% of participants. Dog guardianship may be associated with higher CD4 and adherence; however, having a detectable viral load was not related to dog guardianship.
Toxicity-related antiretroviral drug treatment modifications in individuals starting therapy: A cohort analysis of time patterns, sex, and other risk factors. (Coatia) Modifications to combination antiretroviral drug therapy (CART) regimens can occur for a number of reasons, including adverse drug effects. We investigated the frequency of and reasons for antiretroviral drug modifications (ADM) during the first 3 years after initiation of CART, in a closed cohort of CART-naïve adult patients who started treatment in the period 1998-2007 in Croatia.
Injecting risk behavior among traveling young injection drug users: travel partner and city characteristics. Young injection drug users (IDUs), a highly mobile population, engage in high levels of injecting risk behavior, yet little is understood about how such risk behavior may vary by the characteristics of the cities to which they travel, including the existence of a syringe exchange program (SEP), as well as travel partner characteristics. In 2004-2005, we conducted a 6-month prospective study to investigate the risk behavior of 89 young IDUs as they traveled, with detailed information gathered about 350 city visits.
Fitness consequences of Plasmodium falciparum pfmdr1 polymorphisms inferred from ex vivo culture of Ugandan parasites. Polymorphisms in the Plasmodium falciparum multidrug resistance-1 (pfmdr1) gene impact upon sensitivity to multiple antimalarials. In Africa, polymorphisms at N86Y and D1246Y are common, with varied impacts on sensitivity to different drugs. To gain insight into the fitness consequences of these polymorphisms, we cultured parasites isolated from children with malaria in Tororo, Uganda, where the multiplicity of infection is high, and used pyrosequencing to follow polymorphism prevalences in culture over time.Overall, consistent trends in the direction of selection were seen, although differences were not statistically significant. Our results suggest fitness advantages for parasites with pfmdr1 mutant 86Y and wild type D1246, highlighting the complex interplay between drug resistance and fitness in malaria parasites.
Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda. Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility.
Asymptomatic Cryptococcemia in Resource-Limited Settings. Despite increasing availability of anti-retroviral therapy, invasive cryptococcal disease continues to be a leading cause of death among HIV-infected individuals in resource-limited settings. Screening asymptomatic HIV-infected individuals with advanced immunosuppression for serum cryptococcal antigen clearly identifies a population at high risk of cryptococcal meningitis and death. Screening with serum cryptococcal antigen alone identifies many whom have mild clinical symptoms, sub-clinical meningeal infection, or fungemia. There is wide variation in practice and little evidence to guide the use of anti-fungal and anti-retroviral treatment for asymptomatic cryptococcal antigenemia (ACA). Implementing a targeted screening and treatment intervention for ACA presents challenges for an overburdened health care systems in resource-limited settings. While such an intervention shows promise, there are critical gaps in our understanding of ACA and its implications in the outpatient setting.
Social participation and drug use in a cohort of Brazilian sex workers. Structural interventions focused on community mobilisation to engender an enabling social context have reduced sexual risk behaviours among sex workers. Interventions to date have increased social participation and shown an association between participation and safer sex. Social participation could modify risk for other health behaviours, particularly drug use. We assessed social participation and drug use before and after implementation of a clinical, social and structural intervention with sex workers intended to prevent sexually transmitted infections/HIV infection.
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